101
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Borrelli S, De Nicola L, Minutolo R, Perna A, Provenzano M, Argentino G, Cabiddu G, Russo R, La Milia V, De Stefano T, Conte G, Garofalo C. Sodium toxicity in peritoneal dialysis: mechanisms and "solutions". J Nephrol 2019; 33:59-68. [PMID: 31734929 DOI: 10.1007/s40620-019-00673-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/11/2019] [Indexed: 01/19/2023]
Abstract
The major trials in peritoneal dialysis (PD) have demonstrated that increasing peritoneal clearance of small solutes is not associated with any advantage on survival, whereas sodium and fluid overload heralds higher risk of death and technique failure. On the other hand, higher sodium and fluid overload due to loss of residual kidney function (RKF) and higher transport membrane is associated with poor patient and technique survival. Recent experimental studies also show that, independently from fluid overload, sodium accumulation in the peritoneal interstitium exerts direct inflammatory and angiogenetic stimuli, with consequent structural and functional changes of peritoneum, while in patients with Chronic Kidney Disease sodium stored in interstitial skin acts as independent determinant of left ventricular hypertrophy. Noteworthy, this tissue pool of sodium is modifiable being removed by dialysis. Therefore, novel PD strategies to optimize sodium removal, including the use of bimodal and/or low-sodium solutions, are actively tested. Nonetheless, a holistic approach aimed at preserving peritoneal function and the kidney may represent the key of therapy success in the hard task of preserving adequate sodium balance in PD patients. In this review, we describe the available evidence on sodium toxicity in PD, either related or unrelated to fluid overload, and we also discuss about possible "solutions" to preserve or restore sodium balance in PD patients.
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Affiliation(s)
- Silvio Borrelli
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca De Nicola
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Minutolo
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandra Perna
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | - Toni De Stefano
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Conte
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Garofalo
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy.
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102
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Oppelaar JJ, Vogt L. Body Fluid-Independent Effects of Dietary Salt Consumption in Chronic Kidney Disease. Nutrients 2019; 11:E2779. [PMID: 31731658 PMCID: PMC6893804 DOI: 10.3390/nu11112779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023] Open
Abstract
The average dietary salt (i.e., sodium chloride) intake in Western society is about 10 g per day. This greatly exceeds the lifestyle recommendations by the WHO to limit dietary salt intake to 5 g. There is robust evidence that excess salt intake is associated with deleterious effects including hypertension, kidney damage and adverse cardiovascular health. In patients with chronic kidney disease, moderate reduction of dietary salt intake has important renoprotective effects and positively influences the efficacy of common pharmacological treatment regimens. During the past several years, it has become clear that besides influencing body fluid volume high salt also induces tissue remodelling and activates immune cell homeostasis. The exact pathophysiological pathway in which these salt-induced fluid-independent effects contribute to CKD is not fully elucidated, nonetheless it is clear that inflammation and the development of fibrosis play a major role in the pathogenic mechanisms of renal diseases. This review focuses on body fluid-independent effects of salt contributing to CKD pathogenesis and cardiovascular health. Additionally, the question whether better understanding of these pathophysiological pathways, related to high salt consumption, might identify new potential treatment options will be discussed.
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Affiliation(s)
| | - Liffert Vogt
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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103
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Kordzadeh A, Duchscherer J, Beaulieu C, Stobbe R. Radiofrequency excitation–related
23
Na MRI signal loss in skeletal muscle, cartilage, and skin. Magn Reson Med 2019; 83:1992-2001. [DOI: 10.1002/mrm.28054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Atefeh Kordzadeh
- Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
| | - Jade Duchscherer
- Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
| | - Rob Stobbe
- Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
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104
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Hessels NR, van den Bosch JJON, van Londen M, Bakker SJL, Riphagen IJ, Navis GJ. Clinical and neurohumoral associates of variations in plasma Na +in the PREVEND cohort. Am J Physiol Renal Physiol 2019; 317:F978-F985. [DOI: 10.1152/ajprenal.00465.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Plasma Na+concentration is regulated within narrow limits. Yet, substantial interindividual differences exist even in the normal range. The determinants of these differences are not well understood. We therefore investigated the clinical and neurohumoral associates of plasma Na+. We studied 2,364 men (age: 48 ± 12 yr) and 2,710 women (age: 47 ± 12 yr) from the prospective Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort study. In the present study, we investigated the neurohumoral factors NH2-terminal prohormone of brain natriuretic peptide (NT-proBNP) and aldosterone as volume markers and copeptin as a marker for osmoregulation. Clinical associating variables of plasma Na+were age, sex, and plasma glucose. Furthermore, plasma Na+levels were associated with log2copeptin (men: standardized β = 0.18, P < 0.001; women: standardized β = 0.17, P < 0.001), log2NT-proBNP (men: standardized β = 0.07, P = 0.008; women: standardized β = 0.12, P < 0.001), and log2aldosterone (men: standardized β = −0.06, P = 0.005; women: standardized β = −0.09, P < 0.001). Copeptin and NT-proBNP showed an interaction in their association with plasma Na+. Thus, our data 1) support that osmoregulation, as estimated from copeptin levels, is a main associate of plasma Na+; 2) show a consistent association with volume markers, with higher NT-proBNP and lower aldosterone in individuals with higher plasma Na+; and 3) show that the interaction between copeptin and NT-proBNP illustrates that osmoregulation and volume regulation act in concert in the regulation of plasma Na+.
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Affiliation(s)
- Niek R. Hessels
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacqueline J. O. N. van den Bosch
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ineke J. Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan J. Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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105
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Polychronopoulou E, Braconnier P, Burnier M. New Insights on the Role of Sodium in the Physiological Regulation of Blood Pressure and Development of Hypertension. Front Cardiovasc Med 2019; 6:136. [PMID: 31608291 PMCID: PMC6756190 DOI: 10.3389/fcvm.2019.00136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023] Open
Abstract
A precise maintenance of sodium and fluid balance is an essential step in the regulation of blood pressure and alterations of this balance may lead to the development of hypertension. In recent years, several new advances were made in our understanding of the interaction between sodium and blood pressure regulation. The first is the discovery made possible with by new technology, such as 23Na-MRI, that sodium can be stored non-osmotically in tissues including the skin and muscles particularly when subjects are on a high sodium diet or have a reduced renal capacity to excrete sodium. These observations prompted the refinement of the original model of regulation of sodium balance from a two-compartment model comprising the extracellular fluid within the intravascular and interstitial spaces to a three-compartment model that includes the intracellular space of some tissues, most prominently the skin. In this new model, the immune system plays a role, thereby supporting many previous studies indicating that the immune system is a crucial co-contributor to the maintenance of hypertension through pro-hypertensive effects in the kidney, vasculature, and brain. Lastly, there is now evidence that sodium can affect the gut microbiome, and induce pro-inflammatory and immune responses, which might contribute to the development of salt-sensitive hypertension.
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Affiliation(s)
- Erietta Polychronopoulou
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Philippe Braconnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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106
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Wilferth T, Gast LV, Stobbe RW, Beaulieu C, Hensel B, Uder M, Nagel AM. 23Na MRI of human skeletal muscle using long inversion recovery pulses. Magn Reson Imaging 2019; 63:280-290. [PMID: 31425815 DOI: 10.1016/j.mri.2019.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
23Na inversion recovery (IR) imaging allows for a weighting toward intracellular sodium in the human calf muscle and thus enables an improved analysis of pathophysiological changes of the muscular ion homeostasis. However, sodium signal-to-noise ratio (SNR) is low, especially when using IR sequences. 23Na has a nuclear spin of 3/2 and therefore experiences a strong electrical quadrupolar interaction. This results in very short relaxation times as well as in possible residual quadrupolar splitting. Consequently, relaxation effects during a radiofrequency pulse can no longer be neglected and even allow for increasing SNR as has previously been shown for human brain and knee. The aim of this work was to increase the SNR in 23Na IR imaging of the human calf muscle by using long inversion pulses instead of the usually applied short pulses. First, the influence of the inversion pulse length (1 to 20 ms) on the SNR as well as on image contrast was simulated for different model environments and verified by phantom measurements. Depending on the model environment (agarose 4% and 8%, xanthan 2% and 3%), SNR values increased by a factor of 1.15 up to 1.35, while NaCl solution was successfully suppressed. Thus, image contrast between the non-suppressed model compartments changes with IR pulse length. Finally, in vivo measurements of the human calf muscle of ten healthy volunteers were conducted at 3 Tesla. On average, a 1.4-fold increase in SNR could be achieved by increasing the inversion pulse length from 1 ms to 20 ms, leaving all other parameters - including the scan time - constant. This enables 23Na IR MRI with improved spatial resolution or reduced acquisition time.
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Affiliation(s)
- Tobias Wilferth
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert W Stobbe
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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107
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Milani B, Delacoste J, Burnier M, Pruijm M. Exploring a new method for quantitative sodium MRI in the human upper leg with a surface coil and symmetrically arranged reference phantoms. Quant Imaging Med Surg 2019; 9:985-999. [PMID: 31367553 DOI: 10.21037/qims.2019.06.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The aim of this study is to validate and evaluate the reproducibility of a new setup for the quantification of the tissue sodium concentration (TSC) in the human upper leg muscles with sodium MRI at 3 Tesla. This setup is making use of an emit and receive single loop surface coil together with a set of square, symmetrically arranged reference phantoms. As a second aim, the performances of two MRI protocols for the TSC quantification in the upper leg muscles are compared: one using an ultra-short echo time (UTE) 3-dimensional radial sequence (UTE-protocol), and the other one using standard gradient echo sequence (GRE-protocol). Methods A validation test of the quantification of sodium concentration is performed in phantoms. The bias of the method is estimated and compared between both protocols. The reproducibility of TSC quantification is assessed in phantoms by the coefficient of variation (CV) and compared between both protocols. The reproducibility is also assessed in 11 health volunteers. Signal to noise ratio (SNR) maps are acquired in phantoms with both protocols in order to compare the resulting SNR. Results The apparatus and post processing were successfully implemented. The bias of the method was smaller than 10% in phantoms (excepted for Na concentration of 10 mmol/L when using the GRE protocol). The reproducibility of the method using symmetrically arranged phantoms was high in phantoms and humans (CV <5%). The GRE-protocol leads to a better SNR than the UTE-protocol in 2D images. Conclusions The use of symmetrically arranged reference phantoms lead to reproducible results in phantoms and humans. Sodium imaging in the human upper leg with a single loop surface coil should be performed with a standard 2-dimensional GRE protocol if an optimal SNR is needed. However, the quantification of the fast and slow decay time constants of the sodium signal, which plays a role in the TSC quantification, still has to be done with a UTE sequence. Moreover, the quantification of sodium concentration is more accurate with the UTE protocol for small sodium concentrations (<20 mmol).
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Affiliation(s)
- Bastien Milani
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Departement de Radiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jean Delacoste
- Departement de Radiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michel Burnier
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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108
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Olde Engberink RHG, de Vos J, van Weert A, Zhang Y, van Vlies N, van den Born BJH, Titze JM, van Bavel E, Vogt L. Abnormal sodium and water homeostasis in mice with defective heparan sulfate polymerization. PLoS One 2019; 14:e0220333. [PMID: 31365577 PMCID: PMC6668793 DOI: 10.1371/journal.pone.0220333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/12/2019] [Indexed: 01/09/2023] Open
Abstract
Glycosaminoglycans in the skin interstitium and endothelial surface layer have been shown to be involved in local sodium accumulation without commensurate water retention. Dysfunction of heparan sulfate glycosaminoglycans may therefore disrupt sodium and water homeostasis. In this study, we investigated the effects of combined heterozygous loss of heparan sulfate polymerization genes (exostosin glycosyltransferase 1 and 2; Ext1+/-Ext2+/-) on sodium and water homeostasis. Sodium storage capacity was decreased in Ext1+/-Ext2+/- mice as reflected by a 77% reduction in endothelial surface layer thickness and a lower skin sodium-to-glycosaminoglycan ratio. Also, these mice were characterized by a higher heart rate, increased fluid intake, increased plasma osmolality and a decreased skin water and sodium content, suggesting volume depletion. Upon chronic high sodium intake, the initial volume depletion was restored but no blood pressure increase was observed. Acute hypertonic saline infusion resulted in a distinct blood pressure response: we observed a significant 15% decrease in control mice whereas blood pressure did not change in Ext1+/-Ext2+/- mice. This differential blood pressure response may be explained by the reduced capacity for sodium storage and/or the impaired vasodilation response, as measured by wire myography, which was observed in Ext1+/-Ext2+/- mice. Together, these data demonstrate that defective heparan sulfate glycosaminoglycan synthesis leads to abnormal sodium and water homeostasis and an abnormal response to sodium loading, most likely caused by inadequate capacity for local sodium storage.
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Affiliation(s)
- Rik H. G. Olde Engberink
- Department of Internal Medicine, section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- * E-mail:
| | - Judith de Vos
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Angela van Weert
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Yahua Zhang
- Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Naomi van Vlies
- Laboratory of Genetic Metabolic Disease, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Bert-Jan H. van den Born
- Department of Internal Medicine, section Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jens M. Titze
- Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Ed van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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109
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Christa M, Weng AM, Geier B, Wörmann C, Scheffler A, Lehmann L, Oberberger J, Kraus BJ, Hahner S, Störk S, Klink T, Bauer WR, Hammer F, Köstler H. Increased myocardial sodium signal intensity in Conn's syndrome detected by 23Na magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2019; 20:263-270. [PMID: 30307545 PMCID: PMC6383057 DOI: 10.1093/ehjci/jey134] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/11/2018] [Accepted: 08/29/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS Sodium intake has been linked to left ventricular hypertrophy independently of blood pressure, but the underlying mechanisms remain unclear. Primary hyperaldosteronism (PHA), a condition characterized by tissue sodium overload due to aldosterone excess, causes accelerated left ventricular hypertrophy compared to blood pressure matched patients with essential hypertension. We therefore hypothesized that the myocardium constitutes a novel site capable of sodium storage explaining the missing link between sodium and left ventricular hypertrophy. METHODS AND RESULTS Using 23Na magnetic resonance imaging, we investigated relative sodium signal intensities (rSSI) in the heart, calf muscle, and skin in 8 PHA patients (6 male, median age 55 years) and 12 normotensive healthy controls (HC) (8 male, median age 61 years). PHA patients had a higher mean systolic 24 h ambulatory blood pressure [152 (140; 163) vs. 125 (122; 130) mmHg, P < 0.001] and higher left ventricular mass index [71.0 (63.5; 106.8) vs. 55.0 (50.3; 66.8) g/m2, P = 0.037] than HC. Compared to HC, PHA patients exhibited significantly higher rSSI in the myocardium [0.31 (0.26; 0.34) vs. 0.24 (0.20; 0.27); P = 0.007], calf muscle [0.19 (0.16; 0.22) vs. 0.14 (0.13; 0.15); P = 0.001] and skin [0.28 (0.25; 0.33) vs. 0.19 (0.17; 0.26); P = 0.014], reflecting a difference of +27%, +38%, and +39%, respectively. Treatment of PHA resulted in significant reductions of the rSSI in the myocardium, calf muscle and skin by -13%, -27%, and -29%, respectively. CONCLUSION Myocardial tissue rSSI is increased in PHA patients and treatment of aldosterone excess effectively reduces rSSI, thus establishing the myocardium as a novel site of sodium storage in addition to skeletal muscle and skin.
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Affiliation(s)
- Martin Christa
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Bettina Geier
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Caroline Wörmann
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Anne Scheffler
- Institute of Pharmacy and Food Chemistry, Chair of Food Chemistry, University of Würzburg, Würzburg, Germany
| | - Leane Lehmann
- Institute of Pharmacy and Food Chemistry, Chair of Food Chemistry, University of Würzburg, Würzburg, Germany
| | - Johannes Oberberger
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Bettina J Kraus
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Klink
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Wolfgang R Bauer
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Fabian Hammer
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine, University Greifswald, Greifswald, Germany
| | - Herbert Köstler
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
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110
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Nijst P, Olinevich M, Hilkens P, Martens P, Dupont M, Tang WHW, Lambrichts I, Noben JP, Mullens W. Dermal Interstitial Alterations in Patients With Heart Failure and Reduced Ejection Fraction: A Potential Contributor to Fluid Accumulation? Circ Heart Fail 2019; 11:e004763. [PMID: 30002114 DOI: 10.1161/circheartfailure.117.004763] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Large networks of interstitial glycosaminoglycans help to regulate water and electrolyte homeostasis. The relation between dermal interstitial alterations and occurrence of edema in heart failure patients with reduced ejection fraction (HFrEF) is unknown. We hypothesize that in HFrEF patients (1) interstitial glycosaminoglycan density is increased, (2) changes in the interstitial glycosaminoglycan network are associated with interstitial fluid accumulation, and (3) there is a link between the interstitial glycosaminoglycan network and the renin-angiotensin-aldosterone system. METHODS AND RESULTS Two punch biopsies of the skin were obtained in healthy subjects (n=18) and HFrEF patients (n=29). Alcian blue staining and immunostaining for the angiotensin II type 1 receptor was performed. After obtaining tissue water content, total interstitial glycosaminoglycan (uronic acid) and sulfated glycosaminoglycan were quantified. A venous blood sample, clinical examination, and echocardiography were obtained. A significantly higher interstitial glycosaminoglycan content was observed in HFrEF patients compared with healthy subjects (uronic acid: 13.0±4.2 versus 9.6±1.6 μg/mg; P=0.002; sulfated glycosaminoglycan: 14.1 [11.7; 18.1] versus 10.0 [9.1; 10.8] μg/mg; P<0.001). Uronic acid and sulfated glycosaminoglycan density were strongly associated with tissue water content and peripheral edema (uronic acid: ρ=0.66; P<0.0001 and sulfated glycosaminoglycan: τ=0.58; P<0.0001). Expression of the angiotensin II type 1 receptor was found on dermal cells, although use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker was associated with significantly lower levels of interstitial glycosaminoglycans in HFrEF patients. CONCLUSIONS Interstitial glycosaminoglycan concentration is significantly increased in HFrEF patients compared with healthy subjects and correlated with tissue water content and clinical signs of volume overload. A better appreciation of the interstitial compartment might improve management of volume overload in HF.
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Affiliation(s)
- Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.N., P.M., M.D., W.M.)
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium (P.N., P.H., P.M.)
| | - Mikhail Olinevich
- Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Belgium (P.H., I.L., J.-P.N., W.M., M.O.)
| | - Petra Hilkens
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium (P.N., P.H., P.M.)
- Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Belgium (P.H., I.L., J.-P.N., W.M., M.O.)
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.N., P.M., M.D., W.M.)
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium (P.N., P.H., P.M.)
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.N., P.M., M.D., W.M.)
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (W.H.W.T.)
| | - Ivo Lambrichts
- Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Belgium (P.H., I.L., J.-P.N., W.M., M.O.)
| | - Jean-Paul Noben
- Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Belgium (P.H., I.L., J.-P.N., W.M., M.O.)
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.N., P.M., M.D., W.M.).
- Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Belgium (P.H., I.L., J.-P.N., W.M., M.O.)
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111
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Kannenkeril D, Karg MV, Bosch A, Ott C, Linz P, Nagel AM, Uder M, Schmieder RE. Tissue sodium content in patients with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:485-489. [PMID: 31101486 DOI: 10.1016/j.jdiacomp.2019.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/15/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tissue sodium content by 23Na magnetic resonance imaging (MRI) has been found to be increased in arterial hypertension. We analyzed whether tissue sodium content is increased in patients with type-2 diabetes (T2DM). METHODS Patients with T2DM were compared to those with primary hypertension. Patients with T2DM were off any antidiabetic and hypertensive patients off any antihypertensive therapy for at least 4 weeks. Skin and muscle sodium content was assessed non-invasively with a 3.0 T clinical MRI system (Magnetom Verio, Siemens Health Care, Erlangen, Germany) in each patient. RESULTS In patients with T2DM (N = 59) we observed significantly greater muscle sodium content (diabetes: 20.6 ± 3.5 vs hypertension: 16.3 ± 2.5 mmol/l, p < 0.001) and skin sodium content (diabetes: 24.5 ± 7.2 vs hypertension: 20.6 ± 5.7 mmol/l, p = 0.01) than in those with primary hypertension (N = 33). When potential confounders (age, body mass index, gender, systolic and diastolic blood pressure, estimated glomerular filtration rate) were entered in a covariance analysis, both skin sodium content (p = 0.037) and muscle sodium content (p < 0.001) were still clearly elevated. CONCLUSION Patients with T2DM have greater skin and muscle sodium content. These are the first known data to demonstrate increased tissue sodium content in patients with T2DM, measured by 23Na magnetic resonance imaging. Since tissue sodium content is related to organ damage, therapeutic intervention should aim at reducing tissue sodium content.
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Affiliation(s)
- Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Marina V Karg
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany; Paracelsus Medical School Nürnberg, Nürnberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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112
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Ren J, Crowley SD. Role of T-cell activation in salt-sensitive hypertension. Am J Physiol Heart Circ Physiol 2019; 316:H1345-H1353. [PMID: 30901277 PMCID: PMC6620682 DOI: 10.1152/ajpheart.00096.2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 02/02/2023]
Abstract
The contributions of T lymphocytes to the pathogenesis of salt-sensitive hypertension has been well established. Under hypertensive stimuli, naive T cells develop into different subsets, including Th1, Th2, Th17, Treg, and cytotoxic CD8+ T cells, depending on the surrounding microenviroment in organs. Distinct subsets of T cells may play totally different roles in tissue damage and hypertension. The underlying mechanisms by which hypertensive stimuli activate naive T cells involve many events and different organs, such as neoantigen presentation by dendritic cells, high salt concentration, and the milieu of oxidative stress in the kidney and vasculature. Infiltrating and activated T subsets in injured organs, in turn, exert considerable impacts on tissue dysfunction, including sodium retention in the kidney, vascular stiffness, and remodeling in the vasculature. Therefore, a thorough knowledge of T-cell actions in hypertension may provide novel insights into the development of new therapeutic strategies for patients with hypertension.
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Affiliation(s)
- Jiafa Ren
- Division of Nephrology, Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers , Durham, North Carolina
| | - Steven D Crowley
- Division of Nephrology, Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers , Durham, North Carolina
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113
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Chapp AD, Schum S, Behnke JE, Hahka T, Huber MJ, Jiang E, Larson RA, Shan Z, Chen QH. Measurement of cations, anions, and acetate in serum, urine, cerebrospinal fluid, and tissue by ion chromatography. Physiol Rep 2019; 6:e13666. [PMID: 29654634 PMCID: PMC5899179 DOI: 10.14814/phy2.13666] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
Accurate quantification of cations and anions remains a major diagnostic tool in understanding diseased states. The current technologies used for these analyses are either unable to quantify all ions due to sample size/volume, instrument setup/method, or are only able to measure ion concentrations from one physiological sample (liquid or solid). Herein, we adapted a common analytical chemistry technique, ion chromatography and applied it to measure the concentration of cations; sodium, potassium, calcium, and magnesium (Na+, K+, Ca2+, and Mg2+) and anions; chloride, and acetate (Cl−, −OAc) from physiological samples. Specifically, cations and anions were measured in liquid samples: serum, urine, and cerebrospinal fluid, as well as tissue samples: liver, cortex, hypothalamus, and amygdala. Serum concentrations of Na+, K+, Ca2+, Mg2+, Cl−, and −OAc (mmol/L): 138.8 ± 4.56, 4.05 ± 0.21, 4.07 ± 0.26, 0.98 ± 0.05, 97.7 ± 3.42, and 0.23 ± 0.04, respectively. Cerebrospinal fluid concentrations of Na+, K+, Ca2+, Mg2+, Cl−, and −OAc (mmol/L): 145.1 ± 2.81, 2.41 ± 0.26, 2.18 ± 0.38, 1.04 ± 0.11, 120.2 ± 3.75, 0.21 ± 0.05, respectively. Tissue Na+, K+, Ca2+, Mg2+, Cl−, and −OAc were also measured. Validation of the ion chromatography method was established by comparing chloride concentration between ion chromatography with a known method using an ion selective chloride electrode. These results indicate that ion chromatography is a suitable method for the measurement of cations and anions, including acetate from various physiological samples.
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Affiliation(s)
- Andrew D Chapp
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
| | - Simeon Schum
- Department of Chemistry, Michigan Technological University, Houghton, Michigan
| | - Jessica E Behnke
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
| | - Taija Hahka
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
| | - Michael J Huber
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
| | - Enshe Jiang
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Robert A Larson
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
| | - Qing-Hui Chen
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan.,Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
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114
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Wouda RD, Dekker SEI, Reijm J, Olde Engberink RHG, Vogt L. Effects of Water Loading on Observed and Predicted Plasma Sodium, and Fluid and Urine Cation Excretion in Healthy Individuals. Am J Kidney Dis 2019; 74:320-327. [PMID: 31005371 DOI: 10.1053/j.ajkd.2019.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/23/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The discovery of sodium storage without concurrent water retention suggests the presence of an additional compartment for sodium distribution in the body. The osmoregulatory role of this compartment under hypotonic conditions is not known. STUDY DESIGN Experimental interventional study. SETTING & PARTICIPANTS Single-center study of 12 apparently healthy men. INTERVENTION To investigate whether sodium can be released from its nonosmotic stores after a hypotonic fluid load, a water-loading test (20mL water/kg in 20 minutes) was performed. OUTCOMES During a 240-minute follow-up, we compared the observed plasma sodium concentration ([Na+]) and fluid and urine cation excretion with values predicted by the Barsoum-Levine and Nguyen-Kurtz formulas. These formulas are used for guidance of fluid therapy during dysnatremia, but do not account for nonosmotic sodium stores. RESULTS 30 minutes after water loading, mean plasma [Na+] decreased 3.2±1.6 (SD) mmol/L, after which plasma [Na+] increased gradually. 120 minutes after water loading, plasma [Na+] was significantly underestimated by the Barsoum-Levine (-1.3±1.4mmol/L; P=0.05) and Nguyen-Kurtz (-1.5±1.5mmol/L; P=0.03) formulas. In addition, the Barsoum-Levine and Nguyen-Kurtz formulas overestimated urine volume, while cation excretion was significantly underestimated, with a cation gap of 57±62 (P=0.009) and 63±63mmol (P=0.005), respectively. After 240 minutes, this gap was 28±59 (P=0.2) and 34±60mmol (P=0.08), respectively. LIMITATIONS The compartment from which the mobilized sodium originated was not identified, and heterogeneity in responses to water loading was observed across participants. CONCLUSIONS These data suggest that healthy individuals are able to mobilize osmotically inactivated sodium after an acute hypotonic fluid load. Further research is needed to expand knowledge about the compartment of osmotically inactivated sodium and its role in osmoregulation and therapy for dysnatremias. FUNDING This investigator-initiated study was partly supported by a grant from Unilever Research and Development Vlaardingen, The Netherlands B.V. (MA-2014-01914).
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Affiliation(s)
- Rosa D Wouda
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Shosha E I Dekker
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joelle Reijm
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rik H G Olde Engberink
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Liffert Vogt
- Section of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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115
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Lott J, Platt T, Niesporek SC, Paech D, G. R. Behl N, Niendorf T, Bachert P, Ladd ME, Nagel AM. Corrections of myocardial tissue sodium concentration measurements in human cardiac
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Na MRI at 7 Tesla. Magn Reson Med 2019; 82:159-173. [DOI: 10.1002/mrm.27703] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Johanna Lott
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
| | - Tanja Platt
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
| | | | - Daniel Paech
- German Cancer Research Center (DKFZ) Radiology, Heidelberg Germany
| | - Nicolas G. R. Behl
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
| | - Thoralf Niendorf
- Max Delbrueck Center for Molecular Medicine in the Helmholtz Association Berlin Germany
- MRI. TOOLS GmbH Berlin Germany
| | - Peter Bachert
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
| | - Mark E. Ladd
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
- University of Heidelberg Faculty of Medicine Heidelberg Germany
| | - Armin M. Nagel
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU), University Hospital Erlangen Institute of Radiology Erlangen Germany
- Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU) Institute of Medical Physics Erlangen Germany
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116
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Much Ado about N…atrium: modelling tissue sodium as a highly sensitive marker of subclinical and localized oedema. Clin Sci (Lond) 2018; 132:2609-2613. [PMID: 30545897 PMCID: PMC6365627 DOI: 10.1042/cs20180575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/17/2018] [Accepted: 11/02/2018] [Indexed: 01/24/2023]
Abstract
Hypertonic Na+ accumulation in peripheral tissues is a recently described phenomenon: it has been associated with ageing, hypertension, diabetes, chronic kidney disease and heart failure, but its clinical meaning has yet to be determined. This concept conflicts with the classic physiological paradigm of constant balance between salt intake and excretion, and its water-independent nature is still a matter of debate. We developed a theoretical model explaining changes in the chemical composition of tissues as a function of extracellular volume fraction and excess extracellular fluid, i.e. oedema. The model suggests that the proportional increase in absolute Na+ content and concentration due to different degrees of oedema is higher than the parallel increase in water content, thus making Na+ a more sensitive index to detect this oedema. Our model would explain some of the recent findings of high tissue Na+ content in pathological conditions. More importantly, it prompts the reappraisal of tissue Na+ analysis from being a topic of niche interest to a potential diagnostic tool with broad applicability in the investigation of subclinical systemic and localized oedema.
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117
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Abstract
Kidney diseases can be caused by a wide range of genetic, hemodynamic, toxic, infectious, and autoimmune factors. The diagnosis of kidney disease usually involves the biochemical analysis of serum and blood, but these tests are often insufficiently sensitive or specific to make a definitive diagnosis. Although radiologic imaging currently has a limited role in the evaluation of most kidney diseases, several new imaging methods hold great promise for improving our ability to non-invasively detect structural, functional, and molecular changes within the kidney. New methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and blood oxygen level-dependent (BOLD) MRI, allow functional imaging of the kidney. The use of novel contrast agents, such as microbubbles and nanoparticles, allows the detection of specific molecules in the kidney. These methods could greatly advance our ability to diagnose disease and also to safely monitor patients over time. This could improve the care of individual patients, and it could also facilitate the evaluation of new treatment strategies.
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Affiliation(s)
- Joshua Thurman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
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118
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Xiao L, Patrick DM, Aden LA, Kirabo A. Mechanisms of isolevuglandin-protein adduct formation in inflammation and hypertension. Prostaglandins Other Lipid Mediat 2018; 139:48-53. [PMID: 30278231 PMCID: PMC6299826 DOI: 10.1016/j.prostaglandins.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/15/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022]
Abstract
Inflammation has been implicated in the pathogenesis of hypertension and recent evidence suggests that isolevuglandin (IsoLG)-protein adducts play a role. Several hypertensive stimuli contribute to formation of IsoLG-protein adducts including excess dietary salt and catecholamines. The precise intracellular mechanisms by which these hypertensive stimuli lead to IsoLG-protein adduct formation are still not well understood; however, there is now evidence implicating NADPH-oxidase derived reactive oxygen species (ROS) in this process. ROS oxidize arachidonic acid leading to formation of IsoLGs, which non-covalently adduct to lysine residues and alter protein structure and function. Recent studies suggest that these altered proteins act as neo-antigens leading to an autoimmune state that results in hypertension. The goal of this mini-review is to highlight some of the hypertensive stimuli and the mechanisms contributing to IsoLG-protein adduct formation leading to inflammation and hypertension.
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Affiliation(s)
- Liang Xiao
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David M Patrick
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Luul A Aden
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States; Vanderbilt Institute for Infection, Immunology & Inflammation (VI4), Nashville, TN, United States.
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119
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Bie P. Mechanisms of sodium balance: total body sodium, surrogate variables, and renal sodium excretion. Am J Physiol Regul Integr Comp Physiol 2018; 315:R945-R962. [DOI: 10.1152/ajpregu.00363.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The classical concepts of human sodium balance include 1) a total pool of Na+ of ≈4,200 mmol (total body sodium, TBS) distributed primarily in the extracellular fluid (ECV) and bone, 2) intake variations of 0.03 to ≈6 mmol·kg body mass−1·day−1, 3) asymptotic transitions between steady states with a halftime (T½) of 21 h, 4) changes in TBS driven by sodium intake measuring ≈1.3 day [ΔTBS/Δ(Na+ intake/day)], 5) adjustment of Na+ excretion to match any diet thus providing metabolic steady state, and 6) regulation of TBS via controlled excretion (90–95% renal) mediated by surrogate variables. The present focus areas include 1) uneven, nonosmotic distribution of increments in TBS primarily in “skin,” 2) long-term instability of TBS during constant Na+ intake, and 3) physiological regulation of renal Na+ excretion primarily by neurohumoral mechanisms dependent on ECV rather than arterial pressure. Under physiological conditions 1) the nonosmotic distribution of Na+ seems conceptually important, but quantitatively ill defined; 2) long-term variations in TBS represent significant deviations from steady state, but the importance is undetermined; and 3) the neurohumoral mechanisms of sodium homeostasis competing with pressure natriuresis are essential for systematic analysis of short-term and long-term regulation of TBS. Sodium homeostasis and blood pressure regulation are intimately related. Real progress is slow and will accelerate only through recognition of the present level of ignorance. Nonosmotic distribution of sodium, pressure natriuresis, and volume-mediated regulation of renal sodium excretion are essential intertwined concepts in need of clear definitions, conscious models, and future attention.
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Affiliation(s)
- Peter Bie
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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120
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SUGÁR D, AGÓCS R, TATÁR E, TÓTH G, HORVÁTH P, SULYOK E, SZABÓ AJ. The Contribution of Skin Glycosaminoglycans to the Regulation of Sodium Homeostasis in Rats. Physiol Res 2018; 67:777-785. [DOI: 10.33549/physiolres.933463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The glycosaminoglycan (GAG) molecules are a group of high molecular weight, negatively charged polysaccharides present abundantly in the mammalian organism. By their virtue of ion and water binding capacity, they may affect the redistribution of body fluids and ultimately the blood pressure. Data from the literature suggests that the mitogens Vascular Endothelial Growth Factor (VEGF)-A and VEGF-C are able to regulate the amount and charge density of GAGs and their detachment from the cell surface. Based on these findings we investigated the relationship between the level of dietary sodium intake, the expression levels of VEGF-A and VEGF-C, and the amount of the skin GAGs hyaluronic acid and chondroitin sulfate in an in vivo rat model. Significant correlation between dietary sodium intake, skin sodium levels and GAG content was found. We confirmed the GAG synthesizing role of VEGF-C but failed to prove that GAGs are degraded by VEGF-A. No significant difference in blood pressure was registered between the different dietary groups. A quotient calculated form the ion and water content of the skin tissue samples suggests that – in contrast to previous findings – the osmotically inactive ions and bound water fractions are proportional.
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Affiliation(s)
| | | | | | | | | | | | - A. J. SZABÓ
- First Department of Pediatrics, Research Laboratory, Semmelweis University, Budapest, Hungary
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121
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Hessels L, Oude Lansink-Hartgring A, Zeillemaker-Hoekstra M, Nijsten MW. Estimation of sodium and chloride storage in critically ill patients: a balance study. Ann Intensive Care 2018; 8:97. [PMID: 30306364 PMCID: PMC6179979 DOI: 10.1186/s13613-018-0442-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/03/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nonosmotic sodium storage has been reported in animals, healthy individuals and patients with hypertension, hyperaldosteronism and end-stage kidney disease. Sodium storage has not been studied in ICU patients, who frequently receive large amounts of sodium chloride-containing fluids. The objective of our study was to estimate sodium that cannot be accounted for by balance studies in critically ill patients. Chloride was also studied. We used multiple scenarios and assumptions for estimating sodium and chloride balances. METHODS We retrospectively analyzed patients admitted to the ICU after cardiothoracic surgery with complete fluid, sodium and chloride balance data for the first 4 days of ICU treatment. Balances were obtained from meticulously recorded data on intake and output. Missing extracellular osmotically active sodium (MES) was calculated by subtracting the expected change in plasma sodium from the observed change in plasma sodium derived from balance data. The same method was used to calculate missing chloride (MEC). To address considerable uncertainties on the estimated extracellular volume (ECV) and perspiration rate, various scenarios were used in which the size of the ECV and perspiration were varied. RESULTS A total of 38 patients with 152 consecutive ICU days were analyzed. In our default scenario, we could not account for 296 ± 35 mmol of MES in the first four ICU days. The range of observed MES in the five scenarios varied from 111 ± 27 to 566 ± 41 mmol (P < 0.001). A cumulative value of 243 ± 46 mmol was calculated for MEC in the default scenario. The range of cumulative MEC was between 62 ± 27 and 471 ± 56 mmol (P = 0.001 and P = 0.003). MES minus MEC varied from 1 ± 51 to 123 ± 33 mmol in the five scenarios. CONCLUSIONS Our study suggests considerable disappearance of osmotically active sodium in critically ill patients and is the first to also suggest rather similar disappearance of chloride from the extracellular space. Various scenarios for insensible water loss and estimated size for the ECV resulted in considerable MES and MEC, although these estimates showed a large variation. The mechanisms and the tissue compartments responsible for this phenomenon require further investigation.
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Affiliation(s)
- Lara Hessels
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Annemieke Oude Lansink-Hartgring
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Miriam Zeillemaker-Hoekstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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122
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Abstract
Purpose of Review Dietary sodium is an important trigger for hypertension and humans show a heterogeneous blood pressure response to salt intake. The precise mechanisms for this have not been fully explained although renal sodium handling has traditionally been considered to play a central role. Recent Findings Animal studies have shown that dietary salt loading results in non-osmotic sodium accumulation via glycosaminoglycans and lymphangiogenesis in skin mediated by vascular endothelial growth factor-C, both processes attenuating the rise in BP. Studies in humans have shown that skin could be a buffer for sodium and that skin sodium could be a marker of hypertension and salt sensitivity. Summary Skin sodium storage could represent an additional system influencing the response to salt load and blood pressure in humans.
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Affiliation(s)
- Viknesh Selvarajah
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Box 98, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK.
| | - Kathleen Connolly
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Box 98, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
| | - Carmel McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Box 98, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
| | - Ian Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Box 98, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
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123
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Dyke JP, Meyring-Wösten A, Zhao Y, Linz P, Thijssen S, Kotanko P. Reliability and agreement of sodium ( 23Na) MRI in calf muscle and skin of healthy subjects from the US. Clin Imaging 2018; 52:100-105. [PMID: 30041116 DOI: 10.1016/j.clinimag.2018.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE To quantify the reliability and agreement of sodium (23Na) MRI in calf muscle and skin of healthy subjects and to measure the smallest real difference (SRD) in each. SUBJECTS AND METHODS Thirty healthy subjects underwent 23Na MRI studies of the calf. A scan-rescan protocol was performed the same day and 1 week later. Relative sodium concentration was measured in the calf muscle and skin and compared between studies. RESULTS A high degree of reliability was confirmed between the scan and rescan tests using linear regression analysis. The Bland-Altman plots indicated high agreement between runs in all regions. The SRD was measured between scans taken the same day and one week later. Correlations were also reported with age, gender and race. CONCLUSIONS Reliability and agreement of 23Na MRI in the calf muscle and skin show promise for accurately assessing serial changes in patients.
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Affiliation(s)
- Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America.
| | | | - Yize Zhao
- Division of Biostatistics, Weill Cornell Medicine, New York, NY, United States of America
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stephan Thijssen
- Renal Research Institute, New York, NY, United States of America
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States of America
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124
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Affiliation(s)
- Eliane F.E. Wenstedt
- From the Division of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Rik H.G. Olde Engberink
- From the Division of Nephrology, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Academic Medical Center, University of Amsterdam, The Netherlands
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125
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Titze J, Luft FC. Speculations on salt and the genesis of arterial hypertension. Kidney Int 2018; 91:1324-1335. [PMID: 28501304 DOI: 10.1016/j.kint.2017.02.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 12/25/2022]
Abstract
Blood pressure salt sensitivity and salt resistance are mechanistically imperfectly explained. A prescient systems medicine approach by Guyton and colleagues-more than 50 years ago-suggested how salt intake might influence blood pressure. They proposed that a high-salt diet engenders sodium accumulation, volume expansion, cardiac output adjustments, and then autoregulation for flow maintenance. The autoregulation in all vascular beds increases systemic vascular resistance, causing the kidneys to excrete more salt and water, thus reducing systems to normal and minimizing any changes in blood pressure. This schema, which is remarkably all encompassing, included all regulatory mechanisms Guyton could identify at the time. Guyton introduced the idea that the kidney is central, particularly concerning the regulation of renal pressure natriuresis. Numerous criticisms have been subsequently raised, particularly recently. Kurtz and colleagues argue that the ability of individuals to respond with an appropriate vasodilatory response to increased salt intake is pivotal. Data exist to address that issue. Salt-resistant hypertensive models provide additional information. We identified a mendelian form of hypertension not related to sodium reabsorption in the distal nephron. The hypertension develops because of increased systemic vascular resistance. In addition, we rediscovered a third salt-storage glycose-aminoglycan-related compartment, largely in the skin. This compartment operates independently of renal function, and when perturbed, is associated with salt sensitivity. More recently, we found novel molecular mechanisms demonstrating how large salt quantities are excreted by the kidneys with minimal water losses. We introduce novel interpretations as to how the kidneys excrete salt when the intake is high. The findings could have relevance as to how blood pressure may be regulated at varying salt intakes. Our purposes are to provide the readership with a banquet of thoughts to digest, to pursue Guyton's ideas, and to adjust them accordingly.
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Affiliation(s)
- Jens Titze
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Friedrich C Luft
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Charité Medical Faculty, Berlin, Germany.
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126
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Wiig H, Luft FC, Titze JM. The interstitium conducts extrarenal storage of sodium and represents a third compartment essential for extracellular volume and blood pressure homeostasis. Acta Physiol (Oxf) 2018; 222. [PMID: 29193764 DOI: 10.1111/apha.13006] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 12/15/2022]
Abstract
The role of salt in the pathogenesis of arterial hypertension is not well understood. According to the current understanding, the central mechanism for blood pressure (BP) regulation relies on classical studies linking BP and Na+ balance, placing the kidney at the very centre of long-term BP regulation. To maintain BP homeostasis, the effective circulating fluid volume and thereby body Na+ content has to be maintained within very narrow limits. From recent work in humans and rats, the notion has emerged that Na+ could be stored somewhere in the body without commensurate water retention to buffer free extracellular Na+ and that previously unidentified extrarenal, tissue-specific regulatory mechanisms are operative regulating the release and storage of Na+ from a kidney-independent reservoir. Moreover, immune cells from the mononuclear phagocyte system not only function as local on-site sensors of interstitial electrolyte concentration, but also, together with lymphatics, act as systemic regulators of body fluid volume and BP. These studies have established new and unexpected targets in studies of BP control and thus the pathophysiology of hypertension: the interstitium/extracellular matrix of the skin, its inherent interstitial fluid and the lymphatic vasculature forming a vessel network in the interstitium. Aspects of the interstitium in relation to Na+ balance and hypertension are the focus of this review. Taken together, observations of salt storage in the skin to buffer free extracellular Na+ and macrophage modulation of the extracellular matrix and lymphatics suggest that electrolyte homeostasis in the body cannot be achieved by renal excretion alone, but also relies on extrarenal regulatory mechanisms.
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Affiliation(s)
- H. Wiig
- Department of Biomedicine; University of Bergen; Bergen Norway
| | - F. C. Luft
- Experimental and Clinical Research Center; Max-Delbrück Center for Molecular Medicine; Charité Medical Faculty; Berlin Germany
- Division of Clinical Pharmacology; Department of Medicine; Vanderbilt University School of Medicine; Nashville TN USA
| | - J. M. Titze
- Division of Clinical Pharmacology; Department of Medicine; Vanderbilt University School of Medicine; Nashville TN USA
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127
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Kopp C, Linz P, Maier C, Wabel P, Hammon M, Nagel AM, Rosenhauer D, Horn S, Uder M, Luft FC, Titze J, Dahlmann A. Elevated tissue sodium deposition in patients with type 2 diabetes on hemodialysis detected by 23Na magnetic resonance imaging. Kidney Int 2018; 93:1191-1197. [PMID: 29455909 DOI: 10.1016/j.kint.2017.11.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022]
Abstract
Long-term elevated blood sugar levels result in tissue matrix compositional changes in patients with diabetes mellitus type 2 (T2DM). We hypothesized that hemodialysis patients with T2DM might accumulate more tissue sodium than control hemodialysis patients. To test this, 23Na magnetic resonance imaging (23Na MRI) was used to estimate sodium in skin and muscle tissue in hemodialysis patients with or without T2DM. Muscle fat content was estimated by 1H MRI and tissue sodium content by 23Na MRI pre- and post-hemodialysis in ten hemodialysis patients with T2DM and in 30 matched control hemodialysis patients. We also assessed body fluid distribution with the Body Composition Monitor. 1H MRI indicated a tendency to higher muscle fat content in hemodialysis patients with T2DM compared to non-diabetic hemodialysis patients. 23Na MRI indicated increased sodium content in muscle and skin tissue of hemodialysis patients with T2DM compared to control hemodialysis patients. Multi-frequency bioimpedance was used to estimate extracellular water (ECW), and excess ECW in T2DM hemodialysis patients correlated with HbA1c levels. Sodium mobilization during hemodialysis lowered muscle sodium content post-dialysis to a greater degree in T2DM hemodialysis patients than in control hemodialysis patients. Thus, our findings provide evidence that increased sodium accumulation occurs in hemodialysis patients with T2DM and that impaired serum glucose metabolism is associated with disturbances in tissue sodium and water content.
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Affiliation(s)
- Christoph Kopp
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Peter Linz
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin Maier
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Wabel
- Fresenius Medical Care, Bad Homburg, Germany
| | - Matthias Hammon
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Rosenhauer
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jens Titze
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Anke Dahlmann
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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128
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Karg MV, Bosch A, Kannenkeril D, Striepe K, Ott C, Schneider MP, Boemke-Zelch F, Linz P, Nagel AM, Titze J, Uder M, Schmieder RE. SGLT-2-inhibition with dapagliflozin reduces tissue sodium content: a randomised controlled trial. Cardiovasc Diabetol 2018; 17:5. [PMID: 29301520 PMCID: PMC5753452 DOI: 10.1186/s12933-017-0654-z] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background and aims Sodium tissue content by 23Na magnetic resonance imaging (Na-MRI) has been validated in experimental and human studies. SGLT-2 inhibition blocks the reabsorption of glucose and of sodium in the proximal tubular cells in a 1:1 fashion. We hypothesized that SGLT-2 inhibition in patients with type 2 diabetes characterized by sodium retention leads to decreased tissue sodium content due to its pharmacological action. Materials and methods In a prospective double blind, placebo controlled, cross-over trial 59 patients (61 ± 7.6 years) with type 2 diabetes were randomized to either dapagliflozin 10 mg or placebo once daily for 6 weeks each. In addition to metabolic parameters and ambulatory blood pressure (BP) we analysed the sodium content in the skin and muscles of the lower leg by Na-MRI. Results Compared to baseline 6 weeks treatment with the SGLT-2 inhibitor dapagliflozin decreased fasting (132 ± 28 vs. 114 ± 19 mg/dl, p < 0.001), postprandial blood glucose (178 ± 66 mg/dl vs. 153 ± 46 mg/dl, p < 0.001), body weight (87.6 vs. 86.6 kg, p < 0.001) and systolic (129 ± 12 vs. 126 ± 11 mmHg, p = 0.010), and diastolic (77.4 ± 9 vs. 75.6 ± 8 mmHg, p = 0.024), 24-h ambulatory BP. Tissue sodium content in the skin was reduced after 6 weeks treatment with dapagliflozin compared to baseline [24.1 ± 6.6 vs. 22.7 ± 6.4 A.U.(arbitrary unit) p = 0.013]. No significant reduction of tissue sodium content was observed in the muscle (M. triceps surae: 20.5 ± 3.5 vs. 20.4 ± 3.7 A.U. p = 0.801). No clear significant difference in tissue water content of muscle and skin was observed after 6 weeks of treatment with dapagliflozin, compared to baseline. Conclusion SGLT-2 inhibition with dapagliflozin resulted in a significant decrease in tissue sodium content of the skin after 6 weeks. This observation point to a decrease of total sodium content in patients with type 2 diabetes prone to cardiovascular complications, that might be mitigated by SGLT-2 inhibition. Trial registration The study was registered at http://www.clinicaltrials.gov (NCT02383238) retrospectively registered
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Affiliation(s)
- M V Karg
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - A Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - D Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - K Striepe
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - C Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - M P Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - F Boemke-Zelch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - P Linz
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - A M Nagel
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - J Titze
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Uder
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - R E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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129
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Fernández-Llama P, Calero F. [How does salt intake influence blood pressure? Associated aetiopathogenic mechanisms]. HIPERTENSION Y RIESGO VASCULAR 2017; 35:S1889-1837(17)30105-8. [PMID: 29254634 DOI: 10.1016/j.hipert.2017.11.005] [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: 10/18/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
Abundant evidence from epidemiological and experimental studies has established a link between salt and blood pressure. However, there is heterogeneity in the blood pressure responses of humans to changes in sodium intake. Those individuals in whom a severe, abrupt change in salt intake causes the least change in arterial pressure and are termed salt-resistant, whereas in those in whom this leads to large changes in blood pressure, are called salt sensitive. Classically, Guyton's theory of the pressure-natriuresis phenomenon has been accepted to explain the pressor effect of salt, as well as the fundamental role played by the different protein sodium transporters of the renal tubules. In recent years, new theories have emerged pointing to the possible role of the immune system and the existence of a third sodium store in the body as aetiopathogenic factors.
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Affiliation(s)
- P Fernández-Llama
- Unidad de Hipertensión, Servicio de Nefrología, Fundació Puigvert, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau, Barcelona, España.
| | - F Calero
- Unidad de Hipertensión, Servicio de Nefrología, Fundació Puigvert, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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130
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Norlander AE, Madhur MS, Harrison DG. The immunology of hypertension. J Exp Med 2017; 215:21-33. [PMID: 29247045 PMCID: PMC5748862 DOI: 10.1084/jem.20171773] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/28/2022] Open
Abstract
Emerging evidence indicates that both innate and adaptive immunity contribute to hypertension. Efforts to understand mechanisms of immune activation in hypertension are defining not only new mechanisms of disease but also new therapeutic options for its treatment. Although systemic hypertension affects a large proportion of the population, its etiology remains poorly defined. Emerging evidence supports the concept that immune cells become activated and enter target organs, including the vasculature and the kidney, in this disease. Mediators released by these cells, including reactive oxygen species, metalloproteinases, cytokines, and antibodies promote dysfunction of the target organs and cause damage. In vessels, these factors enhance constriction, remodeling, and rarefaction. In the kidney, these mediators increase expression and activation of sodium transporters, and cause interstitial fibrosis and glomerular injury. Factors common to hypertension, including oxidative stress, increased interstitial sodium, cytokine production, and inflammasome activation promote immune activation in hypertension. Recent data suggest that isolevuglandin-modified self-proteins in antigen-presenting cells are immunogenic, promoting cytokine production by the cells in which they are formed and T cell activation. Efforts to prevent and reverse immune activation may prove beneficial in preventing the long-term sequelae of hypertension and its related cardiovascular diseases.
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Affiliation(s)
- Allison E Norlander
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Meena S Madhur
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - David G Harrison
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN .,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
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131
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Wong MKS, Tsukada T, Ogawa N, Pipil S, Ozaki H, Suzuki Y, Iwasaki W, Takei Y. A sodium binding system alleviates acute salt stress during seawater acclimation in eels. ZOOLOGICAL LETTERS 2017; 3:22. [PMID: 29255617 PMCID: PMC5727781 DOI: 10.1186/s40851-017-0081-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 10/11/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Teleosts transiting from freshwater (FW) to seawater (SW) environments face an immediate osmotic stress from ion influxes and water loss, but some euryhaline species such as eels can maintain a stable plasma osmolality during early SW exposure. The time course changes in the gene expression, protein abundance, and localization of key ion transporters suggested that the reversal of the ion transport systems was gradual, and we investigate how eels utilize a Na-binding strategy to slow down the ion invasion and complement the transporter-mediated osmoregulation. RESULTS Using an electron probe micro-analyzer, we localized bound Na in various eel tissues in response to SW transfer, suggesting that the Na-binding molecules were produced to sequester excess ionic Na+ to negate its osmotic potential, thus preventing acute cellular dehydration. Mucus cells were acutely activated in digestive tract, gill, and skin after SW transfer, producing Na-binding molecule-containing mucus layers that fence off high osmolality of SW. Using gel filtration HPLC, some molecules at 18 kDa were found to bind Na in the luminal secretion of esophagus and intestine, and higher binding was associated with SW transfer. Transcriptome and protein interaction results indicated that downregulation of Notch and β-catenin pathways, and dynamic changes in TGFβ pathways in intestine were involved during early SW transition, supporting the observed histological changes on epithelial desquamation and increased mucus production. CONCLUSIONS The timing for the activation of the Na-binding mechanism to alleviate the adverse osmotic gradient was temporally complementary to the subsequent remodeling of branchial ionocytes and transporting epithelia of the digestive tract. The strategy to manipulate the osmotic potential of Na+ by specific binding molecules is similar to the osmotically inactive Na described in human skin and muscle. The Na-binding molecules provide a buffer to tolerate the salinity changes, which is advantageous to the estuary and migrating fishes. Our data pave the way to identify this unknown class of molecules and open a new area of vertebrate osmoregulation research.
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Affiliation(s)
- Marty Kwok Shing Wong
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa City, Japan
| | - Takehiro Tsukada
- Department of Biomolecular Science, Toho University, Funabashi City, Japan
| | - Nobuhiro Ogawa
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa City, Japan
| | - Supriya Pipil
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa City, Japan
| | - Haruka Ozaki
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa City, Japan
- Bioinformatics Research Unit, Advanced Center for Computing and Communication, RIKEN, Wako City, Japan
| | - Yutaka Suzuki
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa City, Japan
| | - Wataru Iwasaki
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa City, Japan
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa City, Japan
| | - Yoshio Takei
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa City, Japan
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132
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Selvarajah V, Mäki-Petäjä KM, Pedro L, Bruggraber SF, Burling K, Goodhart AK, Brown MJ, McEniery CM, Wilkinson IB. Novel Mechanism for Buffering Dietary Salt in Humans: Effects of Salt Loading on Skin Sodium, Vascular Endothelial Growth Factor C, and Blood Pressure. Hypertension 2017; 70:930-937. [PMID: 28974570 PMCID: PMC5640984 DOI: 10.1161/hypertensionaha.117.10003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na+ accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na+ and K+ concentrations were measured in mg/g of wet tissue and expressed as the ratio Na+:K+ to correct for variability in sample hydration. Skin Na+:K+ increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P=0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na+:K+ in men (2.59±0.09 versus 2.88±0.12; P=0.008) but not women (3.23±0.10 versus 3.36±0.12; P=0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P<0.001) while men did not (96±2 versus 96±2 mm Hg; P=0.91). Skin Na+:K+ correlated with BP, stroke volume, and peripheral vascular resistance in men but not in women. No change was noted in plasma VEGF-C. These findings suggest that the skin may buffer dietary Na+, reducing the hemodynamic consequences of increased salt, and this may be influenced by sex.
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Affiliation(s)
- Viknesh Selvarajah
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (V.S., K.M.M-P., A.K.G., C.M.M., I.B.W.); MRC Human Nutrition Unit, Cambridge, United Kingdom (L.P., S.F.A.B.); NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory, United Kingdom (K.B.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.J.B.).
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133
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Hammon M, Grossmann S, Linz P, Seuss H, Hammon R, Rosenhauer D, Janka R, Cavallaro A, Luft FC, Titze J, Uder M, Dahlmann A. 3 Tesla 23Na Magnetic Resonance Imaging During Acute Kidney Injury. Acad Radiol 2017; 24:1086-1093. [PMID: 28495210 DOI: 10.1016/j.acra.2017.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/08/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES Sodium and proton magnetic resonance imaging (23Na/1H-MRI) have shown that muscle and skin can store Na+ without water. In chronic renal failure and in heart failure, Na+ mobilization occurs, but is variable depending on age, dialysis vintage, and other features. Na+ storage depots have not been studied in patients with acute kidney injury (AKI). MATERIALS AND METHODS We studied 7 patients with AKI (mean age: 51.7 years; range: 25-84) and 14 age-matched and gender-matched healthy controls. All underwent 23Na/1H-MRI at the calf. Patients were studied before and after acute hemodialysis therapy within 5-6 days. The 23Na-MRI produced grayscale images containing Na+ phantoms, which served to quantify Na+ contents. A fat-suppressed inversion recovery sequence was used to quantify H2O content. RESULTS Plasma Na+ levels did not change. Mean Na+ contents in muscle and skin did not significantly change following four to five cycles of hemodialysis treatment (before therapy: 32.7 ± 6.9 and 44.2 ± 13.5 mmol/L, respectively; after dialysis: 31.7 ± 10.2 and 42.8 ± 11.8 mmol/L, respectively; P > .05). Water content measurements did not differ significantly before and after hemodialysis in muscle and skin (P > .05). Na+ contents in calf muscle and skin of patients before hemodialysis were significantly higher than in healthy subjects (16.6 ± 2.1 and 17.9 ± 3.2) and remained significantly elevated after hemodialysis. CONCLUSIONS Na+ in muscle and skin accumulates in patients with AKI and, in contrast to patients receiving chronic hemodialysis and those with acute heart failure, is not mobilized with hemodialysis within 5-6 days.
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134
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Ott C, Kopp C, Dahlmann A, Schmid A, Linz P, Cavallaro A, Hammon M, Ditting T, Veelken R, Uder M, Titze J, Schmieder RE. Impact of renal denervation on tissue Na+ content in treatment-resistant hypertension. Clin Res Cardiol 2017; 107:42-48. [DOI: 10.1007/s00392-017-1156-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/17/2017] [Indexed: 01/11/2023]
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135
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Padovan E. Modulation of CD4+ T Helper Cell Memory Responses in the Human Skin. Int Arch Allergy Immunol 2017; 173:121-137. [PMID: 28787717 DOI: 10.1159/000477728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Immunological memory is defined as the capacity to mount faster and more effective immune responses against antigenic challenges that have been previously encountered by the host. CD4+ T helper (Th) cells play central roles in the establishment of immunological memory as they assist the functions of other leukocytes. Th cells express polarized cytokine profiles and distinct migratory and seeding capacities, but also retain a certain functional plasticity that allows them to modulate their proliferation, activity, and homing behaviour upon need. Thus, in healthy individuals, T cell immunomodulation fulfils the task of eliciting protective immune responses where they are needed. At times, however, Th plasticity can lead to collateral tissue damage and progression to autoimmune diseases or, conversely, incapacity to reject malignant tissues and clear chronic infections. Furthermore, common immune players and molecular pathways of diseases can lead to different outcomes in different individuals. A mechanistic understanding of those pathways is therefore crucial for developing precise and curative medical interventions. Here, I focus on the skin microenvironment and comprehensively describe some of the cellular and molecular determinants of CD4+ T cell memory responses in homeostatic and pathological conditions. In discussing the cellular network orchestrating cutaneous immunity, I comprehensively describe the bidirectional interaction of skin antigen-presenting cells and mononuclear phagocytes with Th17 lymphocytes, and examine how the outcome of this interaction is influenced by endogenous skin molecules, including sodium salts and neuropeptides.
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Affiliation(s)
- Elisabetta Padovan
- Department of Biomedicine, University Hospital, University of Basel, Basel, Switzerland
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136
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Fischereder M, Michalke B, Schmöckel E, Habicht A, Kunisch R, Pavelic I, Szabados B, Schönermarck U, Nelson PJ, Stangl M. Sodium storage in human tissues is mediated by glycosaminoglycan expression. Am J Physiol Renal Physiol 2017; 313:F319-F325. [PMID: 28446462 DOI: 10.1152/ajprenal.00703.2016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/10/2017] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
The current paradigm regarding sodium handling in animals and humans postulates that total body sodium is regulated predominately via regulation of extracellular volume. Active sodium storage independent of volume retention is thought to be negligible. However, studies in animals, hypertensive patients, and healthy humans suggest water-free storage of sodium in skin. We hypothesized that tissue sodium concentrations ([Na]T) found in humans vary and reflect regulation due to variable glycosaminoglycan content due to variable expression of XYLT-1. Twenty seven patients on dialysis and 21 living kidney transplant donors free of clinically detectable edema were studied. During surgery, abdominal skin, muscle, and arteries were biopsied. [Na]T was determined by inductively coupled plasma-optical emission spectrometry, semiquantitative glycosaminoglycan content with Alcian stain, and XYLT-1 expression by real-time PCR. [Na]T of arteries were ranging between 0.86 and 9.83 g/kg wet wt and were significantly higher in arteries (4.52 ± 1.82 g/kg) than in muscle (2.03 ± 1.41 g/kg; P < 0.001) or skin (3.24 ± 2.26 g/kg wet wt; P = 0.038). For individual patients [Na]T correlated for skin and arterial tissue (r = 0.440, P = 0.012). [Na]T also correlated significantly with blinded semiquantitative analysis of glycosaminoglycans staining (r = 0.588, P = 0.004). In arteries XYLT-1 expression was also correlated with [Na]T (r = 0.392, P = 0.003). Our data confirm highly variable [Na]T in human skin and muscle and extend this observation to [Na]T in human arteries. These data support the hypothesis of water-independent sodium storage via regulated glycosaminoglycan synthesis in human tissues, including arteries.
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Affiliation(s)
- Michael Fischereder
- Medizinische Klinik und Poliklinik IV, Renal Division, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany;
| | - Bernhard Michalke
- Research Unit Analytical Biochemistry, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Elisa Schmöckel
- Institut für Pathologie, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Antje Habicht
- Transplantationszentrum, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Raphael Kunisch
- Medizinische Klinik und Poliklinik IV, Renal Division, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Ivana Pavelic
- Medizinische Klinik und Poliklinik IV, Renal Division, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Bernadette Szabados
- Urologische Klinik, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany; and
| | - Ulf Schönermarck
- Medizinische Klinik und Poliklinik IV, Renal Division, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Peter J Nelson
- Medizinische Klinik und Poliklinik IV, Renal Division, Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
| | - Manfred Stangl
- Chirurgische Klinik-Klinikum der Ludwig Maximilians Universitaet, Munich, Germany
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137
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Kopp C, Beyer C, Linz P, Dahlmann A, Hammon M, Jantsch J, Neubert P, Rosenhauer D, Müller DN, Cavallaro A, Eckardt KU, Schett G, Luft FC, Uder M, Distler JHW, Titze J. Na+ deposition in the fibrotic skin of systemic sclerosis patients detected by 23Na-magnetic resonance imaging. Rheumatology (Oxford) 2017; 56:556-560. [PMID: 28013199 DOI: 10.1093/rheumatology/kew371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/14/2022] Open
Abstract
Objective Skin fibrosis is the predominant feature of SSc and arises from excessive extracellular matrix deposition. Glycosaminoglycans are macromolecules of the extracellular matrix, which facilitate Na + accumulation in the skin. We used 23 Na-MRI to quantify Na + in skin. We hypothesized that skin Na + might accumulate in SSc and might be a biomarker for skin fibrosis. Methods In this observational case-control study, skin Na + was determined by 23 Na-MRI using a Na + volume coil in 12 patients with diffuse cutaneous SSc and in 21 control subjects. We assessed skin fibrosis by the modified Rodnan skin score prior to 23 Na-MRI and on follow-up 12 months later. Results 23 Na-MRI demonstrated increased Na + in the fibrotic skin of SSc patients compared with skin from controls [mean ( s . d .): 27.2 (5.6) vs 21.4 (5.3) mmol/l, P < 0.01]. Na + content was higher in fibrotic than in non-fibrotic SSc skin [26.2 (4.8) vs 19.2 (3.4) mmol/l, P < 0.01]. Furthermore, skin Na + amount was correlated with changes in follow-up modified Rodnan skin score (R 2 = 0.68). Conclusions 23 Na-MRI detected increased Na + in the fibrotic SSc skin; high Na + content was associated with progressive skin disease. Our findings provide the first evidence that 23 Na-MRI might be a promising tool to assess skin Na + and thereby predict progression of skin fibrosis in SSc.
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Affiliation(s)
| | - Christian Beyer
- Department of Internal Medicine 3 and Institute for Clinical Immunology
| | - Peter Linz
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | | | - Matthias Hammon
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Regensburg, Regensburg
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Regensburg, Regensburg
| | | | - Dominik N Müller
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Alexander Cavallaro
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | | | - Georg Schett
- Department of Internal Medicine 3 and Institute for Clinical Immunology
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Clinical Pharmocology, Vanderbilt University, Nashville, TN, USA
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | - Jörg H W Distler
- Department of Internal Medicine 3 and Institute for Clinical Immunology
| | - Jens Titze
- Department of Clinical Pharmocology, Vanderbilt University, Nashville, TN, USA
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138
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Deger SM, Wang P, Fissell R, Ellis CD, Booker C, Sha F, Morse JL, Stewart TG, Gore JC, Siew ED, Titze J, Ikizler TA. Tissue sodium accumulation and peripheral insulin sensitivity in maintenance hemodialysis patients. J Cachexia Sarcopenia Muscle 2017; 8:500-507. [PMID: 28150400 PMCID: PMC5476848 DOI: 10.1002/jcsm.12179] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent data suggest that sodium (Na+ ) is stored in the muscle and skin without commensurate water retention in maintenance hemodialysis (MHD) patients. In this study, we hypothesized that excessive Na+ accumulation would be associated with abnormalities in peripheral insulin action. METHODS Eleven MHD patients and eight controls underwent hyperinsulinemic-euglycemic-euaminoacidemic clamp studies to measure glucose (GDR) and leucine disposal rates (LDR), as well as lower left leg 23 Na magnetic resonance imaging to measure Na+ concentration in the muscle and skin tissue. RESULTS The median GDR and LDR levels were lower, and the median muscle Na+ concentration was higher in MHD patients compared with controls. No significant difference was found regarding skin Na+ concentration between group comparisons. Linear regression revealed inverse relationships between muscle Na+ concentration and GDR and LDR in MHD patients, whereas no relationship was observed in controls. There was no association between skin Na+ content and GDR or LDR in either MHD patients or controls. CONCLUSIONS These data suggest that excessive muscle Na+ content might be a determinant of IR in MHD patients, although the causality and mechanisms remain to be proven.
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Affiliation(s)
- Serpil Muge Deger
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.,Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA
| | - Ping Wang
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - Rachel Fissell
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA
| | - Charles D Ellis
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy Booker
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.,Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA
| | - Feng Sha
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer L Morse
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - Edward D Siew
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA
| | - Jens Titze
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Talat Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.,Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA
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139
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Gerlach DA, Schopen K, Linz P, Johannes B, Titze J, Zange J, Rittweger J. Atrophy of calf muscles by unloading results in an increase of tissue sodium concentration and fat fraction decrease: a 23Na MRI physiology study. Eur J Appl Physiol 2017; 117:1585-1595. [DOI: 10.1007/s00421-017-3647-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/17/2017] [Indexed: 01/27/2023]
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140
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Affiliation(s)
- Javid Moslehi
- From the Divisions of Cardiovascular Medicine (J.M., A.K.P., N.B.) and Oncology (J.M.), Cardio-Oncology Program (J.M., A.K.P., N.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Arvind K. Pandey
- From the Divisions of Cardiovascular Medicine (J.M., A.K.P., N.B.) and Oncology (J.M.), Cardio-Oncology Program (J.M., A.K.P., N.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Nirmanmoh Bhatia
- From the Divisions of Cardiovascular Medicine (J.M., A.K.P., N.B.) and Oncology (J.M.), Cardio-Oncology Program (J.M., A.K.P., N.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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141
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Rakova N, Kitada K, Lerchl K, Dahlmann A, Birukov A, Daub S, Kopp C, Pedchenko T, Zhang Y, Beck L, Johannes B, Marton A, Müller DN, Rauh M, Luft FC, Titze J. Increased salt consumption induces body water conservation and decreases fluid intake. J Clin Invest 2017; 127:1932-1943. [PMID: 28414302 DOI: 10.1172/jci88530] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 02/17/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The idea that increasing salt intake increases drinking and urine volume is widely accepted. We tested the hypothesis that an increase in salt intake of 6 g/d would change fluid balance in men living under ultra-long-term controlled conditions. METHODS Over the course of 2 separate space flight simulation studies of 105 and 205 days' duration, we exposed 10 healthy men to 3 salt intake levels (12, 9, or 6 g/d). All other nutrients were maintained constant. We studied the effect of salt-driven changes in mineralocorticoid and glucocorticoid urinary excretion on day-to-day osmolyte and water balance. RESULTS A 6-g/d increase in salt intake increased urine osmolyte excretion, but reduced free-water clearance, indicating endogenous free water accrual by urine concentration. The resulting endogenous water surplus reduced fluid intake at the 12-g/d salt intake level. Across all 3 levels of salt intake, half-weekly and weekly rhythmical mineralocorticoid release promoted free water reabsorption via the renal concentration mechanism. Mineralocorticoid-coupled increases in free water reabsorption were counterbalanced by rhythmical glucocorticoid release, with excretion of endogenous osmolyte and water surplus by relative urine dilution. A 6-g/d increase in salt intake decreased the level of rhythmical mineralocorticoid release and elevated rhythmical glucocorticoid release. The projected effect of salt-driven hormone rhythm modulation corresponded well with the measured decrease in water intake and an increase in urine volume with surplus osmolyte excretion. CONCLUSION Humans regulate osmolyte and water balance by rhythmical mineralocorticoid and glucocorticoid release, endogenous accrual of surplus body water, and precise surplus excretion. FUNDING Federal Ministry for Economics and Technology/DLR; the Interdisciplinary Centre for Clinical Research; the NIH; the American Heart Association (AHA); the Renal Research Institute; and the TOYOBO Biotechnology Foundation. Food products were donated by APETITO, Coppenrath und Wiese, ENERVIT, HIPP, Katadyn, Kellogg, Molda, and Unilever.
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142
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Wolley MJ, Pimenta E, Calhoun D, Gordon RD, Cowley D, Stowasser M. Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoea. J Hum Hypertens 2017; 31:561-567. [PMID: 28382959 DOI: 10.1038/jhh.2017.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/17/2017] [Accepted: 02/22/2017] [Indexed: 01/22/2023]
Abstract
Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment of PA improves sleep apnoea parameters in these patients. We therefore aimed to determine whether specific medical or surgical treatment of PA improves OSA, as measured by the apnoea-hypopnoea index (AHI). We recruited patients undergoing diagnostic workup for PA if they had symptoms suggestive of OSA. Patients with confirmed PA underwent polysomnography (PSG) at baseline and again at least 3 months after specific treatment for PA. Of 34 patients with PA, 7 (21%) had no evidence of OSA (AHI <5), 9 (26%) had mild (AHI ⩾5 and <15), 8 (24%) moderate (AHI ⩾15 and <30) and 10 (29%) severe OSA (AHI ⩾30). Body mass index tertile, neck circumference and 24 h urinary sodium correlated with the AHI. Twenty patients had repeat PSG performed after treatment for PA (mineralocorticoid receptor antagonists in 13 with bilateral PA and adrenalectomy in 7 with unilateral PA). In this group the median (s.d.) AHI reduced from 22.5 (14.7) to 12.3 (12.1) (P=0.02). Neck circumference reduced with PA treatment (41.6 vs 41.2 cm, P=0.012). OSA is common in patients with primary aldosteronism and may improve with specific therapy for this disease. Aldosterone and sodium-mediated fluid retention in the upper airways and neck region may be a potential mechanism for this relationship.
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Affiliation(s)
- M J Wolley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - E Pimenta
- Experimental Medicine CV/Hem, Clinical Sciences, Global Drug Discovery, Bayer Pharma AG, Wuppertal, Germany
| | - D Calhoun
- Sleep/Wake Disorders Center, Division of Pulmonary, Allergy and Critical Care Medicine and Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R D Gordon
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - D Cowley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - M Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
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143
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Involvement of systemic venous congestion in heart failure. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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144
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Olde Engberink RH, Rorije NM, van den Born BJH, Vogt L. Quantification of nonosmotic sodium storage capacity following acute hypertonic saline infusion in healthy individuals. Kidney Int 2017; 91:738-745. [DOI: 10.1016/j.kint.2016.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 11/17/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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145
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Schneider MP, Raff U, Kopp C, Scheppach JB, Toncar S, Wanner C, Schlieper G, Saritas T, Floege J, Schmid M, Birukov A, Dahlmann A, Linz P, Janka R, Uder M, Schmieder RE, Titze JM, Eckardt KU. Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD. J Am Soc Nephrol 2017; 28:1867-1876. [PMID: 28154199 DOI: 10.1681/asn.2016060662] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/25/2016] [Indexed: 12/24/2022] Open
Abstract
The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using 23sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, P<0.001 versus r=0.35, P<0.001; P<0.01 between the two correlations). Linear regression analysis demonstrated that skin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients.
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Affiliation(s)
| | - Ulrike Raff
- Departments of *Nephrology and Hypertension, and
| | | | | | - Sebastian Toncar
- Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany
| | - Georg Schlieper
- Division of Nephrology and Clinical Immunology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany; and
| | - Anna Birukov
- Departments of *Nephrology and Hypertension, and.,Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Peter Linz
- Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Rolf Janka
- Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Jens M Titze
- Departments of *Nephrology and Hypertension, and.,Department of Medicine, Vanderbilt University, Nashville, Tennessee
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146
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Wang P, Deger MS, Kang H, Ikizler TA, Titze J, Gore JC. Sex differences in sodium deposition in human muscle and skin. Magn Reson Imaging 2017; 36:93-97. [PMID: 27989912 PMCID: PMC5222810 DOI: 10.1016/j.mri.2016.10.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
Abstract
The aim of this work was to investigate possible sex differences in the patterns of sodium deposition between muscle and skin using sodium MRI. A total of 38 subjects were examined for comparisons: 20 males, aged 25-79years with a median age of 51; 18 females, aged 38-66years, median age 53. All subjects underwent sodium MRI scans of the calf muscles together with cross sections through four calibration standards containing known sodium contents (10mM, 20mM, 30mM, and 40mM). Tissue sodium concentrations (TSC) in muscle and skin were then calculated by comparing signal intensities between tissues and reference standards using a linear analysis. A Wilcoxon rank sum test was applied to the ΔTSC (=TSCmuscle-TSCskin) series of males and females to examine if they were significantly different. Finally, a multiple linear regression was utilized to account for the effects from two potential confounders, age and body mass index (BMI). We found that sodium content appears to be higher in skin than in muscle for men, however women tend to have higher muscle sodium than skin sodium. This sex-relevant sodium deposition is statistically significant (P=3.10×10-5) by the Wilcoxon rank sum test, and this difference in distribution seems to be more reliable with increasing age. In the multiple linear regression, gender still has a statistically significant effect (P<1.0×10-4) on the difference between sodium deposition in muscle and skin, while taking the effects of age and BMI into account.
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Affiliation(s)
- Ping Wang
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Muge Serpil Deger
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jens Titze
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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147
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Schatz V, Neubert P, Schröder A, Binger K, Gebhard M, Müller DN, Luft FC, Titze J, Jantsch J. Elementary immunology: Na + as a regulator of immunity. Pediatr Nephrol 2017; 32:201-210. [PMID: 26921211 PMCID: PMC5203836 DOI: 10.1007/s00467-016-3349-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Abstract
The skin can serve as an interstitial Na+ reservoir. Local tissue Na+ accumulation increases with age, inflammation and infection. This increased local Na+ availability favors pro-inflammatory immune cell function and dampens their anti-inflammatory capacity. In this review, we summarize available data on how NaCl affects various immune cells. We particularly focus on how salt promotes pro-inflammatory macrophage and T cell function and simultaneously curtails their regulatory and anti-inflammatory potential. Overall, these findings demonstrate that local Na+ availability is a promising novel regulator of immunity. Hence, the modulation of tissue Na+ levels bears broad therapeutic potential: increasing local Na+ availability may help in treating infections, while lowering tissue Na+ levels may be used to treat, for example, autoimmune and cardiovascular diseases.
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Affiliation(s)
- Valentin Schatz
- Institute of Clinical Microbiology and Hygiene, Universitätsklinikum Regensburg-Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, Universitätsklinikum Regensburg-Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Agnes Schröder
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen-Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Katrina Binger
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Matthias Gebhard
- Experimental and Clinical Research Center (ECRC), Research Building, Charité Lindenberger Weg 80, Berlin, Germany
- Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Dominik N Müller
- Experimental and Clinical Research Center (ECRC), Research Building, Charité Lindenberger Weg 80, Berlin, Germany
- Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center (ECRC), Research Building, Charité Lindenberger Weg 80, Berlin, Germany
- Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jens Titze
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen-Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, Universitätsklinikum Regensburg-Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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148
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Rubio Gracia J, Sánchez Marteles M, Pérez Calvo JI. Involvement of systemic venous congestion in heart failure. Rev Clin Esp 2016; 217:161-169. [PMID: 27979306 DOI: 10.1016/j.rce.2016.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022]
Abstract
Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment.
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Affiliation(s)
- J Rubio Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España.
| | - M Sánchez Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J I Pérez Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
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Iatrino R, Manunta P, Zagato L. Salt Sensitivity: Challenging and Controversial Phenotype of Primary Hypertension. Curr Hypertens Rep 2016; 18:70. [DOI: 10.1007/s11906-016-0677-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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150
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Niendorf T, Paul K, Oezerdem C, Graessl A, Klix S, Huelnhagen T, Hezel F, Rieger J, Waiczies H, Frahm J, Nagel AM, Oberacker E, Winter L. W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities. NMR IN BIOMEDICINE 2016; 29:1173-97. [PMID: 25706103 DOI: 10.1002/nbm.3268] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/26/2014] [Accepted: 01/13/2015] [Indexed: 05/12/2023]
Abstract
The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thoralf Niendorf
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Katharina Paul
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Celal Oezerdem
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Andreas Graessl
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Sabrina Klix
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Till Huelnhagen
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Fabian Hezel
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH, am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Göttingen, Germany
| | - Armin M Nagel
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Oberacker
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Lukas Winter
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
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