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Li Y, Qi H, Huang X, Lu G, Pan H. Exogenous and endogenous antioxidants in osteoporosis risk: causal associations unveiled by Mendelian Randomization analysis. Front Physiol 2024; 15:1411148. [PMID: 38883185 PMCID: PMC11176562 DOI: 10.3389/fphys.2024.1411148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recent epidemiological studies and animal experiments have highlighted the significant role of oxidative stress in the development of osteoporosis (OP). The provision of antioxidants is widely considered a fundamental strategy to combat free radical-induced stress, inhibit oxidative damage, and potentially reverse the adverse effects of oxidative stress on bone health. However, there is no consensus in the scientific literature regarding the practical effectiveness of antioxidants in OP prevention and treatment. Some studies have not shown a clear connection between antioxidant supplementation and decreased OP risk. Therefore, it is essential to clarify the potential causal relationship between antioxidants and the development of OP. Methods The study utilized the inverse variance weighted (IVW) approach as the primary analytical method in the Mendelian Randomization (MR) framework to investigate the causal effects of five exogenous and six endogenous antioxidants on the risk of OP. To thoroughly assess potential pleiotropic effects and heterogeneity among the data analyzed, the MR-Egger intercept test was employed, and Cochran's Q statistic was calculated. Results In the evaluation of exogenous antioxidants, single-directional two-sample MR analyses did not reveal any statistically significant relationship between these agents and the risk of OP. Regarding endogenous antioxidants, bidirectional two-sample MR analyses were conducted, which generally indicated that most genetically regulated endogenous antioxidants had no significant association with the onset risk of OP. A significant causal relationship was found between OP and serum albumin levels (β: -0.0552, 95%CI: -0.0879 to -0.0225, p < 0.0011 after Bonferroni adjustment, power = 100%). Conclusion The research uncovers OP as a possible determinant contributing to a decrement in serum albumin levels, and further suggests a potentially intimate relationship between the downward trajectory of serum albumin concentrations and the advancement of the OP disease process.
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Affiliation(s)
- Yuancheng Li
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huaqian Qi
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Huang
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gang Lu
- Department of Acupuncture-Moxibustion and Tuina, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Huashan Pan
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
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Tabata F, Wada Y, Kawakami S, Tamakoshi A, Miyaji K. A Methodological Basis for Estimating Human Mercaptalbumin in Serum and Plasma Using a Thiol-Binding Resin. J Nutr Sci Vitaminol (Tokyo) 2023; 69:340-346. [PMID: 37940574 DOI: 10.3177/jnsv.69.340] [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] [Indexed: 11/10/2023]
Abstract
Human serum albumin is categorized into human mercaptalbumin (HMA) and human non-mercaptalbumin (HNA), according to the redox state of the cysteine residue at position 34. The ratio of HMA to total albumin (%HMA) is a novel biomarker of oxidative stress as well as protein nutritional status, but measuring %HMA normally requires an expensive analyzer such as HPLC and LC-MS, and can hardly be conducted in many clinical sites. To address this issue, we aimed to develop a methodological basis for estimating %HMA without these analyzers. An analytical method was investigated consisting of three steps, i.e., 1) removal of HMA from serum or plasma by using a thiol-binding resin (i.e., thereby obtaining a HNA fraction), 2) determination of both total albumin and HNA concentrations by a colorimetric assay or ELISA, and 3) calculation of %HMA. Proof-of-concept experiments, using serum and plasma samples of 4 adult volunteers, showed that the estimated value of %HMA obtained by this analytical method was significantly correlated with the theoretical value of %HMA determined by HPLC. The subsequent validation experiment, using 86 serum samples of pregnant women in the Japanese participants of SMILE Iwamizawa, also confirmed the significant association between the estimated and theoretical values of %HMA. This analytical method can be a basis to determine %HMA without using HPLC or LC-MS, contributing to the universalization of %HMA measurement as a clinical test.
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Affiliation(s)
- Fuka Tabata
- Hearth Care & Nutritional Science Institute, Morinaga Milk Industry Co., Ltd
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University
| | - Yasuaki Wada
- Innovative Research Institute, Morinaga Milk Industry Co., Ltd
| | - Satomi Kawakami
- Hearth Care & Nutritional Science Institute, Morinaga Milk Industry Co., Ltd
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University
| | | | - Kazuhiro Miyaji
- Hearth Care & Nutritional Science Institute, Morinaga Milk Industry Co., Ltd
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Study of Albumin Oxidation in COVID-19 Pneumonia Patients: Possible Mechanisms and Consequences. Int J Mol Sci 2022; 23:ijms231710103. [PMID: 36077496 PMCID: PMC9456270 DOI: 10.3390/ijms231710103] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Oxidative stress induced by neutrophils and hypoxia in COVID-19 pneumonia leads to albumin modification. This may result in elevated levels of advanced oxidation protein products (AOPPs) and advanced lipoxidation end-products (ALEs) that trigger oxidative bursts of neutrophils and thus participate in cytokine storms, accelerating endothelial lung cell injury, leading to respiratory distress. In this study, sixty-six hospitalized COVID-19 patients with respiratory symptoms were studied. AOPPs-HSA was produced in vitro by treating human serum albumin (HSA) with chloramine T. The interaction of malondialdehyde with HSA was studied using time-resolved fluorescence spectroscopy. The findings revealed a significantly elevated level of AOPPs in COVID-19 pneumonia patients on admission to the hospital and one week later as long as they were in the acute phase of infection when compared with values recorded for the same patients 6- and 12-months post-infection. Significant negative correlations of albumin and positive correlations of AOPPs with, e.g., procalcitonin, D-dimers, lactate dehydrogenase, aspartate transaminase, and radiological scores of computed tomography (HRCT), were observed. The AOPPs/albumin ratio was found to be strongly correlated with D-dimers. We suggest that oxidized albumin could be involved in COVID-19 pathophysiology. Some possible clinical consequences of the modification of albumin are also discussed.
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Zou Y, Zhao L, Zhang J, Wang Y, Wu Y, Ren H, Wang T, Zhang R, Wang J, Zhao Y, Qin C, Xu H, Li L, Chai Z, Cooper ME, Tong N, Liu F. Development and internal validation of machine learning algorithms for end-stage renal disease risk prediction model of people with type 2 diabetes mellitus and diabetic kidney disease. Ren Fail 2022; 44:562-570. [PMID: 35373711 PMCID: PMC8986220 DOI: 10.1080/0886022x.2022.2056053] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aims Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) and is associated with increased morbidity and mortality in patients with diabetes. Identification of risk factors involved in the progression of DKD to ESRD is expected to result in early detection and appropriate intervention and improve prognosis. Therefore, this study aimed to establish a risk prediction model for ESRD resulting from DKD in patients with type 2 diabetes mellitus (T2DM). Methods Between January 2008 and July 2019, a total of 390 Chinese patients with T2DM and DKD confirmed by percutaneous renal biopsy were enrolled and followed up for at least 1 year. Four machine learning algorithms (gradient boosting machine, support vector machine, logistic regression, and random forest (RF)) were used to identify the critical clinical and pathological features and to build a risk prediction model for ESRD. Results There were 158 renal outcome events (ESRD) (40.51%) during the 3-year median follow up. The RF algorithm showed the best performance at predicting progression to ESRD, showing the highest AUC (0.90) and ACC (82.65%). The RF algorithm identified five major factors: Cystatin-C, serum albumin (sAlb), hemoglobin (Hb), 24-hour urine urinary total protein, and estimated glomerular filtration rate. A nomogram according to the aforementioned five predictive factors was constructed to predict the incidence of ESRD. Conclusion Machine learning algorithms can efficiently predict the incident ESRD in DKD participants. Compared with the previous models, the importance of sAlb and Hb were highlighted in the current model.Highlights What is already known? Identification of risk factors for the progression of DKD to ESRD is expected to improve the prognosis by early detection and appropriate intervention. What this study has found? Machine learning algorithms were used to construct a risk prediction model of ESRD in patients with T2DM and DKD. The major predictive factors were found to be CysC, sAlb, Hb, eGFR, and UTP. What are the implications of the study? In contrast with the treatment of participants with early-phase T2DM with or without mild kidney damage, major emphasis should be placed on indicators of kidney function, nutrition, anemia, and proteinuria for participants with T2DM and advanced DKD to delay ESRD, rather than age, sex, and control of hypertension and glycemia.
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Affiliation(s)
- Yutong Zou
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Lijun Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Junlin Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Yiting Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Yucheng Wu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Honghong Ren
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Tingli Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Jiali Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Yuancheng Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Chunmei Qin
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Huan Xu
- Division of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Lin Li
- Division of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhonglin Chai
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Mark E. Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Nanwei Tong
- Division of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
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Serum Albumin Redox States: More Than Oxidative Stress Biomarker. Antioxidants (Basel) 2021; 10:antiox10040503. [PMID: 33804859 PMCID: PMC8063786 DOI: 10.3390/antiox10040503] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/17/2022] Open
Abstract
Serum albumin is the most abundant circulating protein in mammals including humans. It has three isoforms according to the redox state of the free cysteine residue at position 34, named as mercaptalbumin (reduced albumin), non-mercaptalbumin-1 and -2 (oxidized albumin), respectively. The serum albumin redox state has long been viewed as a biomarker of systemic oxidative stress, as the redox state shifts to a more oxidized state in response to the severity of the pathological condition in various diseases such as liver diseases and renal failures. However, recent ex vivo studies revealed oxidized albumin per se could aggravate the pathological conditions. Furthermore, the possibility of the serum albumin redox state as a sensitive protein nutrition biomarker has also been demonstrated in a series of animal studies. A paradigm shift is thus ongoing in the research field of the serum albumin. This article provides an updated overview of analytical techniques for serum albumin redox state and its association with human health, focusing on recent findings.
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Zhang J, Zhang R, Wang Y, Li H, Han Q, Wu Y, Wang T, Liu F. The Level of Serum Albumin Is Associated with Renal Prognosis in Patients with Diabetic Nephropathy. J Diabetes Res 2019; 2019:7825804. [PMID: 30911552 PMCID: PMC6398001 DOI: 10.1155/2019/7825804] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/02/2018] [Accepted: 12/23/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Although hypoalbuminemia is frequently found in most patients with diabetic nephropathy (DN), its relationship to the severity and progression of DN remains largely unknown. Our aim was to investigate the association between the serum albumin levels and clinicopathological features and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DN. MATERIALS AND METHODS A total of 188 patients with T2DM and biopsy-proven DN followed up for at least one year were enrolled. The patients were divided into four groups based on the albumin levels: normal group: ≥35 g/L (n = 87); mild group: 30-35 g/L (n = 34); moderate group: 25-30 g/L (n = 36); and severe group: <25 g/L (n = 31). The renal outcome was defined by progression to end-stage renal disease. The impact of the serum albumin level on renal survival was estimated using Cox regression analysis. RESULTS Among the cases, the serum albumin level had a significant correlation with proteinuria, renal function, and glomerular lesions. A multivariate Cox regression analysis indicated that the severity of hypoalbuminemia remained significantly associated with an adverse renal outcome, independent of clinical and histopathological features. In reference to the normal group, the risk of progression to ESRD increased such that the hazard ratio (HR) for the mild group was 2.09 (95% CI, 0.67-6.56, p = 0.205), 6.20 (95% CI, 1.95-19.76, p = 0.002) for the moderate group, and 7.37 (95% CI, 1.24-43.83, p = 0.028) for the severe group. CONCLUSIONS These findings suggested that hypoalbuminemia was associated with a poorer renal prognosis in patients with T2DM and DN.
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Affiliation(s)
- Junlin Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yiting Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hanyu Li
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qianqian Han
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yucheng Wu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Tingli Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
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Yamasaki K, Nishi K, Anraku M, Taguchi K, Maruyama T, Otagiri M. Metal-catalyzed oxidation of human serum albumin does not alter the interactive binding to the two principal drug binding sites. Biochem Biophys Rep 2018; 14:155-160. [PMID: 29872747 PMCID: PMC5986994 DOI: 10.1016/j.bbrep.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/12/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022] Open
Abstract
It is well known that various physiological factors such as pH, endogenous substances or post-translational modifications can affect the conformational state of human serum albumin (HSA). In a previous study, we reported that both pH- and long chain fatty acid-induced conformational changes can alter the interactive binding of ligands to the two principal binding sites of HSA, namely, site I and site II. In the present study, the effect of metal-catalyzed oxidation (MCO) caused by ascorbate/oxygen/trace metals on HSA structure and the interactive binding between dansyl-L-asparagine (DNSA; a site I ligand) and ibuprofen (a site II ligand) at pH 6.5 was investigated. MCO was accompanied by a time-dependent increase in carbonyl content in HSA, suggesting that the HSA was being oxidized. In addition, The MCO of HSA was accompanied by a change in net charge to a more negative charge and a decrease in thermal stability. SDS-PAGE patterns and α-helical contents of the oxidized HSAs were similar to those of native HSA, indicating that the HSA had not been extensively structurally modified by MCO. MCO also caused a selective decrease in ibuprofen binding. In spite of the changes in the HSA structure and ligand that bind to site II, no change in the interactive binding between DNSA and ibuprofen was observed. These data indicated that amino acid residues in site II are preferentially oxidized by MCO, whereas the spatial relationship between sites I and II (e.g. the distance between sites), the flexibility or space of each binding site are not altered. The present findings provide insights into the structural characteristics of oxidized HSA, and drug binding and drug-drug interactions on oxidized HSA.
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Affiliation(s)
- Keishi Yamasaki
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
- DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Koji Nishi
- Department of Clinical Medicine, Yokohama University of Pharmacy, 601 Matano-cho, Totsuka-ku, Yokohama 245-0066, Japan
| | - Makoto Anraku
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
- DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Kazuaki Taguchi
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Toru Maruyama
- Graduate School of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Kumamoto 862-0973, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
- DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
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Nakazato Y, Kurane R, Hirose S, Watanabe A, Shimoyama H. Aging and death-associated changes in serum albumin variability over the course of chronic hemodialysis treatment. PLoS One 2017; 12:e0185216. [PMID: 28953942 PMCID: PMC5617180 DOI: 10.1371/journal.pone.0185216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 09/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Several epidemiological studies have demonstrated associations between variability in a number of biological parameters and adverse outcomes. As the variability may reflect impaired homeostatic regulation, we assessed albumin variability over time in chronic hemodialysis (HD) patients. Methods Data from 1346 subjects who received chronic HD treatment from May 2001 to February 2015 were analyzed according to three phases of HD treatment: post-HD initiation, during maintenance HD treatment, and before death. The serum albumin values were grouped according to the time interval from HD initiation or death, and the yearly trends for both the albumin levels and the intra-individual albumin variability (quantified by the residual coefficient of variation: Alb-rCV) were examined. The HD initiation and death-associated changes were also analyzed using generalized additive mixed models. Furthermore, the long-term trend throughout the maintenance treatment period was evaluated separately using linear regression models. Results Albumin levels and variability showed distinctive changes during each of the 3 periods. After HD initiation, albumin variability decreased and reached a nadir within a year. During the subsequent maintenance treatment period (interquartile range = 5.2–11.0 years), the log Alb-rCV showed a significant upward trend (mean slope: 0.011 ± 0.035 /year), and its overall mean was -1.49 ± 0.08 (equivalent to an Alb-rCV of 3.22%). During the 1–2 years before death, this upward trend clearly accelerated, and the mean log Alb-rCV in the last year of life was -1.36 ± 0.17. The albumin levels and variability were negatively correlated with each other and exhibited exactly opposite movements throughout the course of chronic HD treatment. Different from the albumin levels, albumin variability was not dependent on chronological age but was independently associated with an individual’s aging and death process. Conclusion The observed upward trend in albumin variability seems to be consistent with a presumed aging-related decline in homeostatic capacity.
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Affiliation(s)
- Yuichi Nakazato
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama-City, Saitama, Japan
- * E-mail:
| | - Riichi Kurane
- Division of Nephrology, Yuai Clinic, Hakuyukai Medical Corporation, Saitama-City, Saitama, Japan
| | - Satoru Hirose
- Division of Nephrology, Yuai Mihashi Clinic, Hakuyukai Medical Corporation, Saitama-City, Saitama, Japan
| | - Akihisa Watanabe
- Division of Nephrology, Yuai Nakagawa Clinic, Hakuyukai Medical Corporation, Saitama-City, Saitama, Japan
| | - Hiromi Shimoyama
- Division of Nephrology, Yuai Clinic, Hakuyukai Medical Corporation, Saitama-City, Saitama, Japan
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Magzal F, Sela S, Szuchman-Sapir A, Tamir S, Michelis R, Kristal B. In-vivo oxidized albumin- a pro-inflammatory agent in hypoalbuminemia. PLoS One 2017; 12:e0177799. [PMID: 28542419 PMCID: PMC5443520 DOI: 10.1371/journal.pone.0177799] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/03/2017] [Indexed: 12/15/2022] Open
Abstract
Hypoalbuminemia of Hemodialysis (HD) patients is an independent cardiovascular risk factor, however, there is no mechanistic explanation between hypoalbuminemia and vascular injury. In the event of oxidative stress and inflammation to which HD patients are exposed, albumin is oxidized and undetected by common laboratory methods, rendering an apparent hypoalbuminemia. We wanted to show that these circulating modified oxidized albumin molecules cause direct vascular damage, mediating inflammation. Once these in-vivo albumin modifications were reduced in- vitro, the apparent hypoalbuminemia concomitantly with its inflammatory effects, were eliminated. Albumin modification profiles from 14 healthy controls (HC) and 14 HD patients were obtained by mass spectrometry (MS) analyses before and after reduction in- vitro, using redox agent 1,4 dithiothreitol (DTT). Their inflammatory effects were explored by exposing human umbilical endothelial cells (HUVEC) to all these forms of albumin. Albumin separated from hypoalbuminemic HD patients increased endothelial mRNA expression of cytokines and adhesion molecules, and augmented secretion of IL-6. This endothelial inflammatory state was almost fully reverted by exposing HUVEC to the in-vitro reduced HD albumin. MS profile of albumin modifications peaks was similar between HD and HC, but the intensities of the various peaks were significantly different. Abolishing the reversible oxidative modifications by DTT prevented endothelial injury and increased albumin levels. The irreversible modifications such as glycation and sulfonation show low intensities in HD albumin profiles and are nearly unobserved in HC. We showed, for the first time, a mechanistic link between hypoalbuminemia and the pro-inflammatory properties of in-vivo oxidized albumin, initiating vascular injury.
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Affiliation(s)
- Faiga Magzal
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
- Laboratory of Human Health and Nutrition Sciences, MIGAL—Galilee Research Institute, Kiryat Shmona, Israel
| | - Shifra Sela
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Andrea Szuchman-Sapir
- Laboratory of Human Health and Nutrition Sciences, MIGAL—Galilee Research Institute, Kiryat Shmona, Israel
| | - Snait Tamir
- Laboratory of Human Health and Nutrition Sciences, MIGAL—Galilee Research Institute, Kiryat Shmona, Israel
| | - Regina Michelis
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Batya Kristal
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
- Department of Nephrology and Hypertension, Galilee Medical Center, Nahariya, Israel
- * E-mail:
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Hasan K, Hassan F, Michelis R. The relationship between oxidized serum albumin and blood pressure in hypoalbuminemic peritoneal dialysis patients. Clin Exp Hypertens 2017; 39:416-420. [PMID: 28534653 DOI: 10.1080/10641963.2016.1259333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Oxidative stress produces molecular modifications of serum albumin that disturb its biological functions and interfere with its detection by the bromocresol green assay (BCG). Oxidative stress, inflammation, and hypoalbuminemia are common peritoneal dialysis (PD). This study aimed to evaluate the relationship between serum albumin, oxidized serum albumin (OSA), oncotic pressure, and blood pressure in hypoalbuminemic PD patients. METHODS Twenty-four PD patients with serum albumin levels <3.5 g/dl enrolled in the study. Data were compared between participants with the mean arterial pressure (MAP) <105 mmHg (n = 12) and MAP ≥ 105 mmHg (n = 12). RESULTS Serum albumin levels were ≤3.0 g/dl and similar in both groups (p = 0.298). The calculated OSA and oncotic pressure were significantly higher in patients with MAP ≥ 105 mmHg than in those with MAP < 105 mmHg. MAP was positively and marginally correlated with serum albumin levels (measured by BCG) (r = 0.34, p = 0.05), and positively and significantly correlated with the calculated OSA and oncotic pressure (r = 0.44, p = 0.015, r = 0.58, p = 0.002; respectively). The oncotic pressure was positively correlated with the calculated OSA (r = 0.47, p = 0.011). CONCLUSION OSA, undetectable by the commonly used BCG, may contribute to higher blood pressure in hypoalbuminemic PD patients.
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Affiliation(s)
- Kamal Hasan
- a Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel.,b Department of Nephrology and Hypertension , Peritoneal Dialysis Unit, Galilee Medical Center , Nahariya , Israel
| | - Fadi Hassan
- c Internal Medicine Department E , Galilee Medical Center , Nahariya , Israel
| | - Regina Michelis
- d Eliachar Research Laboratory, Galilee Medical Center , Nahariya , Israel
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Hoseini SM, Hedayati A, Taheri Mirghaed A, Ghelichpour M. Toxic effects of copper sulfate and copper nanoparticles on minerals, enzymes, thyroid hormones and protein fractions of plasma and histopathology in common carp Cyprinus carpio. ACTA ACUST UNITED AC 2016; 68:493-503. [DOI: 10.1016/j.etp.2016.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/22/2016] [Accepted: 08/08/2016] [Indexed: 02/05/2023]
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12
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Michelis R, Sela S, Zeitun T, Geron R, Kristal B. Unexpected Normal Colloid Osmotic Pressure in Clinical States with Low Serum Albumin. PLoS One 2016; 11:e0159839. [PMID: 27453993 PMCID: PMC4959682 DOI: 10.1371/journal.pone.0159839] [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: 12/20/2015] [Accepted: 07/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In clinical states associated with systemic oxidative stress (OS) and inflammation such as chronic kidney disease (CKD), oxidative modifications of serum albumin impair its quantification, resulting in apparent hypoalbuminemia. As the maintenance of oncotic pressure/colloid osmotic pressure (COP) is a major function of albumin, this study examined the impact of albumin oxidation on COP, both in-vivo and in-vitro. METHODS Patients with proteinuria and patients on chronic hemodialysis (HD) with systemic inflammation and OS were enrolled. Blood samples were collected from 134 subjects: 32 healthy controls (HC), proteinuric patients with high (n = 17) and low (n = 31) systemic inflammation and from 54 patients on chronic hemodialysis (HD) with the highest levels of OS and inflammation. RESULTS In-vitro oxidized albumin showed significantly higher COP values than non-oxidized albumin at identical albumin levels. In vivo, in hypoalbuminemic HD patients with the highest OS and inflammation, COP values were also higher than expected for the low albumin levels. The contribution to COP by other prevalent plasma proteins, such as fibrinogen and immunoglobulins was negligible. We imply that the calculation of COP based on albumin levels should be revisited in face of OS and inflammation. Hence, in hypoalbuminemic proteinuric patients with systemic OS and inflammation the assumption of low COP should be verified by its measurements.
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Affiliation(s)
- Regina Michelis
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
- * E-mail:
| | - Shifra Sela
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Teuta Zeitun
- Nephrology Department, Galilee Medical Center, Nahariya, Israel
| | - Ronit Geron
- Nephrology Department, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Batya Kristal
- Nephrology Department, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
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Hassan K, Kristal B, Hassan F, Abo Saleh S, Michelis R. The impact of oxidized serum albumin on the oncotic pressure and hydration status of peritoneal dialysis patients. Ther Clin Risk Manag 2016; 12:463-9. [PMID: 27069365 PMCID: PMC4818040 DOI: 10.2147/tcrm.s102311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Hypoalbuminemia, fluid overload (FO), and oxidative stress (OS) may be related to cardiovascular morbidity and mortality in peritoneal dialysis (PD) patients. OS produces molecular modifications of serum albumin that interfere with its quantification by the commonly used bromocresol green assay. This study evaluated the impact of oxidized serum albumin (OSA) on oncotic pressure (OP) and hydration status. Patients and methods Twenty-four stable hypoalbuminemic PD patients were enrolled in the study. After performing physical examination, assessment of the hydration status using a whole-body bioimpedance spectroscopy technique was performed, and blood samples were drawn for determination of OP, serum albumin levels, and OSA. Results Extracellular to total body water (E/TBW) ratio was higher in patients with FO ≥1.5 L with or without edema than in patients with FO <1.5 L (P≤0.043). E/TBW ratio was higher in patients with FO ≥1.5 L and edema compared to those with FO ≥1.5 L but without edema (P=0.004). OP was significantly higher in patients with FO ≥1.5 L and without edema compared to those with FO ≥1.5 L and with edema (P<0.001). Albumin-detection index (ADI) in patients with FO ≥1.5 L and without edema was similar to ADI in patients with FO <1.5 L (P=0.520). ADI was significantly lower in patients with FO ≥1.5 L and without edema compared to those with FO ≥1.5 L and edema (P=0.034). E/TBW ratio correlated positively with the ADI (r=0.60, P=0.001) and inversely with the OP (r=−0.54, P=0.002). Conclusion Overhydration may be clinically undetectable in PD patients. Assessing the hydration status and measuring the total serum albumin levels, including the oxidized fraction, should be considered in evaluating hydration status in PD patients.
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Affiliation(s)
- Kamal Hassan
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Peritoneal Dialysis Unit, Department of Nephrology and Hypertension, Galilee Medical Center, Nahariya, Israel
| | - Batya Kristal
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Peritoneal Dialysis Unit, Department of Nephrology and Hypertension, Galilee Medical Center, Nahariya, Israel
| | - Fadi Hassan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saad Abo Saleh
- Department of Urology, Galilee Medical Center, Nahariya, Israel
| | - Regina Michelis
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
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Golden MH. Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium - a response to Malcolm Coulthard's hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia. Paediatr Int Child Health 2015; 35:90-109. [PMID: 25844980 DOI: 10.1179/2046905515y.0000000010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The various types of oedema in man are considered in relation to Starling's hypothesis of fluid movement from capillaries, with the main emphasis on nutritional oedema and the nephrotic syndrome in children. It is concluded that each condition has sufficient anomalous findings to render Starling's hypothesis untenable. The finding that the endothelial glycocalyx is key to control of fluid movement from and into the capillaries calls for complete revision of our understanding of oedema formation. The factors so far known to affect the function of the glycocalyx are reviewed. As these depend upon sulphated proteoglycans and other glycosaminoglycans, the argument is advanced that the same abnormalities will extend to the interstitial space and that kwashiorkor is fundamentally related to a defect in sulphur metabolism which can explain all the clinical features of the condition, including the formation of oedema.
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Key Words
- Albumin,
- Aldosterone,
- Angiotensin,
- Beriberi,
- Edema,
- Epidemic dropsy,
- Famine oedema,
- Glycocalyx,
- Glycosaminoglycans,
- Heart failure,
- Hunger oedema,
- Kwashiorkor,
- Malnutrition,
- Nephrotic syndrome,
- Oedema,
- Potassium deficiency,
- Pre-eclampsia,
- Protein-energy malnutrition,
- Proteoglycans,
- Renin,
- Salt,
- Severe acute malnutrition
- Vitamin E deficiency,
- War oedema,
- Water,
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15
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Ellidag HY, Eren E, Yılmaz N, Cekin Y. Oxidative stress and ischemia-modified albumin in chronic ischemic heart failure. Redox Rep 2014; 19:118-23. [PMID: 24620936 DOI: 10.1179/1351000213y.0000000083] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Knowledge about the role of oxidative stress in human diseases, including cardiovascular system disorders, emphasizes the need for reliable markers of oxidative stress. Here, we evaluated the levels of the novel marker ischemia-modified albumin (IMA), albumin-adjusted IMA (adj-IMA), and the IMA/serum albumin ratio (IMAR) in patients with chronic ischemic heart failure (CIHF). METHODS A total of 55 patients with CIHF and 40 age- and sex-matched healthy individuals were included in the study. Serum levels of IMA, total antioxidant status, and total oxidant status were analyzed, and the adj-IMA level, IMAR, and oxidative stress index were calculated. RESULTS Serum IMA, IMAR, total oxidant status levels, and oxidative stress index were significantly higher in patients with CIHF than in the controls (all P < 0.0001), whereas albumin and total antioxidant status levels were significantly lower in the CIHF patients (P < 0.0001 and P = 0.0004, respectively). However, there was no significant difference in serum adj-IMA levels between the groups (P = 0.8). DISCUSSION We observed impaired oxidant/antioxidant status in favor of oxidative stress in CIHF patients. Oxidative stress may be a key factor in the development of hypoalbuminemia in CIHF. Further studies are needed to establish the relationships among IMA, albumin, and redox balance in CIHF.
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Lim PS, Jeng Y, Wu MY, Pai MA, Wu TK, Liu CS, Chen CH, Kuo YC, Chien SW, Chen HP. Serum oxidized albumin and cardiovascular mortality in normoalbuminemic hemodialysis patients: a cohort study. PLoS One 2013; 8:e70822. [PMID: 23923025 PMCID: PMC3726598 DOI: 10.1371/journal.pone.0070822] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/24/2013] [Indexed: 11/26/2022] Open
Abstract
Background Substantial evidence suggests that increased oxidative stress in hemodialysis (HD) patients may contribute to cardiovascular complications. Oxidative modifications of human serum albumin (HSA), the largest thiol pool in plasma, alter its biological properties and may affect its antioxidant potential in HD patients. Methods We conducted a long-term follow-up study in a cohort of normoalbuminemic HD patients to examine the impact of redox state of serum albumin on patients’ survival by measuring the human nonmercaptoalbumin (HNA) fraction of HSA. Results After adjusting for potential demographic, anthropometric, and clinical confounders, a positive association of HNA level with the risk of death from cardiovascular disease (CVD) and all-cause mortality was observed in normoalbuminemic HD patients. Using stratified analysis, we found a stronger association between HNA level and the risk of death from CVD and all-cause mortality in patients with pre-existing CVD. Conclusions Serum HNA level is a positive predictor of mortality in normoalbuminemic HD patients, especially among those with pre-existing CVD. Increased oxidative stress resulting from biological changes in serum albumin levels could contribute to accelerated atherosclerosis and the development of cardiovascular disease in HD patients.
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Affiliation(s)
- Paik Seong Lim
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
| | - Yachung Jeng
- Division of Epidemiology and Biostatistics, Department of Medical Research, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
- * E-mail:
| | - Ming Ying Wu
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Mei-Ann Pai
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Tsai-Kun Wu
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Chia-San Liu
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Chan Hsu Chen
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Yuan-Chuan Kuo
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Shiaw-Wen Chien
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
| | - Hung Ping Chen
- Division of Renal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung, Taiwan
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Michelis R, Kristal B, Zeitun T, Shapiro G, Fridman Y, Geron R, Sela S. Albumin oxidation leads to neutrophil activation in vitro and inaccurate measurement of serum albumin in patients with diabetic nephropathy. Free Radic Biol Med 2013; 60:49-55. [PMID: 23429046 DOI: 10.1016/j.freeradbiomed.2013.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 01/25/2013] [Accepted: 02/09/2013] [Indexed: 11/22/2022]
Abstract
Previous studies suggest that oxidative modifications of serum albumin lead to underestimation of albumin concentrations using conventional assays. In addition, oxidation of serum albumin may cause neutrophil activation and further oxidation of albumin, which may result in a series of reciprocal cyclical processes. Because hypoalbuminemia, systemic inflammation, and oxidative stress are common in diabetic nephropathy patients, the aim of this study was to show that albumin modifications and neutrophil activation underlie these reciprocal systemic processes. Blood samples from a cohort of 19 patients with diabetic nephropathy and 15 healthy controls were used for albumin separation. An oxidation-dependent "albumin detection index," representing the detection efficacy of the universal bromocresol green assay, was determined for each subject. This index was correlated with serum albumin levels, various markers of oxidative stress or inflammation, and kidney function. Activation of separated neutrophils by glycoxidized albumin was assessed by the release of neutrophil gelatinase-associated lipocalin (NGAL) and myeloperoxidase (MPO). The albumin detection index of diabetic nephropathy patients was significantly lower compared to that of controls, correlating positively with serum levels of albumin and kidney function and negatively with albumin glycoxidation and inflammatory markers. Glycoxidized albumin had a direct role in neutrophil activation, resulting in NGAL and MPO release. The hypoalbuminemia observed in patients with diabetic nephropathy partially results from underestimation of modified/oxidized albumin using the bromocresol green assay. However, modified or oxidized albumin may lead to a cycle of accelerated oxidative stress and inflammation involving neutrophil activation. We suggest that the albumin detection index, a new marker of oxidative stress, may also serve as a biomarker of diabetic nephropathy severity and its progression.
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Affiliation(s)
- Regina Michelis
- Eliachar Research Laboratory, Western Galilee Hospital, Nahariya 22100, Israel.
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Anraku M, Chuang VTG, Maruyama T, Otagiri M. Redox properties of serum albumin. Biochim Biophys Acta Gen Subj 2013; 1830:5465-72. [PMID: 23644037 DOI: 10.1016/j.bbagen.2013.04.036] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oxidative damage results in protein modification, and is observed in numerous diseases. Human serum albumin (HSA), the most abundant circulating protein in the plasma, exerts important antioxidant activities against oxidative damage. SCOPE OF REVIEW The present review focuses on the characterization of chemical changes in HSA that are induced by oxidative damage, their relevance to human pathology and the most recent advances in clinical applications. MAJOR CONCLUSIONS The antioxidant properties of HSA are largely dependent on Cys34 and its contribution to the maintenance of intravascular homeostasis, including protecting the vascular endothelium under disease conditions related to oxidative stress. Recent studies also evaluated the susceptibility of other important amino acid residues to free radicals. The findings suggest that a redox change in HSA is related to the oxidation of several amino acid residues by different oxidants. Further, Cys34 adducts, such as S-nitrosylated and S-guanylated forms also play an important role in clinical applications. On the other hand, the ratio of the oxidized form to the normal form of albumin (HMA/HNA), which is a function of the redox states of Cys34, could serve as a useful marker for evaluating systemic redox states, which would be useful for the evaluation of disease progression and therapeutic efficacy. GENERAL SIGNIFICANCE This review provides new insights into our current understanding of the mechanism of HSA oxidation, based on in vitro and in vivo studies. This article is part of a Special Issue entitled Serum Albumin.
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Affiliation(s)
- Makoto Anraku
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto 860-0082, Japan
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Sela S, Michelis R, Kristal B. Are Oxidative Modifications of Proteins a Metabolomic Signature of Cardiovascular Disease in CKD? Am J Kidney Dis 2013; 61:350-1. [DOI: 10.1053/j.ajkd.2012.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 10/19/2012] [Indexed: 11/11/2022]
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20
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Piroddi M, Bartolini D, Ciffolilli S, Galli F. Nondialyzable Uremic Toxins. Blood Purif 2013; 35 Suppl 2:30-41. [DOI: 10.1159/000350846] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Ramirez SPB, McCullough KP, Thumma JR, Nelson RG, Morgenstern H, Gillespie BW, Inaba M, Jacobson SH, Vanholder R, Pisoni RL, Port FK, Robinson BM. Hemoglobin A(1c) levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Diabetes Care 2012; 35:2527-32. [PMID: 22912431 PMCID: PMC3507600 DOI: 10.2337/dc12-0573] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lowering hemoglobin A(1c) to <7% reduces the risk of microvascular complications of diabetes, but the importance of maintaining this target in diabetes patients with kidney failure is unclear. We evaluated the relationship between A(1c) levels and mortality in an international prospective cohort study of hemodialysis patients. RESEARCH DESIGN AND METHODS Included were 9,201 hemodialysis patients from 12 countries (Dialysis Outcomes and Practice Patterns Study 3 and 4, 2006-2010) with type 1 or type 2 diabetes and at least one A(1c) measurement during the first 8 months after study entry. Associations between A(1c) and mortality were assessed with Cox regression, adjusting for potential confounders. RESULTS The association between A(1c) and mortality was U-shaped. Compared with an A(1c) of 7-7.9%, the hazard ratios (95% CI) for A(1c) levels were 1.35 (1.09-1.67) for <5%, 1.18 (1.01-1.37) for 5-5.9%, 1.21 (1.05-1.41) for 6-6.9%, 1.16 (0.94-1.43) for 8-8.9%, and 1.38 (1.11-1.71) for ≥9.0%, after adjustment for age, sex, race, BMI, serum albumin, years of dialysis, serum creatinine, 12 comorbid conditions, insulin use, hemoglobin, LDL cholesterol, country, and study phase. Diabetes medications were prescribed for 35% of patients with A(1c) <6% and not prescribed for 29% of those with A(1c) ≥9%. CONCLUSIONS A(1c) levels strongly predicted mortality in hemodialysis patients with type 1 or type 2 diabetes. Mortality increased as A(1c) moved further from 7-7.9%; thus, target A(1c) in hemodialysis patients may encompass values higher than those recommended by current guidelines. Modifying glucose-lowering medicines for dialysis patients to target A(1c) levels within this range may be a modifiable practice to improve outcomes.
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Isani G, Andreani G, Carpenè E, Di Molfetta S, Eletto D, Spisni E. Effects of waterborne Cu exposure in gilthead sea bream (Sparus aurata): a proteomic approach. FISH & SHELLFISH IMMUNOLOGY 2011; 31:1051-1058. [PMID: 21925607 DOI: 10.1016/j.fsi.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/25/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
Aquatic organisms may suffer from exposure to high Cu concentrations, since this metal is widely used in feed supplementation, in pesticide formulation and as antifouling. Chronic exposure to Cu, even at sub-lethal doses, may strongly affect fish physiology. To date, several biomarkers have been used to detect Cu exposure in fish producing contrasting results. Therefore, we used a proteomic approach to clarify how Cu exposure may affect the serum proteome of gilthead sea bream (Sparus aurata), since serum could be considered a good source of early-biomarkers of Cu toxicosis. For this purpose we exposed juvenile gilthead sea bream to waterborne Cu (0.5 mg/L). Our results indicate that fish tightly regulate circulating Cu levels, which are not affected by metal exposure. This homeostatic control is mainly achieved by the liver, able to excrete high amounts of the metal via bile. Cu exposure caused differential expression of several serum proteins, 10 of which were identified by Mascot and BLAST search. All these proteins, with the exception of growth hormone receptor and γ-glutamyl-carboxylase, can be related to: 1) Cu-induced hepatotoxicity (cytochrome oxidase subunit I, alanine aminotransferase, glutathione S-transferase); 2) potential immunosuppression due to interference of Cu with the inflammation/immunity network (α-1 antitrypsin, angiotensinogen, complement component C3, recombination-activating protein-1 and warm temperature acclimation-related 65 kDa protein).
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Affiliation(s)
- Gloria Isani
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064 Ozzano Emilia (BO), Italy.
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Abstract
Hypoalbuminemia is common among critically ill/injured patients and is strongly associated with increased morbidity and mortality in the patients with and without neurological conditions. Normal serum albumin is important as the primary intravascular antioxidant, in transporting a variety of hormones, medications and electrolytes, in providing colloid osmotic pressure during trans-compartmental fluid movement, in enhancing organ and tissue blood flow, and in supporting acid-base balance. Studies of albumin administration during intravascular resuscitation have not addressed potential longer term benefits to sustaining serum albumin concentrations during critical care. Evidence for such benefit is present although additional prospective studies are needed.
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Affiliation(s)
- David J Powner
- Departments of Neurosurgery and Internal Medicine, University of Texas Health Sciences Center at Houston Medical School, 6431 Fannin Street, MSB 7.154, Houston, TX 77030, USA.
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