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Poulakis K, Pereira JB, Muehlboeck JS, Wahlund LO, Smedby Ö, Volpe G, Masters CL, Ames D, Niimi Y, Iwatsubo T, Ferreira D, Westman E. Multi-cohort and longitudinal Bayesian clustering study of stage and subtype in Alzheimer's disease. Nat Commun 2022; 13:4566. [PMID: 35931678 PMCID: PMC9355993 DOI: 10.1038/s41467-022-32202-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Understanding Alzheimer's disease (AD) heterogeneity is important for understanding the underlying pathophysiological mechanisms of AD. However, AD atrophy subtypes may reflect different disease stages or biologically distinct subtypes. Here we use longitudinal magnetic resonance imaging data (891 participants with AD dementia, 305 healthy control participants) from four international cohorts, and longitudinal clustering to estimate differential atrophy trajectories from the age of clinical disease onset. Our findings (in amyloid-β positive AD patients) show five distinct longitudinal patterns of atrophy with different demographical and cognitive characteristics. Some previously reported atrophy subtypes may reflect disease stages rather than distinct subtypes. The heterogeneity in atrophy rates and cognitive decline within the five longitudinal atrophy patterns, potentially expresses a complex combination of protective/risk factors and concomitant non-AD pathologies. By alternating between the cross-sectional and longitudinal understanding of AD subtypes these analyses may allow better understanding of disease heterogeneity.
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Affiliation(s)
- Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems (MTH), KTH Royal Institute of Technology, Stockholm, Sweden
| | - Giovanni Volpe
- Department of Physics, University of Gothenburg, Gothenburg, Sweden
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St George's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Yoshiki Niimi
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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2
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Pereira PR, Carrageta DF, Oliveira PF, Rodrigues A, Alves MG, Monteiro MP. Metabolomics as a tool for the early diagnosis and prognosis of diabetic kidney disease. Med Res Rev 2022; 42:1518-1544. [PMID: 35274315 DOI: 10.1002/med.21883] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 01/21/2023]
Abstract
Diabetic kidney disease (DKD) is one of the most prevalent comorbidities of diabetes mellitus and the leading cause of the end-stage renal disease (ESRD). DKD results from chronic exposure to hyperglycemia, leading to progressive alterations in kidney structure and function. The early development of DKD is clinically silent and when albuminuria is detected the lesions are often at advanced stages, leading to rapid kidney function decline towards ESRD. DKD progression can be arrested or substantially delayed if detected and addressed at early stages. A major limitation of current methods is the absence of albuminuria in non-albuminuric phenotypes of diabetic nephropathy, which becomes increasingly prevalent and lacks focused therapy. Metabolomics is an ever-evolving omics technology that enables the study of metabolites, downstream products of every biochemical event that occurs in an organism. Metabolomics disclosures complex metabolic networks and provide knowledge of the very foundation of several physiological or pathophysiological processes, ultimately leading to the identification of diseases' unique metabolic signatures. In this sense, metabolomics is a promising tool not only for the diagnosis but also for the identification of pre-disease states which would confer a rapid and personalized clinical practice. Herein, the use of metabolomics as a tool to identify the DKD metabolic signature of tubule interstitial lesions to diagnose or predict the time-course of DKD will be discussed. In addition, the proficiency and limitations of the currently available high-throughput metabolomic techniques will be discussed.
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Affiliation(s)
- Pedro R Pereira
- Clinical and Experimental Endocrinology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.,Department of Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD, EPE), Vila Real, Portugal
| | - David F Carrageta
- Clinical and Experimental Endocrinology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Pedro F Oliveira
- Department of Chemistry, QOPNA & LAQV, University of Aveiro, Aveiro, Portugal
| | - Anabela Rodrigues
- Department of Nephrology and Department of Clinical Pathology, Santo António General Hospital (Hospital Center of Porto, EPE), Porto, Portugal.,Nephrology, Dialysis and Transplantation, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Marco G Alves
- Clinical and Experimental Endocrinology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.,Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain.,Department of Biology, Unit of Cell Biology, Faculty of Sciences, University of Girona, Girona, Spain
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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3
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Wada H, Shinozaki T, Suzuki M, Sakagami S, Ajiro Y, Funada J, Matsuda M, Shimizu M, Takenaka T, Morita Y, Yonezawa K, Matsubara H, Ono Y, Nakamura T, Fujimoto K, Ninomiya A, Kato T, Unoki T, Takagi D, Wada K, Wada M, Iguchi M, Yamakage H, Kusakabe T, Yasoda A, Shimatsu A, Kotani K, Satoh-Asahara N, Abe M, Akao M, Hasegawa K. Impact of Chronic Kidney Disease on the Associations of Cardiovascular Biomarkers With Adverse Outcomes in Patients With Suspected or Known Coronary Artery Disease: The EXCEED-J Study. J Am Heart Assoc 2022; 11:e023464. [PMID: 35048713 PMCID: PMC9238479 DOI: 10.1161/jaha.121.023464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The impact of chronic kidney disease (CKD) on the prognostic utility of cardiovascular biomarkers in high‐risk patients remains unclear. Methods and Results We performed a multicenter, prospective cohort study of 3255 patients with suspected or known coronary artery disease (CAD) to investigate whether CKD modifies the prognostic utility of cardiovascular biomarkers. Serum levels of cardiovascular and renal biomarkers, including soluble fms‐like tyrosine kinase‐1 (sFlt‐1), N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), high‐sensitivity cardiac troponin‐I (hs‐cTnI), cystatin C, and placental growth factor, were measured in 1301 CKD and 1954 patients without CKD. The urine albumin to creatinine ratio (UACR) was measured in patients with CKD. The primary outcome was 3‐point MACE (3P‐MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. The secondary outcomes were all‐cause death, cardiovascular death, and 5P‐MACE defined as a composite of 3P‐MACE, heart failure hospitalization, and coronary/peripheral artery revascularization. After adjustment for clinical confounders, sFlt‐1, NT‐proBNP, and hs‐cTnI, but not other biomarkers, were significantly associated with 3P‐MACE, all‐cause death, and cardiovascular death in the entire cohort and in patients without CKD. These associations were still significant in CKD only for NT‐proBNP and hs‐cTnI. NT‐proBNP and hs‐cTnI were also significantly associated with 5P‐MACE in CKD. The UACR was not significantly associated with any outcomes in CKD. NT‐proBNP and hs‐cTnI added incremental prognostic information for all outcomes to the model with potential clinical confounders in CKD. Conclusions NT‐proBNP and hs‐cTnI were the most powerful prognostic biomarkers in patients with suspected or known CAD and concomitant CKD.
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Affiliation(s)
- Hiromichi Wada
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tsuyoshi Shinozaki
- Department of Cardiology National Hospital Organization Sendai Medical Center Sendai Japan
| | - Masahiro Suzuki
- Department of Clinical Research National Hospital Organization Saitama Hospital Wako Japan
| | - Satoru Sakagami
- Department of Cardiovascular Medicine National Hospital Organization Kanazawa Medical Center Kanazawa Japan
| | - Yoichi Ajiro
- Division of Clinical Research National Hospital Organization Yokohama Medical Center Yokohama Japan
| | - Junichi Funada
- Department of Cardiology National Hospital Organization Ehime Medical Center Toon Japan
| | - Morihiro Matsuda
- Institute for Clinical Research National Hospital Organization Kure Medical Center and Chugoku Cancer Center Kure Japan
| | - Masatoshi Shimizu
- Department of Cardiology National Hospital Organization Kobe Medical Center Kobe Japan
| | - Takashi Takenaka
- Division of Cardiology National Hospital Organization Hokkaido Medical Center Sapporo Japan
| | - Yukiko Morita
- Department of Cardiology National Hospital Organization Sagamihara National Hospital Sagamihara Japan
| | - Kazuya Yonezawa
- Division of Clinical Research National Hospital Organization Hakodate National Hospital Hakodate Japan
| | - Hiromi Matsubara
- Department of Cardiology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Yujiro Ono
- Department of Cardiology National Hospital Organization Higashihiroshima Medical Center Higashihiroshima Japan
| | - Toshihiro Nakamura
- Department of Cardiology National Hospital Organization Kyushu Medical Center Fukuoka Japan
| | - Kazuteru Fujimoto
- Department of Cardiology National Hospital Organization Kumamoto Medical Center Kumamoto Japan
| | - Akiyo Ninomiya
- Department of Cardiology National Hospital Organization Nagasaki Kawatana Medical Center Nagasaki Japan
| | - Toru Kato
- Department of Clinical Research National Hospital Organization Tochigi Medical Center Utsunomiya Japan
| | - Takashi Unoki
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan.,Intensive Care Unit Saiseikai Kumamoto Hospital Kumamoto Japan
| | - Daisuke Takagi
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan.,Department of Acute Care and General Medicine Saiseikai Kumamoto Hospital Kumamoto Japan
| | - Kyohma Wada
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Miyaka Wada
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Moritake Iguchi
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan.,Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hajime Yamakage
- Department of Endocrinology, Metabolism, and Hypertension Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Akihiro Yasoda
- Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Akira Shimatsu
- Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine Jichi Medical University Shimotsuke Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Mitsuru Abe
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan.,Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masaharu Akao
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan.,Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Koji Hasegawa
- Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
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4
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Steinbrenner I, Schultheiss UT, Kotsis F, Schlosser P, Stockmann H, Mohney RP, Schmid M, Oefner PJ, Eckardt KU, Köttgen A, Sekula P. Urine Metabolite Levels, Adverse Kidney Outcomes, and Mortality in CKD Patients: A Metabolome-wide Association Study. Am J Kidney Dis 2021; 78:669-677.e1. [PMID: 33839201 DOI: 10.1053/j.ajkd.2021.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/22/2021] [Indexed: 01/01/2023]
Abstract
RATIONALE & OBJECTIVE Mechanisms underlying the variable course of disease progression in patients with chronic kidney disease (CKD) are incompletely understood. The aim of this study was to identify novel biomarkers of adverse kidney outcomes and overall mortality, which may offer insights into pathophysiologic mechanisms. STUDY DESIGN Metabolome-wide association study. SETTING & PARTICIPANTS 5,087 patients with CKD enrolled in the observational German Chronic Kidney Disease Study. EXPOSURES Measurements of 1,487 metabolites in urine. OUTCOMES End points of interest were time to kidney failure (KF), a combined end point of KF and acute kidney injury (KF+AKI), and overall mortality. ANALYTICAL APPROACH Statistical analysis was based on a discovery-replication design (ratio 2:1) and multivariable-adjusted Cox regression models. RESULTS After a median follow-up of 4 years, 362 patients died, 241 experienced KF, and 382 experienced KF+AKI. Overall, we identified 55 urine metabolites whose levels were significantly associated with adverse kidney outcomes and/or mortality. Higher levels of C-glycosyltryptophan were consistently associated with all 3 main end points (hazard ratios of 1.43 [95% CI, 1.27-1.61] for KF, 1.40 [95% CI, 1.27-1.55] for KF+AKI, and 1.47 [95% CI, 1.33-1.63] for death). Metabolites belonging to the phosphatidylcholine pathway showed significant enrichment. Members of this pathway contributed to the improvement of the prediction performance for KF observed when multiple metabolites were added to the well-established Kidney Failure Risk Equation. LIMITATIONS Findings among patients of European ancestry with CKD may not be generalizable to the general population. CONCLUSIONS Our comprehensive screen of the association between urine metabolite levels and adverse kidney outcomes and mortality identifies metabolites that predict KF and represents a valuable resource for future studies of biomarkers of CKD progression.
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Affiliation(s)
- Inga Steinbrenner
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg; Department of Medicine IV-Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg
| | - Fruzsina Kotsis
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg; Department of Medicine IV-Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg
| | - Pascal Schlosser
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg
| | - Helena Stockmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin
| | | | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn
| | - Peter J Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin; Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen; Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg.
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg.
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5
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Ajdari A, Xie Y, Richter C, Niyazi M, Duda DG, Hong TS, Bortfeld T. Toward Personalized Radiation Therapy of Liver Metastasis: Importance of Serial Blood Biomarkers. JCO Clin Cancer Inform 2021; 5:315-325. [PMID: 33764817 DOI: 10.1200/cci.20.00118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the added value of serial blood biomarkers in liver metastasis stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS Eighty-nine patients were retrospectively included. Pre- and midtreatment blood samples were analyzed for potential biomarkers of the treatment response. Three biomarker classes were studied: gene mutation status, complete blood count, and inflammatory cytokine concentration in plasma. One-year local failure (LF) and 2-year overall survival (OS) were chosen as study end points. Multivariate logistic regression was used for response prediction. Added predictive benefit was assessed by quantifying the difference between the predictive performance of a baseline model (clinicopathologic and dosimetric predictors) and that of the biomarker-enhanced model, using three metrics: (1) likelihood ratio, (2) predictive variance, and (3) area under the receiver operating characteristic curve (AUC). RESULTS The most important predictors of LF were mutation in KRAS gene (hazard ratio [HR] = 2.92, 95% CI, [1.17 to 7.28], P = .02) and baseline and midtreatment concentration of plasma interleukin-6 (HR = 1.15 [1.04 to 1.26] and 1.06 [1.01 to 1.13], P = .01). Absolute lymphocyte count and platelet-to-lymphocyte ratio at baseline as well as neutrophil-to-lymphocyte ratio at baseline and before fraction 3 (HR = 1.33 [1.16 to 1.51] and 1.19 [1.09 to 1.30]) had the most significant association with OS (P = .0003). Addition of baseline GEN and inflammatory plasma cytokine biomarkers in predicting LF, respectively, increased AUC by 0.06 (from 0.73 to 0.79) and 0.07 (from 0.77 to 0.84). In predicting OS, inclusion of midtreatment complete blood count biomarkers increased AUC from 0.72 to 0.80, along with significant boosts in likelihood ratio and predictive variance. CONCLUSION Inclusion of serial blood biomarkers leads to significant gain in predicting response to liver metastasis stereotactic body radiation therapy and can guide treatment personalization.
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Affiliation(s)
- Ali Ajdari
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Yunhe Xie
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Christian Richter
- OncoRay, National Center of Radiation Research in Oncology, Dresden, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, Ludwig Maximilians University, Munich, Germany
| | - Dan G Duda
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas Bortfeld
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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6
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Provenzano M, Rotundo S, Chiodini P, Gagliardi I, Michael A, Angotti E, Borrelli S, Serra R, Foti D, De Sarro G, Andreucci M. Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease. Int J Mol Sci 2020; 21:ijms21165846. [PMID: 32823966 PMCID: PMC7461617 DOI: 10.3390/ijms21165846] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD), defined as the presence of albuminuria and/or reduction in estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, is considered a growing public health problem, with its prevalence and incidence having almost doubled in the past three decades. The implementation of novel biomarkers in clinical practice is crucial, since it could allow earlier diagnosis and lead to an improvement in CKD outcomes. Nevertheless, a clear guidance on how to develop biomarkers in the setting of CKD is not yet available. The aim of this review is to report the framework for implementing biomarkers in observational and intervention studies. Biomarkers are classified as either prognostic or predictive; the first type is used to identify the likelihood of a patient to develop an endpoint regardless of treatment, whereas the second type is used to determine whether the patient is likely to benefit from a specific treatment. Many single assays and complex biomarkers were shown to improve the prediction of cardiovascular and kidney outcomes in CKD patients on top of the traditional risk factors. Biomarkers were also shown to improve clinical trial designs. Understanding the correct ways to validate and implement novel biomarkers in CKD will help to mitigate the global burden of CKD and to improve the individual prognosis of these high-risk patients.
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Affiliation(s)
- Michele Provenzano
- Renal Unit, Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (I.G.); (A.M.)
- Correspondence: (M.P.); (M.A.); Tel.: +39-3407544146 (M.P.); +39-3396814750 (M.A.)
| | - Salvatore Rotundo
- Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (S.R.); (D.F.)
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy;
| | - Ida Gagliardi
- Renal Unit, Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (I.G.); (A.M.)
| | - Ashour Michael
- Renal Unit, Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (I.G.); (A.M.)
| | - Elvira Angotti
- Clinical Biochemistry Unit, Azienda Ospedaliera Universitaria Mater Domini Hospital, I-88100 Catanzaro, Italy;
| | - Silvio Borrelli
- Renal Unit, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy;
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy;
| | - Daniela Foti
- Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (S.R.); (D.F.)
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, School of Medicine, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy;
| | - Michele Andreucci
- Renal Unit, Department of Health Sciences, “Magna Graecia” University of Catanzaro, I-88100 Catanzaro, Italy; (I.G.); (A.M.)
- Correspondence: (M.P.); (M.A.); Tel.: +39-3407544146 (M.P.); +39-3396814750 (M.A.)
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7
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Kwan B, Fuhrer T, Zhang J, Darshi M, Van Espen B, Montemayor D, de Boer IH, Dobre M, Hsu CY, Kelly TN, Raj DS, Rao PS, Saraf SL, Scialla J, Waikar SS, Sharma K, Natarajan L. Metabolomic Markers of Kidney Function Decline in Patients With Diabetes: Evidence From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2020; 76:511-520. [PMID: 32387023 DOI: 10.1053/j.ajkd.2020.01.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/17/2020] [Indexed: 02/01/2023]
Abstract
RATIONALE & OBJECTIVE Biomarkers that provide reliable evidence of future diabetic kidney disease (DKD) are needed to improve disease management. In a cross-sectional study, we previously identified 13 urine metabolites that had levels reduced in DKD compared with healthy controls. We evaluated associations of these 13 metabolites with future DKD progression. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 1,001 Chronic Renal Insufficiency Cohort (CRIC) participants with diabetes with estimated glomerular filtration rates (eGFRs) between 20 and 70mL/min/1.73m2 were followed up prospectively for a median of 8 (range, 2-10) years. PREDICTORS 13 urine metabolites, age, race, sex, smoked more than 100 cigarettes in lifetime, body mass index, hemoglobin A1c level, blood pressure, urinary albumin, and eGFR. OUTCOMES Annual eGFR slope and time to incident kidney failure with replacement therapy (KFRT; ie, initiation of dialysis or receipt of transplant). ANALYTICAL APPROACH Several clinical metabolite models were developed for eGFR slope as the outcome using stepwise selection and penalized regression, and further tested on the time-to-KFRT outcome. A best cross-validated (final) prognostic model was selected based on high prediction accuracy for eGFR slope and high concordance statistic for incident KFRT. RESULTS During follow-up, mean eGFR slope was-1.83±1.92 (SD) mL/min/1.73m2 per year; 359 (36%) participants experienced KFRT. Median time to KFRT was 7.45 years from the time of entry to the CRIC Study. In our final model, after adjusting for clinical variables, levels of metabolites 3-hydroxyisobutyrate (3-HIBA) and 3-methylcrotonyglycine had a significant negative association with eGFR slope, whereas citric and aconitic acid were positively associated. Further, 3-HIBA and aconitic acid levels were associated with higher and lower risk for KFRT, respectively (HRs of 2.34 [95% CI, 1.51-3.62] and 0.70 [95% CI, 0.51-0.95]). LIMITATIONS Subgroups for whom metabolite signatures may not be optimal, nontargeted metabolomics by flow-injection analysis, and 2-stage modeling approaches. CONCLUSIONS Urine metabolites may offer insights into DKD progression. If replicated in future studies, aconitic acid and 3-HIBA could identify individuals with diabetes at high risk for GFR decline, potentially leading to improved clinical care and targeted therapies.
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Affiliation(s)
- Brian Kwan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Tobias Fuhrer
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Jing Zhang
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Manjula Darshi
- Center of Renal Precision Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Daniel Montemayor
- Center of Renal Precision Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ian H de Boer
- Department of Medicine, University of Washington, Seattle, WA
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Chi-Yuan Hsu
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University, New Orleans, LA
| | - Dominic S Raj
- Division of Kidney Disease and Hypertension, George Washington University, Washington, DC
| | - Panduranga S Rao
- Department of Medicine, University of Michigan, Ann Arbor, Ann Arbor, MI
| | - Santosh L Saraf
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Julia Scialla
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Sushrut S Waikar
- Renal Division, Brigham and Women's Hospital, Boston, MA; Renal Section, Boston University Medical Center, Boston, MA
| | - Kumar Sharma
- Center of Renal Precision Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; Moores Cancer Center, University of California, San Diego, La Jolla, CA.
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