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Ruilope LM, Ortiz A, Lucia A, Miranda B, Alvarez-Llamas G, Barderas MG, Volpe M, Ruiz-Hurtado G, Pitt B. Prevention of cardiorenal damage: importance of albuminuria. Eur Heart J 2022; 44:1112-1123. [PMID: 36477861 DOI: 10.1093/eurheartj/ehac683] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Chronic kidney disease (CKD) is projected to become a leading global cause of death by 2040, and its early detection is critical for effective and timely management. The current definition of CKD identifies only advanced stages, when kidney injury has already destroyed >50% of functioning kidney mass as reflected by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or a urinary albumin/creatinine ratio >six-fold higher than physiological levels (i.e. > 30 mg/g). An elevated urinary albumin-excretion rate is a known early predictor of future cardiovascular events. There is thus a ‘blind spot’ in the detection of CKD, when kidney injury is present but is undetectable by current diagnostic criteria, and no intervention is made before renal and cardiovascular damage occurs. The present review discusses the CKD ‘blind spot’ concept and how it may facilitate a holistic approach to CKD and cardiovascular disease prevention and implement the call for albuminuria screening implicit in current guidelines. Cardiorenal risk associated with albuminuria in the high-normal range, novel genetic and biochemical markers of elevated cardiorenal risk, and the role of heart and kidney protective drugs evaluated in recent clinical trials are also discussed. As albuminuria is a major risk factor for cardiovascular and renal disease, starting from levels not yet considered in the definition of CKD, the implementation of opportunistic or systematic albuminuria screening and therapy, possibly complemented with novel early biomarkers, has the potential to improve cardiorenal outcomes and mitigate the dismal 2040 projections for CKD and related cardiovascular burden.
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Affiliation(s)
- Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Blanca Miranda
- Fundación Renal Íñigo Álvarez de Toledo , José Abascal, 42, 28003 Madrid , Spain
| | - Gloria Alvarez-Llamas
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos (HNP), SESCAM , FINCA DE, Carr. de la Peraleda, S/N, 45004 Toledo , Spain
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome and IRCCS San Raffaele Rome , Sant'Andrea Hospital, Rome , Italy
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
| | - Bertram Pitt
- Division of Cardiology, University of Michigan School of Medicine , Ann Arbor, MI , USA
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Corbacho-Alonso N, Baldán-Martín M, López JA, Rodríguez-Sánchez E, Martínez PJ, Mourino-Alvarez L, Sastre-Oliva T, Cabrera M, Calvo E, Padial LR, Vázquez J, Vivanco F, Alvarez-Llamas G, Ruiz-Hurtado G, Ruilope LM, Barderas MG. Cardiovascular Risk Stratification Based on Oxidative Stress for Early Detection of Pathology. Antioxid Redox Signal 2021; 35:602-617. [PMID: 34036803 DOI: 10.1089/ars.2020.8254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims: Current cardiovascular (CV) risk prediction algorithms are able to quantify the individual risk of CV disease. However, CV risk in young adults is underestimated due to the high dependency of age in biomarker-based algorithms. Because oxidative stress is associated with CV disease, we sought to examine CV risk stratification in young adults based on oxidative stress to approach the discovery of new markers for early detection of pathology. Results: Young adults were stratified into (i) healthy controls, (ii) subjects with CV risk factors, and (iii) patients with a reported CV event. Plasma samples were analyzed using FASILOX, a novel approach to interrogate the dynamic thiol redox proteome. We also analyzed irreversible oxidation by targeted searches using the Uniprot database. Irreversible oxidation of cysteine (Cys) residues was greater in patients with reported CV events than in healthy subjects. These results also indicate that oxidation is progressive. Moreover, we found that glutathione reductase and glutaredoxin 1 proteins are differentially expressed between groups and are proteins involved in antioxidant response, which is in line with the impaired redox homeostasis in CV disease. Innovation: This study, for the first time, describes the oxidative stress (reversible and irreversible Cys oxidation) implication in human plasma according to CV risk stratification. Conclusion: The identification of redox targets and the quantification of protein and oxidative changes might help to better understand the role of oxidative stress in CV disease, and aid stratification for CV events beyond traditional prognostic and diagnostic markers. Antioxid. Redox Signal. 35, 602-617.
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Affiliation(s)
- Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Montserrat Baldán-Martín
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Paula J Martínez
- Departament of Immunology, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | | | - Luis R Padial
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, Toledo, Spain
| | - Jesús Vázquez
- Cardiovascular Proteomics Laboratory and CIBER-CV, CNIC, Madrid, Spain
| | - Fernando Vivanco
- Departament of Immunology, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Gloria Alvarez-Llamas
- Departament of Immunology, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,RED in REN, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
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3
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Corbacho-Alonso N, Rodríguez-Sánchez E, Martin-Rojas T, Mouriño-Alvarez L, Sastre-Oliva T, Hernandez-Fernandez G, Padial LR, Ruilope LM, Ruiz-Hurtado G, Barderas MG. Proteomic investigations into hypertension: what's new and how might it affect clinical practice? Expert Rev Proteomics 2019; 16:583-591. [PMID: 31195841 DOI: 10.1080/14789450.2019.1632197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Hypertension is a multifactorial disease that has, thus far, proven to be a difficult target for pharmacological intervention. The application of proteomic strategies may help to identify new biomarkers for the early diagnosis and prompt treatment of hypertension, in order to control blood pressure and prevent organ damage. Areas covered: Advances in proteomics have led to the discovery of new biomarkers to help track the pathophysiological processes implicated in hypertension. These findings not only help to better understand the nature of the disease, but will also contribute to the clinical needs for a timely diagnosis and more precise treatment. In this review, we provide an overview of new biomarkers identified in hypertension through the application of proteomic techniques, and we also discuss the difficulties and challenges in identifying biomarkers in this clinical setting. We performed a literature search in PubMed with the key words 'hypertension' and 'proteomics', and focused specifically on the most recent literature on the utility of proteomics in hypertension research. Expert opinion: There have been several promising biomarkers of hypertension identified by proteomics, but too few have been introduced to the clinic. Thus, further investigations in larger cohorts are necessary to test the feasibility of this strategy for patients. Also, this emerging field would profit from more collaboration between clinicians and researchers.
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Affiliation(s)
- N Corbacho-Alonso
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - E Rodríguez-Sánchez
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - T Martin-Rojas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L Mouriño-Alvarez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - T Sastre-Oliva
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - G Hernandez-Fernandez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L R Padial
- c Department of Cardiology , Hospital Virgen de la Salud, SESCAM , Toledo , Spain
| | - L M Ruilope
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain.,d Department of Preventive Medicine and Public Health, School of Medicine , Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP) , Madrid , Spain.,e School of Doctoral Studies and Research , Universidad Europea de Madrid , Madrid , Spain
| | - G Ruiz-Hurtado
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - M G Barderas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
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Martin-Lorenzo M, Martinez PJ, Baldan-Martin M, Lopez JA, Minguez P, Santiago-Hernandez A, Vazquez J, Segura J, Ruiz-Hurtado G, Vivanco F, Barderas MG, Ruilope LM, Alvarez-Llamas G. Urine Haptoglobin and Haptoglobin-Related Protein Predict Response to Spironolactone in Patients With Resistant Hypertension. Hypertension 2019; 73:794-802. [PMID: 30712426 DOI: 10.1161/hypertensionaha.118.12242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Resistant hypertension prevalence is progressively increasing, and prolonged exposure to suboptimal blood pressure control results in higher cardiovascular risk and end-organ damage. Among various antihypertensive agents, spironolactone seems the most effective choice to treat resistant hypertension once triple therapy including a diuretic fails. However success in blood pressure control is not guaranteed, adverse effects are not negligible, and no clinical tools are available to predict patient's response. Complementary to our previous study of resistant hypertension metabolism, here we investigated urinary proteome changes with potential capacity to predict response to spironolactone. Twenty-nine resistant hypertensives were included. A prospective study was conducted and basal urine was collected before spironolactone administration. Patients were classified in responders or nonresponders in terms of blood pressure control. Protein quantitation was performed by liquid chromatography-mass spectrometry; ELISA and target mass spectrometry analysis were performed for confirmation. Among 3310 identified proteins, HP (haptoglobin) and HPR (haptoglobin-related protein) showed the most significant variations, with increased levels in nonresponders compared with responders before drug administration (variation rate, 5.98 and 7.83, respectively). Protein-coordinated responses were also evaluated by functional enrichment analysis, finding oxidative stress, chronic inflammatory response, blood coagulation, complement activation, and regulation of focal adhesions as physiopathological mechanisms in resistant hypertension. In conclusion, protein changes able to predict patients' response to spironolactone in basal urine were here identified for the first time. These data, once further confirmed, will support clinical decisions on patients' management while contributing to optimize the rate of control of resistant hypertensives with spironolactone.
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Affiliation(s)
- Marta Martin-Lorenzo
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Paula J Martinez
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.)
| | - Juan A Lopez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain (J.A.L., J.V.)
| | - Pablo Minguez
- Department of Genetics (P.M.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Aranzazu Santiago-Hernandez
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesus Vazquez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain (J.A.L., J.V.)
| | - Julian Segura
- Department of Nephrology, Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain (J.S., L.M.R.)
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12 Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain (G.R.-H., L.M.R.)
| | - Fernando Vivanco
- Department of Biochemistry and Molecular Biology, I Universidad Complutense, Madrid, Spain (F.V.)
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.)
| | - Luis M Ruilope
- Department of Nephrology, Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain (J.S., L.M.R.).,Cardiorenal Translational Laboratory, Instituto de Investigación I+12 Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain (G.R.-H., L.M.R.).,School of Doctoral Studies and Research, Universidad Europea de Madrid, Spain (L.M.R.)
| | - Gloria Alvarez-Llamas
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.,REDINREN, Madrid, Spain (G.A.-L.)
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5
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Martínez PJ, Baldán-Martín M, López JA, Martín-Lorenzo M, Santiago-Hernández A, Agudiez M, Cabrera M, Calvo E, Vázquez J, Ruiz-Hurtado G, Vivanco F, Ruilope LM, Barderas MG, Alvarez-Llamas G. Identification of six cardiovascular risk biomarkers in the young population: A promising tool for early prevention. Atherosclerosis 2019; 282:67-74. [PMID: 30690299 DOI: 10.1016/j.atherosclerosis.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The predictive value of traditional CV risk calculators is limited. Novel indicators of CVD progression are needed particularly in the young population. The main aim of this study was the identification of a molecular profile with added value to classical CV risk estimation. METHODS Eighty-one subjects (30-50 years) were classified in 3 groups according to their CV risk: healthy subjects; individuals with CV risk factors; and those who had suffered a previous CV event. The urine proteome was quantitatively analyzed and significantly altered proteins were identified between patients' groups, either related to CV risk or established organ damage. Target-MS and ELISA were used for confirmation in independent patients' cohorts. Systems Biology Analysis (SBA) was carried out to identify functional categories behind CVD. RESULTS 4309 proteins were identified, 75 of them differentially expressed. ADX, ECP, FETUB, GDF15, GUAD and NOTCH1 compose a fingerprint positively correlating with lifetime risk estimate (LTR QRISK). Best performance ROC curve was obtained when ECP, GDF15 and GUAD were combined (AUC = 0.96). SBA revealed oxidative stress response, dilated cardiomyopathy, signaling by Wnt and proteasome, as main functional processes related to CV risk. CONCLUSIONS A novel urinary protein signature is shown, which correlates with CV risk estimation in young individuals. Pending further confirmation, this six-protein-panel could help in CV risk assessment.
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Affiliation(s)
- Paula J Martínez
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | - Juan A López
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain
| | - Marta Martín-Lorenzo
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Aránzazu Santiago-Hernández
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Marta Agudiez
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | | | - Jesús Vázquez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain
| | - Fernando Vivanco
- Department of Biochemistry and Molecular Biology, I Universidad Complutense, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain; Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain
| | - Gloria Alvarez-Llamas
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain; REDINREN, Madrid, Spain.
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6
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Sanz AB, Ramos AM, Soler MJ, Sanchez-Niño MD, Fernandez-Fernandez B, Perez-Gomez MV, Ortega MR, Alvarez-Llamas G, Ortiz A. Advances in understanding the role of angiotensin-regulated proteins in kidney diseases. Expert Rev Proteomics 2018; 16:77-92. [DOI: 10.1080/14789450.2018.1545577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ana Belén Sanz
- Nephrology, IIS-Fundacion Jimenez Diaz and Universidad Autonoma de Madrid, Madrid, Spain
| | - Adrian Mario Ramos
- Nephrology, IIS-Fundacion Jimenez Diaz and Universidad Autonoma de Madrid, Madrid, Spain
| | - Maria Jose Soler
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | | | - Marta Ruiz Ortega
- Nephrology, IIS-Fundacion Jimenez Diaz and Universidad Autonoma de Madrid, Madrid, Spain
| | - Gloria Alvarez-Llamas
- Nephrology, IIS-Fundacion Jimenez Diaz and Universidad Autonoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- Nephrology, IIS-Fundacion Jimenez Diaz and Universidad Autonoma de Madrid, Madrid, Spain
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7
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Gonzalez-Calero L, Martínez PJ, Martin-Lorenzo M, Baldan-Martin M, Ruiz-Hurtado G, de la Cuesta F, Calvo E, Segura J, Lopez JA, Vázquez J, Barderas MG, Ruilope LM, Vivanco F, Alvarez-Llamas G. Urinary exosomes reveal protein signatures in hypertensive patients with albuminuria. Oncotarget 2018; 8:44217-44231. [PMID: 28562335 PMCID: PMC5546475 DOI: 10.18632/oncotarget.17787] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/20/2017] [Indexed: 01/05/2023] Open
Abstract
Albuminuria is an indicator of cardiovascular risk and renal damage in hypertensive individuals. Chronic renin-angiotensin system (RAS) suppression facilitates blood pressure control and prevents development of new-onset-albuminuria. A significant number of patients, however, develop albuminuria despite chronic RAS blockade, and the physiopathological mechanisms are underexplored. Urinary exosomes reflect pathological changes taking place in the kidney. The objective of this work was to examine exosomal protein alterations in hypertensive patients with albuminuria in the presence of chronic RAS suppression, to find novel clues underlying its development. Patients were followed-up for three years and were classified as: a) patients with persistent normoalbuminuria; b) patients developing de novo albuminuria; and c) patients with maintained albuminuria. Exosomal protein alterations between groups were identified by isobaric tag quantitation (iTRAQ). Confirmation was approached by target analysis (SRM). In total, 487 proteins were identified with high confidence. Specifically, 48 proteins showed an altered pattern in response to hypertension and/or albuminuria. Out of them, 21 proteins interact together in three main functional clusters: glycosaminoglycan degradation, coagulation and complement system, and oxidative stress. The identified proteins constitute potential targets for drug development and may help to define therapeutic strategies to evade albuminuria progression in hypertensive patients chronically treated.
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Affiliation(s)
| | - Paula J Martínez
- Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain
| | | | | | - Gema Ruiz-Hurtado
- Hypertension Unit, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando de la Cuesta
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | | | - Julian Segura
- Hypertension Unit, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Jesús Vázquez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | - Luis M Ruilope
- Hypertension Unit, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Vivanco
- Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain.,Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain
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8
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Translational science in albuminuria: a new view of de novo albuminuria under chronic RAS suppression. Clin Sci (Lond) 2018; 132:739-758. [DOI: 10.1042/cs20180097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/29/2022]
Abstract
The development of de novo albuminuria during chronic renin–angiotensin system (RAS) suppression is a clinical entity that remains poorly recognized in the biomedical literature. It represents a clear increment in global cardiovascular (CV) and renal risk that cannot be counteracted by RAS suppression. Although not specifically considered, it is clear that this entity is present in most published and ongoing trials dealing with the different forms of CV and renal disease. In this review, we focus on the mechanisms promoting albuminuria, and the predictors and new markers of de novo albuminuria, as well as the potential treatment options to counteract the excretion of albumin. The increase in risk that accompanies de novo albuminuria supports the search for early markers and predictors that will allow practising physicians to assess and prevent the development of de novo albuminuria in their patients.
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9
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Baldan-Martin M, Lopez JA, Corbacho-Alonso N, Martinez PJ, Rodriguez-Sanchez E, Mourino-Alvarez L, Sastre-Oliva T, Martin-Rojas T, Rincón R, Calvo E, Vazquez J, Vivanco F, Padial LR, Alvarez-Llamas G, Ruiz-Hurtado G, Ruilope LM, Barderas MG. Potential role of new molecular plasma signatures on cardiovascular risk stratification in asymptomatic individuals. Sci Rep 2018; 8:4802. [PMID: 29555916 PMCID: PMC5859270 DOI: 10.1038/s41598-018-23037-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/05/2018] [Indexed: 12/15/2022] Open
Abstract
The evaluation of cardiovascular (CV) risk is based on equations derived from epidemiological data in individuals beyond the limits of middle age such as the Framingham and SCORE risk assessments. Lifetime Risk calculator (QRisk®), estimates CV risk throughout a subjects’ lifetime, allowing those. A more aggressive and earlier intervention to be identified and offered protection from the consequences of CV and renal disease. The search for molecular profiles in young people that allow a correct stratification of CV risk would be of great interest to adopt preventive therapeutic measures in individuals at high CV risk. To improve the selection of subjects susceptible to intervention with aged between 30–50 years, we have employed a multiple proteomic strategy to search for new markers of early CV disease or reported CV events and to evaluate their relationship with Lifetime Risk. Blood samples from 71 patients were classified into 3 groups according to their CV risk (healthy, with CV risk factors and with a previously reported CV event subjects) and they were analyzed using a high through quantitative proteomics approach. This strategy allowed three different proteomic signatures to be defined, two of which were related to CV stratification and the third one involved markers of organ damage.
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Affiliation(s)
- Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Juan A Lopez
- Cardiovascular Proteomics Laboratory and CIBER-CV, CNIC, Madrid, Spain
| | - Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Paula J Martinez
- Departament of Immunology, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Elena Rodriguez-Sanchez
- Laboratory of Hypertension and Cardiovascular Risk, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Tatiana Martin-Rojas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Raul Rincón
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | | | - Jesus Vazquez
- Cardiovascular Proteomics Laboratory and CIBER-CV, CNIC, Madrid, Spain
| | - Fernando Vivanco
- Departament of Immunology, IIS-Fundacion Jimenez Diaz, Madrid, Spain.,Departamento de Bioquimica y Biologia Molecular I, Universidad Complutense, Madrid, Spain
| | - Luis R Padial
- Departamento de Cardiologia, Complejo Hospitalario de Toledo, SESCAM, Toledo, Spain
| | | | - Gema Ruiz-Hurtado
- Laboratory of Hypertension and Cardiovascular Risk, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Ruilope
- Laboratory of Hypertension and Cardiovascular Risk, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain.
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10
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Rodriguez-Padial L, Akerström F, Barderas MG, Vivanco F, Arias MA, Segura J, Ruilope LM. Progression of Renal Insufficiency in Patients with Essential Hypertension Treated with Renin Angiotensin Aldosterone System Blockers: An Electrocardiographic Correlation. Diseases 2017; 5:E33. [PMID: 29292714 PMCID: PMC5750544 DOI: 10.3390/diseases5040033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is a frequent association between renal insufficiency and cardiovascular disease in patients with essential hypertension (HTN). The aim of this study was to analyze the relationship between ECG parameters and the progress of renal damage in patients with treated HTN. METHODS 109 patients with HTN had their microalbuminuria monitored over a 3-year time frame. During the last 3 months of follow-up, an ECG was recorded. Patients were divided into 3 groups according to the deterioration of their renal function: normoalbuminuria during the study period (normo-normo; n = 51); normoalbuminuria developing microalbuminuria (normo-micro; n = 29); and microalbuminuria at baseline (micro-micro; n = 29). RESULTS There were no differences in presence of left ventricular hypertrophy between the 3 groups. RV6/RV5 >1 was observed more frequently as renal function declined (p = 0.025). The 12-lead QRS-complex voltage-duration product was significantly increased in patients without microalbuminuria at baseline who went on to develop microalbuminuria (p = 0.006). Patients who developed microalbuminuria during follow-up, with positive Cornell voltage criteria, showed a lesser degree of progression of microalbuminuria when compared with the rest of the subgroups (p = 0.044). Furthermore, patients with microalbuminuria at baseline treated with angiotensin receptor blockers and diuretics, and positive Cornell voltage criteria, showed a higher degree of microalbuminuria compared to those with negative Cornell voltage criteria (p = 0.016). CONCLUSIONS In patients with HTN, we identified some ECG parameters, which predict renal disease progression in patients with HTN, which may permit the identification of patients who are at risk of renal disease progression, despite optimal antihypertensive pharmacotherapy.
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Affiliation(s)
| | - Finn Akerström
- Department of Cardiology, Hospital Virgen de la Salud, 45005 Toledo, Spain.
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, 45005 Toledo, Spain.
| | - Fernando Vivanco
- Department of Imunology, Fundacion Jimenez Diaz, UAM, 28220 Madrid, Spain.
| | - Miguel A Arias
- Department of Cardiology, Hospital Virgen de la Salud, 45005 Toledo, Spain.
| | - Julian Segura
- Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, 28220 Madrid, Spain.
| | - Luis M Ruilope
- Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, 28220 Madrid, Spain.
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11
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de la Cuesta F, Baldan-Martin M, Moreno-Luna R, Alvarez-Llamas G, Gonzalez-Calero L, Mourino-Alvarez L, Sastre-Oliva T, López JA, Vázquez J, Ruiz-Hurtado G, Segura J, Vivanco F, Ruilope LM, Barderas MG. Kalirin and CHD7: novel endothelial dysfunction indicators in circulating extracellular vesicles from hypertensive patients with albuminuria. Oncotarget 2017; 8:15553-15562. [PMID: 28152519 PMCID: PMC5362505 DOI: 10.18632/oncotarget.14948] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/05/2016] [Indexed: 11/25/2022] Open
Abstract
Despite of the great advances in anti-hypertensive therapies, many patients under Renin-Angiotensin- System (RAS) suppression develop albuminuria, which is a clear indicator of therapeutic inefficiency. Hence, indicators of vascular function are needed to assess patients’ condition and help deciding future therapies. Proteomic analysis of circulating extracellular vesicles (EVs) showed two proteins, kalirin and chromodomain-helicase-DNA-binding protein 7 (CHD7), increased in albuminuric patients. A positive correlation of both with the expression of the endothelial activation marker E-selectin was found in EVs. In vitro analysis using TNFα-treated adult human endothelial cells proved their involvement in endothelial cell activation. Hence, we propose protein levels of kalirin and CHD7 in circulating EVs as novel endothelial dysfunction markers to monitor vascular condition in hypertensive patients with albuminuria.
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Affiliation(s)
- Fernando de la Cuesta
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain.,Current address: Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Rafael Moreno-Luna
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | | | | | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
| | | | | | - Gema Ruiz-Hurtado
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Julian Segura
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Vivanco
- Department of Immunology, IIS-Fundacion Jimenez Diaz, Madrid, Spain.,Departamento de Bioquimica y Biologia Molecular I, Universidad Complutense, Madrid, Spain
| | - Luis M Ruilope
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain
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12
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Gonzalez-Calero L, Martin-Lorenzo M, Martínez PJ, Baldan-Martin M, Ruiz-Hurtado G, Segura J, de la Cuesta F, Barderas MG, Ruilope LM, Vivanco F, Alvarez-Llamas G. Hypertensive patients exhibit an altered metabolism. A specific metabolite signature in urine is able to predict albuminuria progression. Transl Res 2016; 178:25-37.e7. [PMID: 27477079 DOI: 10.1016/j.trsl.2016.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/22/2016] [Accepted: 07/06/2016] [Indexed: 11/27/2022]
Abstract
Hypertension (HTN) is increasing in prevalence, and albuminuria is a strong indicator of cardiovascular risk and renal damage progression. Despite blood pressure control with chronic treatment, a relevant subgroup of patients develop albuminuria. However, the biological factors responsible for albuminuria development and progression are underexplored. We aimed to identify key metabolic targets and biological pathways involved in the negative progression of cardiovascular and renal damage in hypertensives undergoing chronic treatment. A series of 1533 patients were followed for 5 years to investigate the evolution of albuminuria. Patients were classified as: (1) patients with persistent normoalbuminuria; (2) patients developing de novo albuminuria; and (3) patients with maintained albuminuria. At the end of follow-up, urine from 30 nonhypertensive subjects (control group) and a representative cohort of 118 patients was collected for metabolomic analysis. Metabolic patterns of interest were identified in a first discovery phase by nuclear magnetic resonance and further confirmed by liquid chromatography-mass spectrometry. Metabolites corresponding to HTN or albuminuria were measured in a prospective study carried out in 35 individuals still in normoalbuminuria, to evaluate their potential as predictors of albuminuria development. Nine metabolites were significantly altered, linking β-alanine metabolism, arginine and proline metabolism, and tricarboxylic acid cycle. The prospective study revealed a panel composed of guanidinoacetate, glutamate, and pantothenate, which was able to predict development of albuminuria. These metabolic signatures open new possibilities in hypertensive therapy and cardiovascular risk control, providing prompt and more efficient intervention, particularly in patients with worse cardiovascular prognosis.
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Affiliation(s)
| | | | - Paula J Martínez
- Departamento de Inmunologia, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | | | - Gema Ruiz-Hurtado
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Spain
| | - Julian Segura
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando de la Cuesta
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | - Maria G Barderas
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | - Luis M Ruilope
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Fernando Vivanco
- Departamento de Inmunologia, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain; Departamento de Bioquimica y Biologia Molecular I, Universidad Complutense de Madrid, Spain
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13
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Mourino-Alvarez L, Baldan-Martin M, Gonzalez-Calero L, Martinez-Laborde C, Sastre-Oliva T, Moreno-Luna R, Lopez-Almodovar LF, Sanchez PL, Fernandez-Aviles F, Vivanco F, Padial LR, Akerstrom F, Alvarez-Llamas G, de la Cuesta F, Barderas MG. Patients with calcific aortic stenosis exhibit systemic molecular evidence of ischemia, enhanced coagulation, oxidative stress and impaired cholesterol transport. Int J Cardiol 2016; 225:99-106. [PMID: 27716559 DOI: 10.1016/j.ijcard.2016.09.089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The most common valve diseases are calcific aortic stenosis (AS) and aortic regurgitation (AR). The former is characterized by thickening of valve leaflets followed by progressive calcification, which produces progressive aortic valve (AV) narrowing, increased pressure afterload on the left ventricle (LV) and subsequent LV hypertrophy. On the other hand, AR is due to malcoaptation of the valve leaflets with resultant diastolic reflux of blood from aorta back to the LV producing volume and pressure overload and progressive LV dilatation. In order to isolate the molecular mechanisms taking place during AS, we have used an integrated "-omic" approach to compare plasma samples from AS and from AR patients used as controls. The final purpose of this work is to find molecular changes in response to the calcification of the AV, diminishing the effects of the AV dysfunction. METHODS AND RESULTS Using two-dimensional difference gel electrophoresis (2D-DIGE) and gas chromatography coupled to mass spectrometry (GC-MS) in a cohort of 6 subjects, we have found differences in 24 protein spots and 19 metabolites, respectively. Among them, 7 proteins and 3 metabolites have been verificated by orthogonal techniques (SRM or turbidimetry): fibrinogen beta and gamma chain, vitronectin, apolipoprotein C-II, antithrombin III, haptoglobin, succinic acid, pyroglutamic acid and alanine. Classification according to their main function showed alterations related to coagulation, inflammation, oxidative stress, response to ischemia and lipid metabolism, defining 4 different molecular panels that characterize AS with high specificity and sensitivity. CONCLUSION These results may facilitate management of these patients by making faster diagnostics of the disease and better understand these pathways for regulating its progression.
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Affiliation(s)
- Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | | | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Rafael Moreno-Luna
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Vivanco
- Department of Immunology, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Luis R Padial
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, Toledo, Spain
| | - Finn Akerstrom
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, Toledo, Spain
| | | | - Fernando de la Cuesta
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
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14
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Izquierdo I, Rosa I, Bravo SB, Guitián E, Pérez-Serra A, Campuzano O, Brugada R, Mangas A, García Á, Toro R. Proteomic identification of putative biomarkers for early detection of sudden cardiac death in a family with a LMNA gene mutation causing dilated cardiomyopathy. J Proteomics 2016; 148:75-84. [PMID: 27457270 DOI: 10.1016/j.jprot.2016.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 01/20/2023]
Abstract
UNLABELLED Dilated cardiomyopathy (DCM) is a severe heart disease characterized by progressive ventricular dilation and impaired systolic function of the left ventricle. We recently identified a novel pathogenic mutation in the LMNA gene in a family affected by DCM showing sudden death background. We now aimed to identify potential biomarkers of disease status, as well as sudden death predictors, in members of this family. We analysed plasma samples from 14 family members carrying the mutation, four of which (with relevant clinical symptoms) were chosen for the proteomic analysis. Plasma samples from these four patients and from four sex- and age-matched healthy controls were processed for their enrichment in low- and medium-abundance proteins (ProteoMiner™) prior to proteomic analysis by 2D-DIGE and MS. 111 spots were found to be differentially regulated between mutation carriers and control groups, 83 of which were successfully identified by MS, corresponding to 41 different ORFs. Some proteins of interest were validated either by turbidimetry or western blot in family members and healthy controls. Actin, alpha-1-antytripsin, clusterin, vitamin-D binding protein and antithrombin-III showed increased levels in plasma from the diseased group. We suggest following these proteins as putative biomarkers for the evaluation of DCM status in LMNA mutation carriers. BIOLOGICAL SIGNIFICANCE We developed a proteomic analysis of plasma samples from a family showing history of dilated cardiomyopathy caused by a LMNA mutation, which may lead to premature death or cardiac transplant. We identified a number of proteins augmented in mutation carriers that could be followed as potential biomarkers for dilated cardiomyopathy on these patients.
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Affiliation(s)
- Irene Izquierdo
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidad de Santiago de Compostela, and Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain; Departament of Pharmacology, Faculty of Pharmacy, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Isaac Rosa
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidad de Santiago de Compostela, and Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Susana Belén Bravo
- Proteomic Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Esteban Guitián
- Mass Spectrometry and Proteomic Unit, Rede de Infraestructuras de Apoio á Investigación e ao Desenvolvemento Tecnolóxico (RIAIDT), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Oscar Campuzano
- Cardiovascular Genetics Center, IDIBGI, University of Girona, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, IDIBGI, University of Girona, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Cardiac Genetics Unit, Hospital Josep Trueta, University of Girona, Girona, Spain
| | - Alipio Mangas
- Medicine Department, School of Medicine, Universidad de Cádiz, Spain
| | - Ángel García
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidad de Santiago de Compostela, and Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain; Departament of Pharmacology, Faculty of Pharmacy, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Rocio Toro
- Medicine Department, School of Medicine, Universidad de Cádiz, Spain.
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15
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Baldan-Martin M, Mourino-Alvarez L, Gonzalez-Calero L, Moreno-Luna R, Sastre-Oliva T, Ruiz-Hurtado G, Segura J, Lopez JA, Vazquez J, Vivanco F, Alvarez-Llamas G, Ruilope LM, de la Cuesta F, Barderas MG. Plasma Molecular Signatures in Hypertensive Patients With Renin–Angiotensin System Suppression. Hypertension 2016; 68:157-66. [DOI: 10.1161/hypertensionaha.116.07412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/27/2016] [Indexed: 01/08/2023]
Abstract
Albuminuria is a risk factor strongly associated with cardiovascular disease, the first cause of death in the general population. It is well established that renin–angiotensin system suppressors prevent the development of new-onset albuminuria in naïf hypertensive patients and diminish its excretion, but we cannot forget the percentage of hypertensive patients who develop de novo albuminuria. Here, we applied multiple proteomic strategy with the purpose to elucidate specific molecular pathways involved in the pathogenesis and provide predictors and chronic organ damage indicators. Briefly, 1143 patients were followed up for a minimum period of 3 years. One hundred and twenty-nine hypertensive patients chronically renin–angiotensin system suppressed were recruited, classified in 3 different groups depending on their albuminuria levels (normoalbuminuria, de novo albuminuria, and sustained albuminuria), and investigated by multiple proteomic strategies. Our strategy allowed us to perform one of the deepest plasma proteomic analysis to date, which has shown 2 proteomic signatures: (1) with predictive value of de novo albuminuria and (2) sustained albuminuria indicator proteins. These proteins are involved in inflammation, immune as well as in the proteasome activation occurring in situations of endoplasmic reticulum stress. Furthermore, these results open the possibility of a future strategy based on anti-immune therapy to treat hypertension which could help to prevent the development of albuminuria and, hence, the progression of kidney damage.
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Affiliation(s)
- Montserrat Baldan-Martin
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Laura Mourino-Alvarez
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Laura Gonzalez-Calero
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Rafael Moreno-Luna
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Tamara Sastre-Oliva
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Gema Ruiz-Hurtado
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Julian Segura
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Juan Antonio Lopez
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Jesus Vazquez
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Fernando Vivanco
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Gloria Alvarez-Llamas
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Luis M. Ruilope
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Fernando de la Cuesta
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
| | - Maria G. Barderas
- From the Departamento de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos (HNP), SESCAM, Toledo, Spain (M.B.-M., L.M.-A., R.M.-L., T.S.-O., F.d.l.C., M.G.B.); Departamento de Inmunologia, IIS-Fundacion JimenezDiaz, Madrid, Spain (L.G.-C., F.V., G.A.-L.); Unidad de Hipertension, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.S., L.M.R.); Unidad de Proteomica CNIC, Madrid, Spain (J.A.L., J.V.); and Departamento de Bioquimica y Biologia
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Role of matrix metalloproteinase-9 in chronic kidney disease: a new biomarker of resistant albuminuria. Clin Sci (Lond) 2016; 130:525-38. [PMID: 26733721 DOI: 10.1042/cs20150517] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/04/2016] [Indexed: 12/21/2022]
Abstract
Resistant albuminuria, developed under adequate chronic blockade of the renin-angiotensin system, is a clinical problem present in a small number of patients with chronic kidney disease (CKD). The mechanism underlying this resistant albuminuria remains unknown. Matrix metalloproteinases (MMPs) are involved in the pathophysiology of cardiovascular and renal diseases. In the present study we tested the role of MMPs in resistant albuminuria. First we evaluated gelatinase MMP-2 and MMP-9 activity by zymography in the Munich Wistar Frömter (MWF) rat, a model of progressive albuminuria, and subsequently in patients with resistant albuminuria. Markers of oxidative stress were observed in the kidneys of MWF rats, together with a significant increase in pro-MMP-2 and active MMP-9 forms. These changes were normalized together with reduced albuminuria in consomic MWF-8(SHR) rats, in which chromosome 8 of MWF was replaced with the respective chromosome from spontaneously hypertensive rats. The MMP-2 and MMP-9 protein levels were similar in patients with normal and resistant albuminuria; however, high circulating levels of collagen IV, a specific biomarker of tissue collagen IV degradation, were observed in patients with resistant albuminuria. These patients showed a significant increase in gelatinase MMP-2 and MMP-9 activity, but only a significant increase in the active MMP-9 form quantified by ELISA, which correlated significantly with the degree of albuminuria. Although the expression of the tissue inhibitor of MMP-9 (TIMP)-1 was similar, a novel AlphaLISA assay demonstrated that the MMP-9-TIMP-1 interaction was reduced in patients with resistant albuminuria. It is of interest that oxidized TIMP-1 expression was higher in patients with resistant albuminuria. Therefore, increased circulating MMP-9 activity is associated with resistant albuminuria and a deleterious oxidative stress environment appears to be the underlying mechanism. These changes might contribute to the progression of CKD in these patients.
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