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Determination of tissue-specific interaction between vitamin C and vitamin E in vivo using senescence marker protein-30 knockout mice as a vitamin C synthesis deficiency model. Br J Nutr 2022; 128:993-1003. [PMID: 34725010 PMCID: PMC9381305 DOI: 10.1017/s0007114521004384] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Vitamin E (α-tocopherol; VE) is known to be regenerated from VE radicals by vitamin C (L-ascorbic acid; VC) in vitro. However, their in vivo interaction in various tissues is still unclear. Therefore, we alternatively examined the in vivo interaction of VC and VE by measurement of their concentrations in various tissues of senescence marker protein-30 (SMP30) knockout (KO) mice as a VC synthesis deficiency model. Male SMP30-KO mice were divided into four groups (VC+/VE+, VC+/VE-, VC-/VE+ and VC-/VE-), fed diets with or without 500 mg/kg VE and given water with or without 1·5 g/l VC ad libitum. Then, VC and VE concentrations in the plasma and various tissues were determined. Further, gene expression levels of transporters associated with VC and VE, such as α-tocopherol transfer protein (α-TTP) and sodium-dependent vitamin C transporters (SVCTs), were examined. These results showed that the VE levels in the VC-depleted (VC-/VE+) group were significantly lower than those in the VC+/VE+ group in the liver and heart; the VC levels in the VE-depleted (VC+/VE-) group were significantly lower than those in the VC+/VE+ group in the kidneys. The α-TTP gene expression in the liver and kidneys was decreased by VC and/or VE depletion. Moreover, SVCT1 gene expression in the liver was decreased by both VC and VE depletion. In conclusion, these results indicate that VC spares VE mainly in the liver and heart and that VE spares VC in the kidneys of SMP30-KO mice. Thus, interaction between VC and VE is likely to be tissue specific.
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Influence of SGLT2 Inhibitor Treatment on Urine Antioxidant Status in Type 2 Diabetic Patients: A Pilot Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5593589. [PMID: 34336104 PMCID: PMC8294983 DOI: 10.1155/2021/5593589] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/10/2021] [Accepted: 06/10/2021] [Indexed: 01/10/2023]
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been recognized as potent antioxidant agents. Since SGLT2i are nephroprotective drugs, we aimed to examine the urine antioxidant status in patients with type 2 diabetes mellitus (T2DM). One hundred and one subjects participated in this study, including 37 T2DM patients treated with SGLT2i, 31 T2DM patients not using SGLT2i, and 33 healthy individuals serving as a control group. Total antioxidant capacity (TAC), superoxide dismutase (SOD), manganese superoxide dismutase (MnSOD), free thiol groups (R-SH, sulfhydryl groups), and catalase (CAT) activity, as well as glucose concentration, were assessed in the urine of all participants. Urine SOD and MnSOD activity were significantly higher among T2DM patients treated with SGLT2i than T2DM patients without SGLT2i treatment (p = 0.009 and p = 0.003, respectively) and to the healthy controls (p = 0.002 and p = 0.001, respectively). TAC was significantly lower in patients with T2DM treated with SGLT2i when compared to those not treated and healthy subjects (p = 0.036 and p = 0.019, respectively). It could be hypothesized that the mechanism by which SGLT2i provides nephroprotective effects involves improvement of the SOD antioxidant activity. However, lower TAC might impose higher OS (oxidative stress), and elevation of SOD activity might be a compensatory mechanism.
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The protein-bound uremic toxin p-cresyl-sulfate promotes intracellular ROS production and lipid peroxidation in 3T3-L1 adipose cells. Biochimie 2021; 189:137-143. [PMID: 34217821 DOI: 10.1016/j.biochi.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
Patients with chronic kidney disease (CKD) often exhibit increased level of oxidative stress that contribute to the deterioration of renal function and uremic complications. White adipose tissue (WAT) has been recognized as a major site of production of radical oxygen species (ROS) in the context of metabolic diseases. This study was designed to decipher whether the protein bound uremic toxin p-cresyl-sulfate (p-CS) could contribute to ROS production in WAT and promote oxidative stress. Mouse 3T3-L1 adipocytes were incubated for 2 h in culture medium containing 212 μM p-CS, a concentration chosen to mimic levels encountered in end stage renal disease patients or KCl as a control and intracellular ROS production was measured using the fluorescent probe 5-6-carboxy-2',7'-dichlorodihydrofluorescein diacetate. Oxidative insult was estimated by the measurement of malondialdehyde (MDA) content and glutathione content. The effects of probenecid (1 mM) a potent inhibitor of organic anion transporter, apocynin (1 mM) an inhibitor of NADPH oxidase or common antioxidants such as α-tocopherol (2.5 μM), ascorbate (200 μM), and N-acetylcysteine (500 μM) were further evaluated. p-CS triggered a striking increase in ROS production (+228%, p < 0.01), in MDA content (+214%, p < 0.005) and a decrease in glutathione (-47%, P < 0.01). Pre-treatment of cells with probenecid, apocynin or antioxidants prevented the p-CS induced ROS production and oxidative insults. These results suggest that in uremic state, the intracellular accumulation of p-CS in adipose cells could contribute, through an activation of NADPH oxidase, to the redox imbalance often reported in CKD patients.
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Roumeliotis S, Roumeliotis A, Gorny X, Mertens PR. Could Antioxidant Supplementation Delay Progression of Cardiovascular Disease in End-Stage Renal Disease Patients? Curr Vasc Pharmacol 2021; 19:41-54. [PMID: 32183680 DOI: 10.2174/1570161118666200317151553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/27/2022]
Abstract
In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenia Gorny
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Leipziger Str. 40, 39120, Magdeburg, Germany
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Leipziger Str. 40, 39120, Magdeburg, Germany
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Verma S, Singh P, Khurana S, Ganguly NK, Kukreti R, Saso L, Rana DS, Taneja V, Bhargava V. Implications of oxidative stress in chronic kidney disease: a review on current concepts and therapies. Kidney Res Clin Pract 2021; 40:183-193. [PMID: 34078023 PMCID: PMC8237115 DOI: 10.23876/j.krcp.20.163] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
Moderate levels of endogenous reactive oxygen species (ROS) are important for various cellular activities, but high levels lead to toxicity and are associated with various diseases. Levels of ROS are maintained as a balance between oxidants and antioxidants. Accumulating data suggest that oxidative stress is a major factor in deterioration of renal function. In this review, we highlight the possible mechanism by which oxidative stress can lead to chronic kidney disease (CKD). This review also describes therapies that counter the effect of oxidative stress in CKD patients. Numerous factors such as upregulation of genes involved in oxidative phosphorylation and ROS generation, chronic inflammation, vitamin D deficiency, and a compromised antioxidant defense mechanism system cause progressive detrimental effects on renal function that eventually lead to loss of kidney function. Patients with renal dysfunction are highly susceptible to oxidative stress, as risk factors such as diabetes, renal hypertension, dietary restrictions, hemodialysis, and old age predispose them to increased levels of ROS. Biomolecular adducts (DNA, proteins, and lipids) formed due to reaction with ROS can be used to determine oxidative stress levels. Based on the strong correlation between oxidative stress and CKD, reversal of oxidative stress is being explored as a major therapeutic option. Xanthine oxidase inhibitors, dietary antioxidants, and other agents that scavenge free radicals are gaining interest as treatment modalities in CKD patients.
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Affiliation(s)
- Sagar Verma
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Priyanka Singh
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shiffali Khurana
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Ritushree Kukreti
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Luciano Saso
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | | | - Vibha Taneja
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
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Bergin P, Leggett A, Cardwell CR, Woodside JV, Thakkinstian A, Maxwell AP, McKay GJ. The effects of vitamin E supplementation on malondialdehyde as a biomarker of oxidative stress in haemodialysis patients: a systematic review and meta-analysis. BMC Nephrol 2021; 22:126. [PMID: 33832458 PMCID: PMC8034191 DOI: 10.1186/s12882-021-02328-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background Haemodialysis (HD) patients tend to have higher levels of oxidative stress (OS), associated with increased morbidity and premature mortality, compared to the general population. Levels of malondialdehyde (MDA), a biomarker of OS, are reduced by the antioxidant properties of vitamin E (VE) but outcomes from randomised control trials of VE supplementation on MDA in HD patients have been inconsistent. Methods We undertook a systematic review and meta-analysis of adult HD patients from VE supplementation studies with measures of MDA. The following search criteria of MEDLINE and EMBASE were considered from inception to January 2020: ‘dialysis’ AND ‘Vitamin E OR tocopherol’ AND ‘malondialdehyde OR MDA’. Two reviewers independently extracted study data and assessed risk of bias. Mean MDA levels and standard deviation were determined before and after VE supplementation. Standardised mean difference (SMD) and standard error were calculated as the within person difference and units of measure were not consistently recorded across all studies. The SMD were pooled using random effects meta-analysis. Results The SMD of MDA levels from 18 comparisons was significantly lower in HD patients following VE supplementation (− 1.55; confidence interval: − 2.17 to − 0.94, P < 0.00001). There were significant levels of heterogeneity between studies (I2 value = 91%; P < 0.00001) with evidence of potential publication bias toward smaller studies. Conclusions Our findings support the use of VE to reduce the effects of OS in HD patients although high levels of heterogeneity and variation in the methodological approaches used by some studies highlight the need for further investigation.
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Affiliation(s)
- Peter Bergin
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aoife Leggett
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK. .,Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
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Watanabe Y, Mitomo S, Demir OM, Liu KL, Tung YC, Chieffo A, Montorfano M, Chang CJ, Nakamura S, Colombo A. Clinical Outcomes of Dialysis Patients Treated with Drug-Eluting Stent for Left Main Distal Bifurcation Lesions. Cardiorenal Med 2021; 11:99-108. [PMID: 33657556 DOI: 10.1159/000510731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) distal bifurcation lesions using drug-eluting stents (DES) in hemodialysis (HD) patients compared to non-HD patients. METHODS AND RESULTS We identified 1,858 consecutive patients who underwent PCI for ULMCA distal bifurcation lesions at 4 high-volume centers in Japan, Italy, and Taiwan between January 2005 and December 2015. Of them, 1,416 patients were treated with DES including 113 HD patients and 1,303 non-HD patients. The primary end point was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. HD patients were more likely to be younger and have diabetes mellitus, dyslipidemia, peripheral artery disease, lower ejection fraction, and higher EuroSCORE. TLF rate at 3 years was significantly higher in HD group than in non-HD group (adjusted hazard ratio [HR] 2.43 [1.75-3.38], p < 0.001). Cardiac mortality and TLR rate were also significantly higher in HD group than in non-HD group (adjusted HR 3.85 [2.34-6.34], p < 0.001, and HR 2.10 [1.41-3.14], p < 0.001, respectively). CONCLUSIONS HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy, .,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan,
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Kuan-Liang Liu
- Department of Cardiology, Landseed International Hospital, Taoyuan, Taiwan
| | - Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chi-Jen Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
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Ilic Begovic T, Radic J, Radic M, Modun D, Seselja-Perisin A, Tandara L. Seasonal variations in nutritional status and oxidative stress in patients on hemodialysis: Are they related? Nutrition 2021; 89:111205. [PMID: 33836426 DOI: 10.1016/j.nut.2021.111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/31/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Seasonal variations in body composition and parameters that reflect nutritional status are well established in patients on hemodialysis (HD). However, to our knowledge, no study has assessed the changes in oxidative stress (OS). The aims of this study were to assess seasonal variations in OS, body composition, and other nutritional parameters. METHODS Seasonal variations in fat tissue mass (FTM), fat tissue index (FTI), adipose tissue mass (ATM), lean tissue mass (LTM), lean tissue index (LTI), body cell mass (BCM), overhydration (OH) volume, and OS (blood levels of derivatives of reactive oxygen metabolites [d-ROMs], thiobarbituric reactive substances, plasma protein reduced thiol content [THIOLS], and ferric reducing ability of plasma) were assessed in 45 patients on HD, 70 y of age (60.5-76.5 y). RESULTS FTM (P < 0.001), FTI (P < 0.001), and ATM (P < 0.001) significantly increased, whereas LTI (P < 0.001), LTM (P < 0.001), BCM (P < 0.001), and OH volume (P = 0.004) significantly decreased over the season. Additionally, significant seasonal variations in the levels of d-ROMs (P = 0.02) and THIOLS (P = 0.02) were found. Levels of d-ROMs were found to be a significant predictor of LTM and BCM (β = -0.57; 95% confidence interval [CI], -1.08 to -0.06; P = 0.03; β = -0.04; 95% CI, -0.075 to -0.006; P = 0.02). Furthermore, hip circumference was found to be the most significant predictor of the level of d-ROMs (β = 2.66; 95% CI; 0.28-5.04; P = 0.03) and waist-to-height ratio (β = 251; 95% CI, 16.6-477.2; P = 0.03) and serum prealbumin levels of THIOLS (β = 263; 95% CI, 6.8-521.1; P = 0.04). CONCLUSION These results suggest seasonal variations in OS in patients on HD and a possible interaction between OS and nutritional status in these patients.
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Affiliation(s)
- Tanja Ilic Begovic
- Intensive Care Unit of the Department of Internal Medicine, University Hospital Centre Split, Split, Croatia
| | - Josipa Radic
- Division of Nephrology and Dialysis, University Hospital Centre Split, University of Split School of Medicine, Split, Croatia; Department of Internal medicine, University of Split, School of Medicine, Split, Croatia.
| | - Mislav Radic
- Department of Internal medicine, University of Split, School of Medicine, Split, Croatia; Division of Rheumatology and Clinical Immunology, University Hospital Centre Split, University of Split School of Medicine, Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ana Seselja-Perisin
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Leida Tandara
- Department of Medical Laboratory Diagnostic, University Hospital Centre Split, Split, Croatia
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9
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Hongsawong N, Chawprang N, Kittisakmontri K, Vittayananan P, Srisuwan K, Chartapisak W. Vitamin C deficiency and impact of vitamin C administration among pediatric patients with advanced chronic kidney disease. Pediatr Nephrol 2021; 36:397-408. [PMID: 32683655 DOI: 10.1007/s00467-020-04662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vitamin C deficiency is common in chronic kidney disease (CKD) due to losses through dialysis and dietary intake below requirement. We investigated prevalence of vitamin C deficiency and impact of vitamin C treatment in deficient/insufficient patients. METHODS A prospective cohort study in patients aged 1-18 years with CKD stages 4 and 5D collected demographic data including underlying disease, treatment, and anthropometric assessment. Vitamin C intake was assessed using 24-h dietary recall. Hemoglobin, iron status, serum vitamin C, and serum oxalate were measured at baseline and after treatment. Vitamin C (250 mg/day) was given orally for 3 months to deficient/insufficient patients. RESULTS Nineteen patients (mean age 12.00 ± 4.1 years) showed prevalence of 10.6% vitamin C insufficiency and 78.9% deficiency. There were no associations between vitamin C level and daily vitamin C intake (p = 0.64) or nutritional status (p = 0.87). Median serum vitamin C was 1.51 (0.30-1.90) mg/L. In 16 patients receiving treatment, median serum vitamin C increased from 1.30 (0.23-1.78) to 3.22 (1.77-5.96) mg/L (p = 0.008) without increasing serum oxalate (79.92 (56.6-106.84) vs. 80.47 (56.88-102.95) μmol/L, p = 0.82). However, 62.5% failed to achieve normal vitamin C levels. Ordinal regression analysis revealed patients with non-oligoanuric CKD were less likely to achieve normal vitamin C levels (β = - 3.41, p = 0.03). CONCLUSION We describe high prevalence of vitamin C insufficiency/deficiency among pediatric CKD patients. Vitamin C levels could not be solely predicted by nutritional status or daily intake. The treatment regimen raised serum vitamin C without increasing serum oxalate; however, it was largely insufficient to normalize levels, particularly in non-oligoanuric CKD. Graphical abstract .
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Affiliation(s)
- Nattaphorn Hongsawong
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Notethasoung Chawprang
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kulnipa Kittisakmontri
- Department of Pediatrics, Division of Pediatric Nutrition, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Parach Vittayananan
- Department of Pediatrics, Division of Pediatric Nephrology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Konggrapun Srisuwan
- Department of Pediatrics, Division of Pediatric Nephrology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Wattana Chartapisak
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Plasma Protein Carbonyls as Biomarkers of Oxidative Stress in Chronic Kidney Disease, Dialysis, and Transplantation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2975256. [PMID: 33299524 PMCID: PMC7707964 DOI: 10.1155/2020/2975256] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/03/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
Accumulating evidence indicates that oxidative stress plays a role in the pathophysiology of chronic kidney disease (CKD) and its progression; during renal replacement therapy, oxidative stress-derived oxidative damage also contributes to the development of CKD systemic complications, such as cardiovascular disease, hypertension, atherosclerosis, inflammation, anaemia, and impaired host defence. The main mechanism underlying these events is the retention of uremic toxins, which act as a substrate for oxidative processes and elicit the activation of inflammatory pathways targeting endothelial and immune cells. Due to the growing worldwide spread of CKD, there is an overwhelming need to find oxidative damage biomarkers that are easy to measure in biological fluids of subjects with CKD and patients undergoing renal replacement therapy (haemodialysis, peritoneal dialysis, and kidney transplantation), in order to overcome limitations of invasive monitoring of CKD progression. Several studies investigated biomarkers of protein oxidative damage in CKD, including plasma protein carbonyls (PCO), the most frequently used biomarker of protein damage. This review provides an up-to-date overview on advances concerning the correlation between plasma protein carbonylation in CKD progression (from stage 1 to stage 5) and the possibility that haemodialysis, peritoneal dialysis, and kidney transplantation improve plasma PCO levels. Despite the fact that the role of plasma PCO in CKD is often underestimated in clinical practice, emerging evidence highlights that plasma PCO can serve as good biomarkers of oxidative stress in CKD and substitutive therapies. Whether plasma PCO levels merely serve as biomarkers of CKD-related oxidative stress or whether they are associated with the pathogenesis of CKD complications deserves further evaluation.
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11
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Honore PM, Spapen HD, Marik P, Boer W, Oudemans-van Straaten H. Dosing vitamin C in critically ill patients with special attention to renal replacement therapy: a narrative review. Ann Intensive Care 2020; 10:23. [PMID: 32052229 PMCID: PMC7016079 DOI: 10.1186/s13613-020-0640-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/06/2020] [Indexed: 01/02/2023] Open
Abstract
Rationale/methods The primary aim of the present contribution is to find a literature-based agreement on dose adjustments of vitamin C in critically ill patients undergoing renal replacement therapy (RRT). Available data/study results Critical illness is frequently accompanied by severe vitamin C deficiency. High-dose supplementation beneficially affects clinical outcome in small cohorts of patients with sepsis, burn injury, and trauma. There are no specific data on clinical outcomes in patients receiving renal replacement therapy (RRT). Vitamin C plasma concentrations in patients on RRT are comparable to critically ill patients not receiving RRT. Vitamin C is cleared from the circulation during RRT at a rate dependent on the plasma concentration, dose and duration of RRT. Sieving coefficient is about 1. While the dose of RRT is lower than normal renal function, tubular reabsorption is absent. Sparse evidence suggests that vitamin C dosing during continuous RRT should not exceed the dose administered to critically ill patients not receiving continuous RRT. Low plasma concentrations are expected during prolonged RRT because of persistent extracorporeal removal, absent renal reabsorption and enhanced metabolic loss due to circuit-induced oxidative stress. A dosage of twice 1 g vitamin C daily may be necessary to achieve normal plasma concentrations during RRT, but more studies are needed. There is no available evidence that high doses of vitamin C administered over a short period can induce oxalate stones or has pro-oxidant effects. Conclusions Supplementing vitamin C 1 g twice daily to critically ill patients has a solid pathophysiological rationale and a good safety profile. Patients on RRT probably need similar doses as critically ill patients not receiving RRT. Intravenous vitamin C in a dose of 2 g/day may be necessary to achieve normal plasma concentrations during RRT. However, data on dose adjustment of vitamin C during intermittent or chronic RRT are sparse and require more thorough pharmacokinetic and dose–response studies.
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Affiliation(s)
- Patrick M Honore
- ICU Dept, Centre Hospitalier Universitaire Brugmann/Brugmann University Hospîtal, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium.
| | - Herbert D Spapen
- Development, Ageing & Pathology Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paul Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Av, Suite 410, Norfolk, VA, 23507, USA
| | - Willem Boer
- Dept. of Anesthesiology, Intensive Care Medicine, Emergency Medicine & Pain Medicine, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Heleen Oudemans-van Straaten
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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12
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Hirahara I, Kusano E, Jin D, Takai S. Hypermetabolism of glutathione, glutamate and ornithine via redox imbalance in methylglyoxal-induced peritoneal injury rats. J Biochem 2020; 167:185-194. [PMID: 31593282 DOI: 10.1093/jb/mvz077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 11/13/2022] Open
Abstract
Peritoneal dialysis (PD) is a blood purification treatment for patients with reduced renal function. However, the peritoneum is exposed to oxidative stress during PD and long-term PD results in peritoneal damage, leading to the termination of PD. Methylglyoxal (MGO) contained in commercial PD fluids is a source of strong oxidative stress. The aim of this study was to clarify the mechanism of MGO-induced peritoneal injury using metabolome analysis in rats. We prepared peritoneal fibrosis rats by intraperitoneal administration of PD fluids containing MGO for 21 days. As a result, MGO-induced excessive proliferation of mesenchymal cells with an accumulation of advanced glycation end-products (AGEs) at the surface of the thickened peritoneum in rats. The effluent levels of methionine sulfoxide, an oxidative stress marker and glutathione peroxidase activity were increased in the MGO-treated rats. The levels of glutathione, glutamate, aspartate, ornithine and AGEs were also increased in these rats. MGO upregulated the gene expression of transporters and enzymes related to the metabolism of glutathione, glutamate and ornithine in the peritoneum. These results suggest that MGO may induce peritoneal injury with mesenchymal cell proliferation via increased redox metabolism, directly or through the formation of AGEs during PD.
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Affiliation(s)
- Ichiro Hirahara
- Department of Innovative Medicine, Graduate School of Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 568-8686
| | - Eiji Kusano
- JCHO Utsunomiya Hospital, 11-17 Minamitakasago-chou, Utsunomiya, Tochigi 321-0143, Japan
| | - Denan Jin
- Department of Innovative Medicine, Graduate School of Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 568-8686
| | - Shinji Takai
- Department of Innovative Medicine, Graduate School of Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 568-8686
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Zhan X, Yang M, Chen Y, Yan C, Wang Y, Zhao Q, Chen Q, Zhang L. Relationship between serum bilirubin levels and mortality in patients on peritoneal dialysis. Ren Fail 2019; 41:532-539. [PMID: 31240974 PMCID: PMC6598530 DOI: 10.1080/0886022x.2019.1628062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Studies have shown that the serum total bilirubin (TBil) is associated with the mortality of the general population and of hemodialysis patients. However, few studies have examined the associations of the direct bilirubin (DBil) and indirect bilirubin (IBil) with the mortality of peritoneal dialysis (PD) patients. Methods: This was a retrospective cohort study. Clinical and laboratory data were collected from 740 PD patients. The primary endpoint was 5-year all-cause mortality. Survival analysis was performed using the Kaplan–Meier method with the log-rank test. The mortality hazard ratio was evaluated using Cox regression models. Results: Among the 740 PD patients, the mean age was 49.9 ± 15.0 years, 54.9% were men, and 20.3% had diabetes. During the median follow-up period of 28 months (interquartile range, 14–41 months), 178 patients died. Kaplan–Meier analysis revealed that all-cause mortality was higher in the patients in the higher TBil group than in the lower TBil group (25.6% vs. 18.3%, p = .017) and in patients in the higher IBil group than in the lower IBil group (24.3% vs. 19%, p = .026). Multivariate analysis showed that compared with the lower TBil group, the 5-year mortality risk was higher in the higher TBil group (HR = 1.69, 95% CI: 1.11–2.56, p = .014). Similarly, there was a 56% higher risk of 5-year mortality in the higher IBil group than in the lower IBil group (HR = 1.56, 95% CI: 1.04–2.34, p = .032). However, no such associations were observed between the DBil and the mortality risk. Conclusions: The baseline serum TBil and IBil levels were significantly associated with 5-year all-cause mortality among PD patients.
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Affiliation(s)
- Xiaojiang Zhan
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Mei Yang
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Yanbing Chen
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Caixia Yan
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Yifan Wang
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Qing Zhao
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Qinkai Chen
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Li Zhang
- a Department of Nephrology , The First Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
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Potential Role of Nutrient Intake and Malnutrition as Predictors of Uremic Oxidative Toxicity in Patients with End-Stage Renal Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:7463412. [PMID: 31871556 PMCID: PMC6906803 DOI: 10.1155/2019/7463412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022]
Abstract
Oxidative stress is an important risk factor for cardiovascular disease and death in hemodialysis (HD) patients. However, whether biochemical and nutritional markers might be useful to stratify HD patients according to the risk of oxidative damage remains unclear. We investigated whether low-cost and easily available parameters such as the profile of nutrients intake, nutritional status, and antioxidant defenses can predict lipid and protein oxidation in HD patients. Forty-nine HD patients (women = 20, men = 29), ranging from 18 to 65 years of age (73.5%) were submitted to biochemical and nutritional analysis. At least 93.9% of HD patients had malnutrition. A patient's stratification according to nutritional risk was highly coherent with anthropometric parameters and nutrients intake, which were complementarily used as markers of malnutrition. Nutritional stratification was unable to reveal differences in the oxidative status. On the other hand, carbohydrate and zinc intake, serum zinc (Zn), glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC), and nonprotein antioxidants (npAC) in serum were predictive markers of lipid (R 2 = 0.588, P < 0.001) and protein (R 2 = 0.581, P < 0.001) oxidation. Interestingly, GPx activity, TAC, and npAC exhibited good (>80% < 90%) or excellent (>90%) accuracy to estimate lipid oxidation (P ≤ 0.01). Regarding the prediction of protein oxidation, GPx activity and TAC presented regular accuracy (>70% < 80%), and Zn serum levels exhibited good sensitivity (P ≤ 0.01). Herein, we provided evidence that clinical characteristics relevant to predict different levels of lipid and protein oxidation in HD patients can be easily obtained, during routine hospital visits by means of the combined analyses of biochemical and nutritional parameters.
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Influence of Dietary Ingredients on Lean Body Percent, Uremic Toxin Concentrations, and Kidney Function in Senior-Adult Cats. Metabolites 2019; 9:metabo9100238. [PMID: 31635090 PMCID: PMC6836002 DOI: 10.3390/metabo9100238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
The goal of this study was to determine if modification of currently available maintenance foods with alternative ingredients, botanicals (fruit and vegetables), and increased amounts of functional lipids (fish oil) would delay the age-associated decline in glomerular filtration rate (GFR) and lean body mass (LBM) in senior-adult cats. Forty-four healthy cats (mean age, 12.2 years; range 10.7 to 14.0 years) were fed one of three foods (n = 14 or 15 per group) for six months: control food with 32.6% protein (as fed), or control food supplemented with increasing amounts of functional food bioactives: fish oil, fruit and vegetables, different protein sources, and <32.0% protein [functional foods one (FF1) and two (FF2)]. Senior-adult cats were compared before and after the feeding trial with 20 young-adult cats (mean age, 3.5 years; range 2.1 to 4.9 years). Compared with younger cats, older cats had decreased lean-body percent and serum albumin concentrations. Feeding FF1 and FF2 for six months increased lean-body percent, maintained serum albumin concentrations, increased GFR, decreased serum symmetric dimethylarginine (SDMA) concentrations, and decreased concentrations of the uremic toxin 3-indoxyl sulfate. These dietary changes may assist in offsetting sarcopenia and the chronic inflammation associated with aging in senior-adult cats.
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Stepanova N, Korol L, Burdeyna O. Oxidative Stress in Peritoneal Dialysis Patients: Association with the Dialysis Adequacy and Technique Survival. Indian J Nephrol 2019; 29:309-316. [PMID: 31571736 PMCID: PMC6755929 DOI: 10.4103/ijn.ijn_242_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Increased oxidative stress is suggested as one of the possible mechanisms of structural and functional damage to the peritoneal membrane in peritoneal dialysis patients. But there are few available data on the association of oxidative stress with peritoneal dialysis adequacy and technique survival. The present study was undertaken to investigate the association of oxidative stress biomarkers with the peritoneal dialysis adequacy and technique survival. Methods: This prospective single-center observational study was conducted between January 2010 and May 2015. Adequacy of dialysis, malondialdehyde levels in the serum and erythrocytes (as an indicator of lipid peroxidation), the concentration of ceruloplasmin, transferrin, and sulfhydryl groups in the blood, and total peroxidase activity in erythrocyte (as indicators of antioxidant system) were determined in 44 stable ambulatory non-diabetic peritoneal dialysis patients. Results: The follow-up period was 3 years. We identified a negative correlation between the serum level of malondialdehyde in the patients and total weekly Kt/V. Peritoneal weekly CrCl was positively correlated with the levels of transferrin, total peroxidase activity, and SH– groups. Daily peritoneal ultrafiltration had a positive correlation with the total peroxidase activity and the serum transferrin levels. The results of the Kaplan–Meier analysis and the log-rank test also demonstrated a significant difference in the cumulative technique survival rate between the patients with ceruloplasmin level ≤0.19 g/l and ≥0.2 g/l. Conclusions: The results mentioned above could be considered as one of the ways to explain better technique survival in PD patients.
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Affiliation(s)
- Natalia Stepanova
- Department of Nephrology and Dialysis, Institute of Nephrology of the National Academy of Medical Sciences, Kyiv, Ukraine
| | - Lesya Korol
- Biochemistry Laboratory, Institute of Nephrology of the National Academy of Medical Sciences, Kyiv, Ukraine
| | - Olena Burdeyna
- Department of Nephrology and Dialysis, Institute of Nephrology of the National Academy of Medical Sciences, Kyiv, Ukraine
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17
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Mitochondria as a Source and a Target for Uremic Toxins. Int J Mol Sci 2019; 20:ijms20123094. [PMID: 31242575 PMCID: PMC6627204 DOI: 10.3390/ijms20123094] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/23/2023] Open
Abstract
Elucidation of molecular and cellular mechanisms of the uremic syndrome is a very challenging task. More than 130 substances are now considered to be "uremic toxins" and represent a very diverse group of molecules. The toxicity of these molecules affects many cellular processes, and expectably, some of them are able to disrupt mitochondrial functioning. However, mitochondria can be the source of uremic toxins as well, as the mitochondrion can be the site of complete synthesis of the toxin, whereas in some scenarios only some enzymes of the pathway of toxin synthesis are localized here. In this review, we discuss the role of mitochondria as both the target and source of pathological processes and toxic compounds during uremia. Our analysis revealed about 30 toxins closely related to mitochondria. Moreover, since mitochondria are key regulators of cellular redox homeostasis, their functioning might directly affect the production of uremic toxins, especially those that are products of oxidation or peroxidation of cellular components, such as aldehydes, advanced glycation end-products, advanced lipoxidation end-products, and reactive carbonyl species. Additionally, as a number of metabolic products can be degraded in the mitochondria, mitochondrial dysfunction would therefore be expected to cause accumulation of such toxins in the organism. Alternatively, many uremic toxins (both made with the participation of mitochondria, and originated from other sources including exogenous) are damaging to mitochondrial components, especially respiratory complexes. As a result, a positive feedback loop emerges, leading to the amplification of the accumulation of uremic solutes. Therefore, uremia leads to the appearance of mitochondria-damaging compounds, and consecutive mitochondrial damage causes a further rise of uremic toxins, whose synthesis is associated with mitochondria. All this makes mitochondrion an important player in the pathogenesis of uremia and draws attention to the possibility of reducing the pathological consequences of uremia by protecting mitochondria and reducing their role in the production of uremic toxins.
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18
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Adesso S, Ruocco M, Rapa SF, Piaz FD, Raffaele Di Iorio B, Popolo A, Autore G, Nishijima F, Pinto A, Marzocco S. Effect of Indoxyl Sulfate on the Repair and Intactness of Intestinal Epithelial Cells: Role of Reactive Oxygen Species' Release. Int J Mol Sci 2019; 20:ijms20092280. [PMID: 31072046 PMCID: PMC6539031 DOI: 10.3390/ijms20092280] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease (CKD) is characterized by an oxidative stress status, driving some CKD-associated complications, even at the gastrointestinal level. Indoxyl Sulfate (IS) is a protein-bound uremic toxin, poorly eliminated by dialysis. This toxin is able to affect the intestinal system, but its molecular mechanism/s in intestinal epithelial cells (IECs) remain poorly understood. This study's aim was to evaluate the effect of IS (31.2-250 µM) on oxidative stress in IEC-6 cells and on the intactness of IECs monolayers. Our results indicated that IS enhanced oxidative cell damage by inducing reactive oxygen species (ROS) release, reducing the antioxidant response and affecting Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) nuclear translocation as well its related antioxidant enzymes. In the wound healing assay model, IS reduced IEC-6 migration, slightly impaired actin cytoskeleton rearrangement; this effect was associated with connexin 43 alteration. Moreover, we reported the effect of CKD patients' sera in IEC-6 cells. Our results indicated that patient sera induced ROS release in IEC-6 cells directly related to IS sera content and this effect was reduced by AST-120 serum treatment. Results highlighted the effect of IS in inducing oxidative stress in IECs and in impairing the intactness of the IECs cell monolayer, thus significantly contributing to CKD-associated intestinal alterations.
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Affiliation(s)
- Simona Adesso
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Marco Ruocco
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Shara Francesca Rapa
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Fabrizio Dal Piaz
- Department of Medicine, University of Salerno, I-84084 Fisciano, Salerno, Italy.
| | | | - Ada Popolo
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Giuseppina Autore
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Fuyu Nishijima
- Pharmaceuticals Division, Kureha Corporation, 169-8503 Tokyo, Japan.
| | - Aldo Pinto
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
| | - Stefania Marzocco
- Department of Pharmacy, University of Salerno, I-84084, Fisciano, Salerno, Italy.
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Oxidative Balance and Inflammation in Hemodialysis Patients: Biomarkers of Cardiovascular Risk? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:8567275. [PMID: 30886674 PMCID: PMC6388354 DOI: 10.1155/2019/8567275] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 12/15/2022]
Abstract
During chronic kidney disease, the progressive deterioration of renal function induces several biological/clinical dysfunctions, including enhancement of synthesis of inflammation/oxidative stress mediators. Impaired renal function is an independent cardiovascular risk factor; indeed, cardiovascular complications dominate the landscape of both chronic kidney disease and end-stage renal disease. The aim of this study is to explore the correlation between the global oxidative balance in hemodialysis patients and both inflammatory markers and cardiovascular events. Using photometric tests, this study explored plasmatic oxidative balance in 97 hemodialysis patients compared to a healthy population. In the hemodialysis patients, we showed that oxidative stress values were significantly lower than in controls while effectiveness in the antioxidant barrier was significantly increased in the hemodialysis group. Furthermore, we highlighted a strong correlation between oxidative index and blood levels of C-reactive protein. When patients were divided into two groups based on previous cardiovascular events, we found that subjects with previous cardiovascular events had higher values of both oxidative stress and antioxidant barrier than patients without cardiovascular events. Our results indicated that in hemodialysis patients, the clinical and prognostic significance of oxidative status is very different from general population. As cardiovascular complications represent a strong negative factor for survival of hemodialysis patients, the research of new cardiovascular risk biomarkers in these patients takes on particular importance in order to translate them into clinical practice/primary care.
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20
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Antioxidant Supplementation in Renal Replacement Therapy Patients: Is There Evidence? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9109473. [PMID: 30774749 PMCID: PMC6350615 DOI: 10.1155/2019/9109473] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 12/26/2022]
Abstract
The disruption of balance between production of reactive oxygen species and antioxidant systems in favor of the oxidants is termed oxidative stress (OS). To counteract the damaging effects of prooxidant free radicals, all aerobic organisms have antioxidant defense mechanisms that are aimed at neutralizing the circulating oxidants and repair the resulting injuries. Antioxidants are either endogenous (the natural defense mechanisms produced by the human body) or exogenous, found in supplements and foods. OS is present at the early stages of chronic kidney disease, augments progressively with renal function deterioration, and is further exacerbated by renal replacement therapy. End-stage renal disease patients, on hemodialysis (HD) or peritoneal dialysis (PD), suffer from accelerated OS, which has been associated with increased risk for mortality and cardiovascular disease. During HD sessions, the bioincompatibility of dialyzers and dialysate trigger activation of white blood cells and formation of free radicals, while a significant loss of antioxidants is also present. In PD, the bioincompatibility of solutions, including high osmolality, elevated lactate levels, low pH, and accumulation of advanced glycation end-products trigger formation of prooxidants, while there is significant loss of vitamins in the ultrafiltrate. A number of exogenous antioxidants have been suggested to ameliorate OS in dialysis patients. Vitamins B, C, D, and E, coenzyme Q10, L-carnitine, a-lipoic acid, curcumin, green tea, flavonoids, polyphenols, omega-3 polyunsaturated fatty acids, statins, trace elements, and N-acetylcysteine have been studied as exogenous antioxidant supplements in both PD and HD patients.
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Liakopoulos V, Roumeliotis S, Zarogiannis S, Eleftheriadis T, Mertens PR. Oxidative stress in hemodialysis: Causative mechanisms, clinical implications, and possible therapeutic interventions. Semin Dial 2018; 32:58-71. [PMID: 30288786 DOI: 10.1111/sdi.12745] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oxidative stress (OS) is the result of prooxidant molecules overwhelming the antioxidant defense mechanisms. Hemodialysis (HD) constitutes a state of elevated inflammation and OS, due to loss of antioxidants during dialysis and activation of white blood cells triggering production of reactive oxygen species. Dialysis vintage, dialysis methods, and type and condition of vascular access, biocompatibility of dialyzer membrane and dialysate, iron administration, and anemia all can play a role in aggravating OS, which in turn has been associated with increased morbidity and mortality. Oral or intravenous administration of antioxidants may detoxify the oxidative molecules and at least in part repair OS-mediated tissue damage. Lifestyle interventions and optimization of a highly biocompatible HD procedure might ameliorate OS development in dialysis.
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Affiliation(s)
- Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Zarogiannis
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
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22
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Oxidative Stress in Patients Undergoing Peritoneal Dialysis: A Current Review of the Literature. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:3494867. [PMID: 29750088 PMCID: PMC5892210 DOI: 10.1155/2017/3494867] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/15/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
Peritoneal dialysis (PD) patients manifest excessive oxidative stress (OS) compared to the general population and predialysis chronic kidney disease patients, mainly due to the composition of the PD solution (high-glucose content, low pH, elevated osmolality, increased lactate concentration and glucose degradation products). However, PD could be considered a more biocompatible form of dialysis compared to hemodialysis (HD), since several studies showed that the latter results in an excess accumulation of oxidative products and loss of antioxidants. OS in PD is tightly linked with chronic inflammation, atherogenesis, peritoneal fibrosis, and loss of residual renal function. Although exogenous supplementation of antioxidants, such as vitamins E and C, N-acetylcysteine, and carotenoids, in some cases showed potential beneficial effects in PD patients, relevant recommendations have not been yet adopted in everyday clinical practice.
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Oxidative Stress in Hemodialysis Patients: A Review of the Literature. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:3081856. [PMID: 29138677 PMCID: PMC5613374 DOI: 10.1155/2017/3081856] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
Hemodialysis (HD) patients are at high risk for all-cause mortality and cardiovascular events. In addition to traditional risk factors, excessive oxidative stress (OS) and chronic inflammation emerge as novel and major contributors to accelerated atherosclerosis and elevated mortality. OS is defined as the imbalance between antioxidant defense mechanisms and oxidant products, the latter overwhelming the former. OS appears in early stages of chronic kidney disease (CKD), advances along with worsening of renal failure, and is further exacerbated by the HD process per se. HD patients manifest excessive OS status due to retention of a plethora of toxins, subsidized under uremia, nutrition lacking antioxidants and turn-over of antioxidants, loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. Duration of dialysis therapy, iron infusion, anemia, presence of central venous catheter, and bioincompatible dialyzers are several factors triggering the development of OS. Antioxidant supplementation may take an overall protective role, even at early stages of CKD, to halt the deterioration of kidney function and antagonize systemic inflammation. Unfortunately, clinical studies have not yielded unequivocal positive outcomes when antioxidants have been administered to hemodialysis patients, likely due to their heterogeneous clinical conditions and underlying risk profile.
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Jankowska M, Lichodziejewska-Niemierko M, Rutkowski B, Dębska-Ślizień A, Małgorzewicz S. Water soluble vitamins and peritoneal dialysis - State of the art. Clin Nutr 2016; 36:1483-1489. [PMID: 28089619 DOI: 10.1016/j.clnu.2016.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 01/19/2023]
Abstract
This review presents the results of a systematic literature search concerning water soluble vitamins and peritoneal dialysis modality. We provide an overview of the data available on vitamin requirements, dietary intake, dialysis related losses, metabolism and the benefits of supplementation. We also summarise the current recommendations concerning the supplementation of vitamins in peritoneal dialysis and discuss the safety of an administration of vitamins in pharmacological doses.
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Affiliation(s)
- Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | | | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
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25
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Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE. Positive Impact of Nutritional Interventions on Serum Symmetric Dimethylarginine and Creatinine Concentrations in Client-Owned Geriatric Dogs. PLoS One 2016; 11:e0153653. [PMID: 27088214 PMCID: PMC4835100 DOI: 10.1371/journal.pone.0153653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 03/03/2016] [Indexed: 12/26/2022] Open
Abstract
A prospective study was conducted in client-owned geriatric dogs to evaluate the short-term effects of a test food on serum symmetric dimethylarginine (SDMA) and creatinine (Cr) concentrations. Test food contained functional lipids (fish oil), antioxidants (lipoic acid, vitamins C and E), L-carnitine, botanicals (fruits and vegetables), controlled sodium concentration, and high quality protein sources (high bioavailability and an ideal amino acid composition). Dogs (n = 210) were fed either test food or owner's-choice foods (non-nutritionally controlled cohort). Dogs were included based on age and body weight: small (6.8 to 11.4 kg) and medium dogs (11.5 to 22.7 kg) were ≥ 9 years, whereas dogs >22.7 kg were ≥ 7 years at baseline. At baseline, all dogs had to have serum Cr concentrations within the reference interval and be free of chronic disease. Renal function biomarkers and urinalysis results at baseline, and after consuming test food or owner's-choice foods for 3 and 6 months, were evaluated. Only dogs consuming test food showed significant decreases in serum SDMA and Cr concentrations (both P ≤ 0.05) across time. At baseline or during the 6-month feeding trial, 18 dogs (8.6%) had increased serum SDMA, but normal serum Cr, consistent with IRIS Stage 1 chronic kidney disease. This included 9 dogs fed test food and 9 dogs fed owner's-choice foods. Compared with baseline, after feeding 9 dogs test food for 6 months, serum SDMA decreased in 8 dogs and increased in 1 dog. After feeding 9 dogs owner's-choice foods for 6 months, serum SDMA decreased in 4 dogs and increased in 4 dogs (remained stable in 1 dog). The decreases in serum SDMA and Cr concentrations were significant (both P = 0.03) only for dogs fed test food. These results suggest that nonazotemic dogs with elevated serum SDMA (early renal insufficiency) when fed a test food designed to promote healthy aging are more likely to demonstrate improved renal function compared with dogs fed owner's-choice foods.
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Affiliation(s)
- Jean A. Hall
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, United States of America
| | - Jennifer MacLeay
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Maha Yerramilli
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Edward Obare
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Murthy Yerramilli
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Heidi Schiefelbein
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Inke Paetau-Robinson
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Dennis E. Jewell
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
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Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE. Positive Impact of Nutritional Interventions on Serum Symmetric Dimethylarginine and Creatinine Concentrations in Client-Owned Geriatric Cats. PLoS One 2016; 11:e0153654. [PMID: 27078852 PMCID: PMC4831797 DOI: 10.1371/journal.pone.0153654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/26/2016] [Indexed: 12/11/2022] Open
Abstract
A prospective study was conducted in client-owned geriatric cats to evaluate the short- term effects of a test food on serum symmetric dimethylarginine (SDMA) and creatinine (Cr) concentrations. Test food contained functional lipids (fish oil), antioxidants (vitamins C and E), L-carnitine, botanicals (vegetables), highly bioavailable protein, and amino acid supplements. Cats (n = 80) were fed either test food or owner's-choice foods (non-nutritionally controlled cohort). Cats were included based on age (≥ 9 years), indoor only, neutered, and free of chronic disease. At baseline, all cats had serum Cr concentrations within the reference interval. Renal function biomarkers and urinalysis results at baseline and after consuming test food or owner's-choice foods for 3 and 6 months were evaluated. Cats consuming test food showed significant decreases in serum Cr and BUN concentrations across time. Overall, cats consuming owner's-choice foods showed significant increases in serum SDMA concentrations at 3 and 6 months compared with baseline (P ≤ 0.05), whereas in cats consuming test food serum SDMA concentrations did not change. At baseline or during the 6-month feeding trial, 23 (28.8%) cats had increased serum SDMA, but normal serum Cr consistent with IRIS Stage 1 chronic kidney disease. This included 6 cats fed test food and 17 cats fed owner's-choice foods. In the 6 cats fed test food, serum SDMA decreased in 3 cats and remained stable in 1 cat, whereas in the 17 cats fed owner's-choice foods, serum SDMA increased in 13 cats and decreased or remained stable in 4 cats. The increase in serum SDMA concentration was significant (P = 0.02) only for cats fed owner's-choice foods. These results suggest that nonazotemic cats with elevated serum SDMA (early renal insufficiency) when fed a food designed to promote healthy aging are more likely to demonstrate stable renal function compared with cats fed owner's-choice foods. Cats fed owner's-choice foods were more likely to demonstrate progressive renal insufficiency.
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Affiliation(s)
- Jean A. Hall
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, United States of America
| | - Jennifer MacLeay
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Maha Yerramilli
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Edward Obare
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Murthy Yerramilli
- IDEXX Laboratories, Inc., One IDEXX Drive, Westbrook, Maine, United States of America
| | - Heidi Schiefelbein
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Inke Paetau-Robinson
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
| | - Dennis E. Jewell
- Pet Nutrition Center, Hill's Pet Nutrition, Inc, Topeka, Kansas, United States of America
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Firuzi O, Khajehrezaei S, Ezzatzadegan S, Nejati M, Jahanshahi KA, Roozbeh J. Effects of silymarin on biochemical and oxidative stress markers in end-stage renal disease patients undergoing peritoneal dialysis. Hemodial Int 2016; 20:558-563. [PMID: 27040041 DOI: 10.1111/hdi.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction End-stage renal disease (ESRD) patients especially those undergoing dialysis are vulnerable to several complications, in particular those related to oxidative stress. Silymarin is an herbal medicine commonly used as an antioxidant in different pathologies. Methods To evaluate the effect of silymarin on biochemical and oxidative stress markers, 50 ESRD patients undergoing peritoneal dialysis were randomly divided into two groups of silymarin (n = 28) and control (n = 22) and received silymarin (140 mg every 8 hours) or placebo for 2 months, respectively. Ferric reducing antioxidant power and total 8-iso-prostaglandin F2α were measured in plasma, while catalase enzyme activity was measured in erythrocytes of both groups before and after treatment. Findings Ferric reducing antioxidant power values after treatment were significantly decreased in silymarin group compared to before treatment values (17.2 ± 2.9 and 15.9 ± 3.1 µM equivalent of quercetin/dL, respectively, P < 0.05). Conversely, catalase levels were increased 17.3% after silymarin consumption, while it was decreased 9.1% in control group. Further, hemoglobin (from 10.94 ± 2.17 to 11.54 ± 2.03 g/dL, P < 0.05) and albumin levels (from 3.48 ± 0.67 to 3.61 ± 0.53 g/dL, P < 0.05) were significantly increased after silymarin administration. Discussion It is concluded that silymarin could be regarded as a supplementary therapy for ESRD patients undergoing peritoneal dialysis in order to reduce complications.
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Affiliation(s)
- Omidreza Firuzi
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Khajehrezaei
- Department of Internal medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nejati
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Jamshid Roozbeh
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Salivary and Urinary Total Antioxidant Capacity as Biomarkers of Oxidative Stress in Humans. PATHOLOGY RESEARCH INTERNATIONAL 2016; 2016:5480267. [PMID: 26966611 PMCID: PMC4761395 DOI: 10.1155/2016/5480267] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/10/2016] [Indexed: 12/20/2022]
Abstract
Total Antioxidant Capacity (TAC) is a biomarker often used in order to investigate oxidative stress in many pathological conditions. Saliva and urine can be collected noninvasively and represent attractive diagnostic fluids for detecting biomarkers of various pathological conditions. The reviewed case-control and intervention studies that measured salivary or urinary TAC revealed that diseases, antioxidant foods, or supplements and age, gender, and lifestyle factors influenced salivary or urinary TAC. Salivary and urinary TAC were particularly affected by oral or renal status, respectively, as well as by infection; therefore these factors must be taken into account in both case-control and intervention studies. Furthermore, some considerations on sample collection and normalization strategies could be made. In particular, unstimulated saliva could be the better approach to measure salivary TAC, whereas 24 h or spontaneous urine collection should be chosen on the basis of the study outcome and of the creatinine clearance. Finally, the uric acid-independent TAC could be the better approach to evaluate red-ox status of body, in particular after nutritional interventions and in diseases associated with hyperuricaemia.
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Hall JA, Yerramilli M, Obare E, Yerramilli M, Panickar KS, Bobe G, Jewell DE. Nutritional Interventions that Slow the Age-Associated Decline in Renal Function in a Canine Geriatric Model for Elderly Humans. J Nutr Health Aging 2016; 20:1010-1023. [PMID: 27925141 DOI: 10.1007/s12603-015-0636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the effects of feeding traditional and renal protective foods (RPF) supplemented with functional food bioactives on glomerular filtration rate (GFR), lean body percent (LB%), and selected circulating biomarker and metabolite concentrations in a geriatric dog model. DESIGN Randomized block design and cross-sectional study. SETTING Hill's Pet Nutrition, Inc. dog colony. PARTICIPANTS Eighty-one geriatric dogs (mean age, 10.4; range, 7.9-14.2 years) and 30 mature-adult dogs (mean age, 5.0; range, 3.3-6.9 years). INTERVENTION Geriatric dogs were fed one of three foods (n = 27 per group) for 6 months: a traditional RPF (control) that was energy dense and mildly protein-restricted, or control food supplemented with increasing amounts of functional food bioactives: fish oil, lipoic acid, fruits and vegetables, and higher quality protein sources [functional foods one (FF1) and two (FF2)]. Geriatric dogs were compared before and after the feeding trial with mature adult dogs. MEASUREMENTS Renal function was assessed by GFR, LB% was determined by dual energy x-ray absorptiometry, and circulating biomarkers and metabolites were measured in blood. RESULTS Before the feeding trial, GFR (+28.2%), LB% (+18.6%), and serum total protein (+10.0%) were higher in mature versus healthy geriatric dogs (all P<0.001). Geriatric dogs consuming all three foods increased (P<0.001) GFR over time; group averages ranged from 13.0-16.9%. Dogs fed the highest supplemented level of bioactives (FF2) had lower (P<0.001) symmetric dimethylarginine (SDMA) concentrations (-14.3%). Feeding functional foods did not alter body weight, but increased (P<0.001) serum protein concentration (+6.7%). CONCLUSION Supplementation with functional food bioactives can temporarily reverse the age-associated decline in renal function and serum total protein.
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Affiliation(s)
- J A Hall
- Jean A. Hall, Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Dryden Hall 206, Corvallis, OR 97331-4802. Phone (541) 737-6537; FAX (541) 737-2730; E-mail
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Granata S, Dalla Gassa A, Tomei P, Lupo A, Zaza G. Mitochondria: a new therapeutic target in chronic kidney disease. Nutr Metab (Lond) 2015; 12:49. [PMID: 26612997 PMCID: PMC4660721 DOI: 10.1186/s12986-015-0044-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/18/2015] [Indexed: 12/24/2022] Open
Abstract
Cellular metabolic changes during chronic kidney disease (CKD) may induce higher production of oxygen radicals that play a significant role in the progression of renal damage and in the onset of important comorbidities. This condition seems to be in part related to dysfunctional mitochondria that cause an increased electron "leakage" from the respiratory chain during oxidative phosphorylation with a consequent generation of reactive oxygen species (ROS). ROS are highly active molecules that may oxidize proteins, lipids and nucleic acids with a consequent damage of cells and tissues. To mitigate this mitochondria-related functional impairment, a variety of agents (including endogenous and food derived antioxidants, natural plants extracts, mitochondria-targeted molecules) combined with conventional therapies could be employed. However, although the anti-oxidant properties of these substances are well known, their use in clinical practice has been only partially investigated. Additionally, for their correct utilization is extremely important to understand their effects, to identify the correct target of intervention and to minimize adverse effects. Therefore, in this manuscript, we reviewed the characteristics of the available mitochondria-targeted anti-oxidant compounds that could be employed routinely in our nephrology, internal medicine and renal transplant centers. Nevertheless, large clinical trials are needed to provide more definitive information about their use and to assess their overall efficacy or toxicity.
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Affiliation(s)
- Simona Granata
- Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, VR Italy
| | - Alessandra Dalla Gassa
- Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, VR Italy
| | - Paola Tomei
- Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, VR Italy
| | - Antonio Lupo
- Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, VR Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, VR Italy
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Norouzi L, Shirpoor A, Ansari MHK, Ilkhanizadeh B. Vitamin E attenuates alcohol-induced aortic wall damage in rats. Artery Res 2015. [DOI: 10.1016/j.artres.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Associations between serum hepcidin level, FGF-21 level and oxidative stress with arterial stiffness in CAPD patients. Int Urol Nephrol 2014; 46:2409-14. [PMID: 24908281 DOI: 10.1007/s11255-014-0753-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/22/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. Atherosclerosis is associated with increased arterial stiffness (AS), endothelial dysfunction and elevated oxidative stress (OS) and inflammation. We aimed to investigate the relationship between oxidative stress status, arterial stiffness, hepcidin and fibroblast growth factor-21 (FGF-21) levels in CAPD patients. METHODS As a prospective observational study, we analyzed 56 CAPD patients, aged between 30 and 63 years. Serum hepcidin, FGF-21 levels, OS status and AS were determined. Arterial stiffness was measured by flow-mediated dilatation (FMD). Oxidative stress status was determined by total antioxidant status, total oxidant status (TOS) and oxidative stress index (OSI). RESULTS FMD was negatively correlated with TOS, OSI, hepcidin and FGF-21 (r: -0.313, p: 0.020; r: -0.0331, p: 0.014; r: -0.498, p < 0.001; r: -0.403, p: 0.002, respectively). OSI was positively correlated with hepcidin, parathormone and negatively correlated with FMD (r: 0.278, p: 0.040; r: 0.462, p < 0.001; r: -0.0331, p: 0.014, respectively). CONCLUSION There are many factors affecting arterial stiffness in CAPD patients. In our study, higher levels of OS status, hepcidin and FGF-21 were independent determinants of arterial stiffness in PD patients. Therefore, definition and improvement of these new parameters will be helpful to reduce the cardiovascular disease risk and mortality in CAPD patients.
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High-dialysate-glucose-induced oxidative stress and mitochondrial-mediated apoptosis in human peritoneal mesothelial cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:642793. [PMID: 24891925 PMCID: PMC4026970 DOI: 10.1155/2014/642793] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/30/2014] [Accepted: 04/01/2014] [Indexed: 11/23/2022]
Abstract
Human peritoneal mesothelial cells (HPMCs) are a critical component of the peritoneal membrane and play a pivotal role in dialysis adequacy. Loss of HPMCs can contribute to complications in peritoneal dialysis. Compelling evidence has shown that high-dialysate glucose is a key factor causing functional changes and cell death in HPMCs. We investigated the mechanism of HPMC apoptosis induced by high-dialysate glucose, particularly the role of mitochondria in the maintenance of HPMCs. HPMCs were incubated at glucose concentrations of 5 mM, 84 mM, 138 mM, and 236 mM. Additionally, N-acetylcysteine (NAC) was used as an antioxidant to clarify the mechanism of high-dialysate-glucose-induced apoptosis. Exposing HPMCs to high-dialysate glucose resulted in substantial apoptosis with cytochrome c release, followed by caspase activation and poly(ADP-ribose) polymerase cleavage. High-dialysate glucose induced excessive reactive oxygen species production and lipid peroxidation as well as oxidative damage to DNA. Mitochondrial fragmentation, multiple mitochondrial DNA deletions, and dissipation of the mitochondrial membrane potential were also observed. The mitochondrial dysfunction and cell death were suppressed using NAC. These results indicated that mitochondrial dysfunction is one of the main causes of high-dialysate-glucose-induced HPMC apoptosis.
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