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Zhu Y, Lai Y, Hu Y, Fu Y, Zhang Z, Lin N, Huang W, Zheng L. The mechanisms underlying acute myocardial infarction in chronic kidney disease patients undergoing hemodialysis. Biomed Pharmacother 2024; 177:117050. [PMID: 38968794 DOI: 10.1016/j.biopha.2024.117050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death in chronic kidney disease (CKD). Hemodialysis is one of the main treatments for patients with end-stage kidney disease. Epidemiological data has shown that acute myocardial infarction (AMI) accounts for the main reason for death in patients with CKD under hemodialysis therapy. Immune dysfunction and changes in metabolism (including a high level of inflammatory cytokines, a disorder of lipid and mineral ion homeostasis, accumulation of uremic toxins et al.) during CKD can deteriorate stability of atherosclerotic plaque and promote vascular calcification, which are exactly the pathophysiological mechanisms underlying the occurrence of AMI. Meanwhile, the hemodialysis itself also has adverse effects on lipoprotein, the immune system and hemodynamics, which contribute to the high incidence of AMI in these patients. This review aims to summarize the mechanisms and further promising methods of prevention and treatment of AMI in CKD patients undergoing hemodialysis, which can provide an excellent paradigm for exploring the crosstalk between the kidney and cardiovascular system.
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Affiliation(s)
- Yujie Zhu
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, State Key Laboratory of Vascular Homeostasis and Remodeling, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China
| | - Yuchen Lai
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yuxuan Hu
- Hubei University of Science and Technology, Xianning 437100, China
| | - Yiwen Fu
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, State Key Laboratory of Vascular Homeostasis and Remodeling, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China
| | - Zheng Zhang
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, State Key Laboratory of Vascular Homeostasis and Remodeling, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China
| | - Nan Lin
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350013, China
| | - Wei Huang
- Department of Cardiology, General Hospital of Central Theater Command, No.627, Wuluo Road, Wuhan 430070, China.
| | - Lemin Zheng
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, State Key Laboratory of Vascular Homeostasis and Remodeling, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China; Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100050, China.
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2
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Zhang B, Swanson WB, Durdan M, Livingston HN, Dodd M, Vidanapathirana SM, Desai A, Douglas L, Mishina Y, Weivoda M, Greineder CF. Affinity targeting of therapeutic proteins to the bone surface-local delivery of sclerostin-neutralizing antibody enhances efficacy. J Bone Miner Res 2024; 39:717-728. [PMID: 38526976 DOI: 10.1093/jbmr/zjae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/02/2024] [Accepted: 03/23/2024] [Indexed: 03/27/2024]
Abstract
Currently available biotherapeutics for the treatment of osteoporosis lack explicit mechanisms for bone localization, potentially limiting efficacy and inducing off-target toxicities. While various strategies have been explored for targeting the bone surface, critical aspects remain poorly understood, including the optimal affinity ligand, the role of binding avidity and circulation time, and, most importantly, whether or not this strategy can enhance the functional activity of clinically relevant protein therapeutics. To investigate, we generated fluorescent proteins (eg, mCherry) with site-specifically attached small molecule (bisphosphonate) or peptide (deca-aspartate, D10) affinity ligands. While both affinity ligands successfully anchored fluorescent protein to the bone surface, quantitative radiotracing revealed only modest femoral and vertebral accumulation and suggested a need for enhanced circulation time. To achieve this, we fused mCherry to the Fc fragment of human IgG1 and attached D10 peptides to each C-terminus. The mCherry-Fc-D10 demonstrated an ~80-fold increase in plasma exposure and marked increases in femoral and vertebral accumulation (13.6% ± 1.4% and 11.4% ± 1.3% of the injected dose/g [%ID/g] at 24 h, respectively). To determine if bone surface targeting could enhance the efficacy of a clinically relevant therapeutic, we generated a bone-targeted sclerostin-neutralizing antibody, anti-sclerostin-D10. The targeted antibody demonstrated marked increases in bone accumulation and retention (20.9 ± 2.5% and 19.5 ± 2.5% ID/g in femur and vertebrae at 7 days) and enhanced effects in a murine model of ovariectomy-induced bone loss (bone volume/total volume, connectivity density, and structure model index all increased [P < .001] vs untargeted anti-sclerostin). Collectively, our results indicate the importance of both bone affinity and circulation time in achieving robust targeting of therapeutic proteins to the bone surface and suggest that this approach may enable lower doses and/or longer dosing intervals without reduction in biotherapeutic efficacy. Future studies will be needed to determine the translational potential of this strategy and its potential impact on off-site toxicities.
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Affiliation(s)
- Boya Zhang
- Department of Pharmacology, Medical School, University of Michigan, Ann Arbor, MI 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - William Benton Swanson
- Department of Biologic and Materials Science, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Margaret Durdan
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather N Livingston
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michaela Dodd
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sachith M Vidanapathirana
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alec Desai
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lindsey Douglas
- Department of Biologic and Materials Science, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuji Mishina
- Department of Biologic and Materials Science, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Megan Weivoda
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Hematology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Colin F Greineder
- Department of Pharmacology, Medical School, University of Michigan, Ann Arbor, MI 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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Karadeniz H, Kesen S, Akhan MB, Unlu S, Kardas RC, Guler AA, Yıldırım D, Vasi I, Kaya B, Duran R, Tore NG, Erden A, Kucuk H, Goker B, Ozturk MA, Tufan A. Vascular calcification in Takayasu arteritis: relationship with metabolic syndrome, left ventricular mass index, and intima-media thickness. Hellenic J Cardiol 2024:S1109-9666(24)00082-4. [PMID: 38697292 DOI: 10.1016/j.hjc.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT). METHODS A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches. RESULTS Forty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (-) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (-) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (-) group (p < 0.05). CONCLUSION Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.
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Affiliation(s)
- Hazan Karadeniz
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey; Division of Rheumatology, Mehmet Akif Inan Training and Research Hospital, Sanlıurfa, Turkey.
| | - Sevcihan Kesen
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Mert Burak Akhan
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Serkan Unlu
- Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Rıza Can Kardas
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Aslıhan Avanoglu Guler
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Derya Yıldırım
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Ibrahim Vasi
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Burcugul Kaya
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Rahime Duran
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Nurten Gizem Tore
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Hamit Kucuk
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Berna Goker
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Mehmet Akif Ozturk
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey.
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Turkey; Inflammatory Disease Section, National Human Genome Research Institute, USA.
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Jin J, Hao W, Xie D. Meta-analysis of the correlation between pulmonary hypertension and echocardiographic parameters in patients with chronic kidney disease. PeerJ 2024; 12:e17245. [PMID: 38650651 PMCID: PMC11034503 DOI: 10.7717/peerj.17245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Objective To investigate the correlation between pulmonary hypertension (PH) and echocardiographic parameters in patients with chronic kidney disease (CKD). Methods PubMed, Embase, Web of Science, Cochrane, VIP, CNKI, and Wanfang databases were systematically searched for articles published from inception to 19 May 2023. Study quality was estimated using the Quality Assessment of Case-Control Studies tool. Forest plots were drawn using R language software. The "metacor" function in the "meta" package was utilized for meta-analysis of the r-values and their standard errors. Heterogeneity and sensitivity analyses were carried out, with the main outcomes as r-value, p-value, and I2 value. Results Eleven studies were included, with 1,809 CKD patients. The correlations between 12 echocardiographic parameters and PH were analyzed. Except for FS and LVEF which were negatively correlated with CKD-PH, the other 10 parameters were positively correlated with CKD-PH. Among them, LA was highly correlated with CKD-PH (0.70 < r < 0.89); LVDD, RA, RV, LVMI, and LVDS were moderately correlated with CKD-PH (0.40 < r < 0.69); while PA, IVS, LVPW, SV, FS, and LVEF were lowly correlated with CKD-PH (0.20 < r < 0.39). The synthesized estimates were stable against heterogeneity. Conclusion CKD-PH patients may have large cardiac chambers, thickened septal tissue on both sides of the chambers, reduced pulmonary artery flow rates, and decreased left ventricular function.
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Affiliation(s)
- Jiahui Jin
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
| | - Wen Hao
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
| | - Deqiong Xie
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
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He M, Wei W, Zhang Y, Xiang Z, Peng D, Kasimumali A, Rong S. Gut microbial metabolites SCFAs and chronic kidney disease. J Transl Med 2024; 22:172. [PMID: 38369469 PMCID: PMC10874542 DOI: 10.1186/s12967-024-04974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/11/2024] [Indexed: 02/20/2024] Open
Abstract
The global incidence of Chronic Kidney Disease (CKD) is steadily escalating, with discernible linkage to the intricate terrain of intestinal microecology. The intestinal microbiota orchestrates a dynamic equilibrium in the organism, metabolizing dietary-derived compounds, a process which profoundly impacts human health. Among these compounds, short-chain fatty acids (SCFAs), which result from microbial metabolic processes, play a versatile role in influencing host energy homeostasis, immune function, and intermicrobial signaling, etc. SCFAs emerge as pivotal risk factors influencing CKD's development and prognosis. This paper review elucidates the impact of gut microbial metabolites, specifically SCFAs, on CKD, highlighting their role in modulating host inflammatory responses, oxidative stress, cellular autophagy, the immune milieu, and signaling cascades. An in-depth comprehension of the interplay between SCFAs and kidney disease pathogenesis may pave the way for their utilization as biomarkers for CKD progression and prognosis or as novel adjunctive therapeutic strategies.
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Affiliation(s)
- Meng He
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Wenqian Wei
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yichen Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Zhouxia Xiang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Dan Peng
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Ayijiaken Kasimumali
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shu Rong
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Wathanavasin W, Tanateerapong P, Susantitaphong P. Multiple Painless Masses in a Peritoneal Dialysis Patient. KIDNEY360 2023; 4:713-714. [PMID: 37229732 PMCID: PMC10371282 DOI: 10.34067/kid.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 05/27/2023]
Affiliation(s)
- Wannasit Wathanavasin
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Patchara Tanateerapong
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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7
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Brandenburg V, Ketteler M. Vitamin D and Secondary Hyperparathyroidism in Chronic Kidney Disease: A Critical Appraisal of the Past, Present, and the Future. Nutrients 2022; 14:nu14153009. [PMID: 35893866 PMCID: PMC9330693 DOI: 10.3390/nu14153009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 12/28/2022] Open
Abstract
The association between vitamin D deficiency and especially critical shortage of active vitamin D (1,25-dihydroxyvitamin D, calcitriol) with the development of secondary hyperparathyroidism (sHPT) is a well-known fact in patients with chronic kidney disease (CKD). The association between sHPT and important clinical outcomes, such as kidney disease progression, fractures, cardiovascular events, and mortality, has turned the prevention and the control of HPT into a core issue of patients with CKD and on dialysis. However, vitamin D therapy entails the risk of unwanted side effects, such as hypercalcemia and hyperphosphatemia. This review summarizes the developments of vitamin D therapies in CKD patients of the last decades, from calcitriol substitution to extended-release calcifediol. In view of the study situation for vitamin D insufficiency and sHPT in CKD patients, we conclude that the nephrology community has to solve three core issues: (1) What is the optimal parathyroid hormone (PTH) target level for CKD and dialysis patients? (2) What is the optimal vitamin D level to support optimal PTH titration? (3) How can sHPT treatment support reduction in the occurrence of hard renal and cardiovascular events in CKD and dialysis patients?
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Affiliation(s)
- Vincent Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas-Klinikum Würselen, Mauerfeldchen 25, 52146 Würselen, Germany
- Correspondence:
| | - Markus Ketteler
- Departmentof General Internal Medicine and Nephrology, Robert-Bosch Hospital, Auerbachstraße 110, 70376 Stuttgart, Germany;
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Young K, Beggs MR, Grimbly C, Alexander RT. Regulation of 1 and 24 hydroxylation of vitamin D metabolites in the proximal tubule. Exp Biol Med (Maywood) 2022; 247:1103-1111. [PMID: 35482362 PMCID: PMC9335508 DOI: 10.1177/15353702221091982] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Calcium and phosphate are critical for numerous physiological processes. Consequently, the plasma concentration of these ions are tightly regulated. Calcitriol, the active form of vitamin D, is a positive modulator of mineralization as well as calcium and phosphate metabolism. The molecular and physiological effects of calcitriol are well documented. Calcitriol increases blood calcium and phosphate levels by increasing absorption from the intestine, and resorption of bone. Calcitriol synthesis is a multistep process. A precursor is first made via skin exposure to UV, it is then 25-hydroxylated in the liver to form 25-hydroxyitamin D. The next hydroxylation step occurs in the renal proximal tubule via the 1-αhydroxylase enzyme (encoded by CYP27B1) thereby generating 1,25-dihydroxyvitamin D, that is, calcitriol. At the same site, the 25-hydroxyvitamin D 24-hydroxlase enzyme encoded by CYP24A1 can hydroxylate 25-hydroxyvitamin D or calcitriol to deactivate the hormone. Plasma calcitriol levels are primarily determined by the regulated expression of CYP27B1 and CYP24A1. This occurs in response to parathyroid hormone (increases CYP27B1), calcitriol itself (decreases CYP27B1 and increases CYP24A1), calcitonin (increases or decreases CYP24A1 and increases CYP27B1), FGF23 (decreases CYP27B1 and increases CYP24A1) and potentially plasma calcium and phosphate levels themselves (mixed effects). Herein, we review the regulation of CYP27B1 and CYP24A1 transcription in response to the action of classic phophocalciotropic hormones and explore the possibility of direct regulation by plasma calcium.
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Affiliation(s)
- Kennedi Young
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada,Women and Children’s Health Institute, Edmonton, AB T6G 1C9, Canada
| | - Megan R Beggs
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada,Women and Children’s Health Institute, Edmonton, AB T6G 1C9, Canada
| | - Chelsey Grimbly
- Department of Paediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - R Todd Alexander
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada,Women and Children’s Health Institute, Edmonton, AB T6G 1C9, Canada,Department of Paediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada,R Todd Alexander.
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Ketteler M, Schanz M, Schricker S. Vitamin K: should we supplement to protect the kidneys and the heart? Nephrol Dial Transplant 2021; 36:2196-2198. [PMID: 31943083 DOI: 10.1093/ndt/gfz291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Moritz Schanz
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Severin Schricker
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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10
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Vecchiato CG, Delsante C, Galiazzo G, Perfetti S, Pinna C, Sabetti MC, Zagnoli L, Biagi G, Pietra M. Case Report: A Case Series Linked to Vitamin D Excess in Pet Food: Cholecalciferol (Vitamin D3) Toxicity Observed in Five Cats. Front Vet Sci 2021; 8:707741. [PMID: 34490396 PMCID: PMC8416511 DOI: 10.3389/fvets.2021.707741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Cholecalciferol (vitamin D3) toxicity caused by defective pet food formulations is a rare occurrence described in cats. Nevertheless, it poses a health risk, even though the affected pet food is not fed as the sole diet. Excessive vitamin D3 intake might cause hypercalcemia and soft tissue mineralization, which are findings that prompt clinicians to further investigate the feasible etiology. This case series describes the effects of an extremely high vitamin D3 intake in five young cats caused by the consumption of a fish-based complementary kitten pet food (KPF) that was fed to all of the cats as part of their diet (cases 1, 2, and 3) or eaten exclusively (cases 4 and 5). Due to the different amounts of vitamin D3 consumed, diagnostic examinations showed different degrees of severity of hypercalcemia and azotemia as well as different radiographic findings in cases where diagnostic imaging was performed (cases 2, 4, and 5). All of the cats were treated by withdrawing the affected food and providing medical management of the hypercalcemia. All of the cats recovered, except for two persistent azotemic cats, which developed chronic kidney disease. The goal of this case series is, therefore, to describe the occurrence and resolution of an acute vitamin D3 toxicity due to the highest amount of dietary vitamin D3 intake that has ever been described in domestic cats.
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Affiliation(s)
- Carla G Vecchiato
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Costanza Delsante
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Giorgia Galiazzo
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Simone Perfetti
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Carlo Pinna
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Maria C Sabetti
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Laura Zagnoli
- Clinica Veterinaria dell' Orologio - AniCura, Sasso Marconi, Italy
| | - Giacomo Biagi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Marco Pietra
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
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11
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Düsing P, Zietzer A, Goody PR, Hosen MR, Kurts C, Nickenig G, Jansen F. Vascular pathologies in chronic kidney disease: pathophysiological mechanisms and novel therapeutic approaches. J Mol Med (Berl) 2021; 99:335-348. [PMID: 33481059 PMCID: PMC7900031 DOI: 10.1007/s00109-021-02037-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease (CVD) is a major cause of death in patients with chronic kidney disease (CKD). Both conditions are rising in incidence as well as prevalence, creating poor outcomes for patients and high healthcare costs. Recent data suggests CKD to be an independent risk factor for CVD. Accumulation of uremic toxins, chronic inflammation, and oxidative stress have been identified to act as CKD-specific alterations that increase cardiovascular risk. The association between CKD and cardiovascular mortality is markedly influenced through vascular alterations, in particular atherosclerosis and vascular calcification (VC). While numerous risk factors promote atherosclerosis by inducing endothelial dysfunction and its progress to vascular structural damage, CKD affects the medial layer of blood vessels primarily through VC. Ongoing research has identified VC to be a multifactorial, cell-mediated process in which numerous abnormalities like mineral dysregulation and especially hyperphosphatemia induce a phenotype switch of vascular smooth muscle cells to osteoblast-like cells. A combination of pro-calcifying stimuli and an impairment of inhibiting mechanisms like fetuin A and vitamin K-dependent proteins like matrix Gla protein and Gla-rich protein leads to mineralization of the extracellular matrix. In view of recent studies, intercellular communication pathways via extracellular vesicles and microRNAs represent key mechanisms in VC and thereby a promising field to a deeper understanding of the involved pathomechanisms. In this review, we provide an overview about pathophysiological mechanisms connecting CKD and CVD. Special emphasis is laid on vascular alterations and more recently discovered molecular pathways which present possible new therapeutic targets.
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Affiliation(s)
- Philip Düsing
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Philip Roger Goody
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mohammed Rabiul Hosen
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Felix Jansen
- Heart Center, Department of Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Holmar J, de la Puente-Secades S, Floege J, Noels H, Jankowski J, Orth-Alampour S. Uremic Toxins Affecting Cardiovascular Calcification: A Systematic Review. Cells 2020; 9:cells9112428. [PMID: 33172085 PMCID: PMC7694747 DOI: 10.3390/cells9112428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular calcification is highly prevalent and associated with increased morbidity in chronic kidney disease (CKD). This review examines the impact of uremic toxins, which accumulate in CKD due to a failing kidney function, on cardiovascular calcification. A systematic literature search identified 41 uremic toxins that have been studied in relation to cardiovascular calcification. For 29 substances, a potentially causal role in cardiovascular calcification was addressed in in vitro or animal studies. A calcification-inducing effect was revealed for 16 substances, whereas for three uremic toxins, namely the guanidino compounds asymmetric and symmetric dimethylarginine, as well as guanidinosuccinic acid, a calcification inhibitory effect was identified in vitro. At a mechanistic level, effects of uremic toxins on calcification could be linked to the induction of inflammation or oxidative stress, smooth muscle cell osteogenic transdifferentiation and/or apoptosis, or alkaline phosphatase activity. For all middle molecular weight and protein-bound uremic toxins that were found to affect cardiovascular calcification, an increasing effect on calcification was revealed, supporting the need to focus on an increased removal efficiency of these uremic toxin classes in dialysis. In conclusion, of all uremic toxins studied with respect to calcification regulatory effects to date, more uremic toxins promote rather than reduce cardiovascular calcification processes. Additionally, it highlights that only a relatively small part of uremic toxins has been screened for effects on calcification, supporting further investigation of uremic toxins, as well as of associated post-translational modifications, on cardiovascular calcification processes.
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Affiliation(s)
- Jana Holmar
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany; (J.H.); (S.d.l.P.-S.); (H.N.)
| | - Sofia de la Puente-Secades
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany; (J.H.); (S.d.l.P.-S.); (H.N.)
| | - Jürgen Floege
- Division of Nephrology, RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany;
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany; (J.H.); (S.d.l.P.-S.); (H.N.)
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany; (J.H.); (S.d.l.P.-S.); (H.N.)
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence: (J.J.); (S.O.-A.); Tel.: +49-241-80-80580 (J.J. & S.O.-A.)
| | - Setareh Orth-Alampour
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital Aachen, 52074 Aachen, Germany; (J.H.); (S.d.l.P.-S.); (H.N.)
- Correspondence: (J.J.); (S.O.-A.); Tel.: +49-241-80-80580 (J.J. & S.O.-A.)
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Significance of acPWV for Survival of Hemodialysis Patients. ACTA ACUST UNITED AC 2020; 56:medicina56090435. [PMID: 32872092 PMCID: PMC7558400 DOI: 10.3390/medicina56090435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Abnormal arterial stiffness (AS) is a major complication in end-stage kidney disease (ESKD) patients treated by dialysis. Our study aimed to determine the significance of AS for survival of prevalent dialysis patients, as well as its association with cardiovascular parameters or vascular calcification promoters/inhibitors or both and AS. MATERIALS AND METHODS The study involved 80 adult hemodialysis patients. Besides standard laboratory analyses, we also determined promoters and inhibitors of vascular calcification (bone biomarkers): serum levels of fibroblast growth factor 23 (FGF23), soluble Klotho, intact parathormone (iPTH), 1,25-dihydroxyvitamin D3, osteoprotegerin, sclerostin, AS measured as ankle carotid pulse wave velocity (acPWV), Ankle Brachial Index (ABI), and vascular calcification (VC) score. Patients were monitored for up to 28 months. According to the median acPWV value, we divided patients into a group with acPWV ≤ 8.8 m/s, and a group with acPWV > 8.8 m/s, and the two groups were compared. RESULTS Values for bone biomarkers were similar in both groups. Mean arterial blood pressure (MAP), central systolic and diastolic brachial blood pressure, heart rate, and pulse pressure were higher in the group with acPWV > 8.8 m/s than in the group with acPWV ≤ 8.8 m/s. The mortality was higher for patients with acPWV > 8.8 m/s at any given time over 28 months of follow-up. In multivariable analysis, predictors of higher acPWV were age >60.5, higher pulse rate, and higher central systolic or brachial diastolic blood pressure. CONCLUSIONS According to our results, we advise the measurement of acPWV preferentially in younger dialysis patients for prognosis, as well as intervention planning before the development of irreversible changes in blood vessels. In addition, measuring central systolic blood pressure seems to be useful for monitoring AS in prevalent hemodialysis patients.
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Djuric P, Dimkovic N, Schlieper G, Djuric Z, Pantelic M, Mitrovic M, Jankovic A, Milanov M, Kuzmanovic Pficer J, Floege J. Sodium thiosulphate and progression of vascular calcification in end-stage renal disease patients: a double-blind, randomized, placebo-controlled study. Nephrol Dial Transplant 2020; 35:162-169. [PMID: 31764989 DOI: 10.1093/ndt/gfz204] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sodium thiosulphate (NaTS) is mostly used in haemodialysis (HD) patients with calcific uraemic arteriolopathy. This double-blind, randomized, placebo-controlled study assessed the effect of NaTS on progression of cardiovascular calcifications in HD patients. METHODS From 65 screened patients, we recruited 60 patients with an abdominal aorta Agatston calcification score ≥100. Thirty patients were randomized to receive NaTS 25 g/1.73 m2 and 30 patients to receive 100 mL of 0.9% sodium chloride intravenously during the last 15 min of HD over a period of 6 months. The primary endpoint was the absolute change of the abdominal aortic calcification score. RESULTS The abdominal aortic calcification score and calcification volume of the abdominal aorta increased similarly in both treatment groups during the trial. As compared with the saline group, patients receiving NaTS exhibited a reduction of their iliac artery calcification score (-137 ± 641 versus 245 ± 755; P = 0.049), reduced pulse wave velocity (9.6 ± 2.7 versus 11.4 ± 3.6; P = 0.000) and a lower carotid intima-media thickness (0.77 ± 0.1 versus 0.83 ± 00.17; P = 0.033) and had better preservation of echocardiographic parameters of left ventricular hypertrophy. No patient of the NaTS group developed new cardiac valve calcifications during the trial as compared with 8 of 29 patients in the saline group. By univariate analysis, NaTS therapy was the only predictor of not developing new valvular calcifications. No adverse events possibly related to NaTS infusion were noted. CONCLUSIONS While NaTS failed to retard abdominal aortic calcification progress, it positively affected calcification progress in iliac arteries and heart valves as well as several other cardiovascular functional parameters.
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Affiliation(s)
- Petar Djuric
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Nada Dimkovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Georg Schlieper
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
| | - Zivka Djuric
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Milan Pantelic
- Center for Radiology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Beograd, Serbia
| | - Aleksandar Jankovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Marko Milanov
- Clinical Department for Cardiology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Jovana Kuzmanovic Pficer
- Department for Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jürgen Floege
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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15
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Holmar J, Noels H, Böhm M, Bhargava S, Jankowski J, Orth-Alampour S. Development, establishment and validation of in vitro and ex vivo assays of vascular calcification. Biochem Biophys Res Commun 2020; 530:462-470. [PMID: 32560961 DOI: 10.1016/j.bbrc.2020.05.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Vascular calcification (VC) is one major complication in patients with chronic kidney disease, with a misbalance in calcium and phosphate metabolism playing crucial role. The mechanisms underlying VC have not been entirely revealed to date. As studies aiming at the identification and characterization of the involved mediators are highly relevant, we developed a standardized operating protocol for in vitro and ex vivo approaches in this study to aiming at the comparability of these studies. APPROACH AND RESULTS We analyzed in vitro and ex vivo experimental conditions to study VC. Therefore, vascular smooth muscle cells were used for in vitro experiments and rat aorta for ex vivo experiments. The degree of calcification was estimated by quantification of calcium concentrations and by von Kossa staining. As a result, a step-by-step protocol for performing experiments on VC was established. We were able to demonstrate that the degree and the location of VC in vascular smooth muscle cells and aortic rings was highly dependent on the phosphate and CaCl2 concentration in the medium as well as the incubation time. Furthermore, the VC was reduced upon increasing fetal calf serum concentration in the medium. CONCLUSION In the current study, we developed and validated a standardized operating protocol for systematic in vitro and ex vivo analyses of medial calcification, which is essential for the comparability of the results of future studies.
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Affiliation(s)
- Jana Holmar
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital, Aachen, Germany
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital, Aachen, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, University Hospital of Saarland, Saarland University, Homburg, Germany
| | - Shruti Bhargava
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital, Aachen, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital, Aachen, Germany; School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
| | - Setareh Orth-Alampour
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, University Hospital, Aachen, Germany
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Mulay SR, Steiger S, Shi C, Anders HJ. A guide to crystal-related and nano- or microparticle-related tissue responses. FEBS J 2020; 287:818-832. [PMID: 31829497 DOI: 10.1111/febs.15174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
Crystals and nano- and microparticles form inside the human body from intrinsic proteins, minerals, or metabolites or enter the body as particulate matter from occupational and environmental sources. Associated tissue injuries and diseases mostly develop from cellular responses to such crystal deposits and include inflammation, cell necrosis, granuloma formation, tissue fibrosis, and stone-related obstruction of excretory organs. But how do crystals and nano- and microparticles trigger these biological processes? Which pathomechanisms are identical across different particle types, sizes, and shapes? In addition, which mechanisms are specific to the atomic or molecular structure of crystals or to specific sizes or shapes? Do specific cellular or molecular mechanisms qualify as target for therapeutic interventions? Here, we provide a guide to approach this diverse and multidisciplinary research domain. We give an overview about the clinical spectrum of crystallopathies, about shared and specific pathomechanisms as a conceptual overview before digging deeper into the specialty field of interest.
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Affiliation(s)
- Shrikant R Mulay
- Pharmacology Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Stefanie Steiger
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
| | - Chongxu Shi
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
| | - Hans-Joachim Anders
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
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Martín AR, Patel JM, Zlotnick HM, Carey JL, Mauck RL. Emerging therapies for cartilage regeneration in currently excluded 'red knee' populations. NPJ Regen Med 2019; 4:12. [PMID: 31231546 PMCID: PMC6542813 DOI: 10.1038/s41536-019-0074-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
The field of articular cartilage repair has made significant advances in recent decades; yet current therapies are generally not evaluated or tested, at the time of pivotal trial, in patients with a variety of common comorbidities. To that end, we systematically reviewed cartilage repair clinical trials to identify common exclusion criteria and reviewed the literature to identify emerging regenerative approaches that are poised to overcome these current exclusion criteria. The term “knee cartilage repair” was searched on clinicaltrials.gov. Of the 60 trials identified on initial search, 33 were further examined to extract exclusion criteria. Criteria excluded by more than half of the trials were identified in order to focus discussion on emerging regenerative strategies that might address these concerns. These criteria included age (<18 or >55 years old), small defects (<1 cm2), large defects (>8 cm2), multiple defect (>2 lesions), BMI >35, meniscectomy (>50%), bilateral knee pathology, ligamentous instability, arthritis, malalignment, prior repair, kissing lesions, neurologic disease of lower extremities, inflammation, infection, endocrine or metabolic disease, drug or alcohol abuse, pregnancy, and history of cancer. Finally, we describe emerging tissue engineering and regenerative approaches that might foster cartilage repair in these challenging environments. The identified criteria exclude a majority of the affected population from treatment, and thus greater focus must be placed on these emerging cartilage regeneration techniques to treat patients with the challenging “red knee”.
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Affiliation(s)
- Anthony R Martín
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA
| | - Jay M Patel
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA
| | - Hannah M Zlotnick
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA.,3Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - James L Carey
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Robert L Mauck
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA.,3Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA
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Dual Roles of the Mineral Metabolism Disorders Biomarkers in Prevalent Hemodilysis Patients: In Renal Bone Disease and in Vascular Calcification. J Med Biochem 2019; 38:134-144. [PMID: 30867641 PMCID: PMC6411002 DOI: 10.2478/jomb-2018-0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months). Methods Besides routine laboratory analyzes, serum levels of FGF 23, soluble Klotho, iPTH, 1,25-dihydroxyvitamin D3; pulse wave velocity (PWV); left ventricular (LV) mass by ultrasound; and VCs score by Adragao method were measured. Results VC was found in 60% and LV concentric or eccentric hypertrophy in 50% patients. Dialysis vintage (OR 1.025, 95%CI 1.007–1.044, p=0.006) FGF23 (OR 1.006, 95% CI 0.992–1.012, p=0.029) and serum magnesium (OR 0.000, 95%CI 0.000–0.214, p=0.04) were associated with VC. Changes in myocardial geometry was associated with male sex (beta=-0.273, 95% CI -23.967 1.513, p=0.027), iPTH (beta 0.029, 95%CI -0.059–0.001, p=0.027) and vitamin D treatment (beta 25.49, 95%CI 11.325–39.667, p=0.001). Also, patients with the more widespread VC had the highest LV remodeling categories. PWV was associated patient’s age, cholesterol, diastolic blood pressure, LV mass (positively) and serum calcium (negatively), indicating potential link with atherosclerotic risk. Conclusions Despite to different risk factors for VC and myocardial remodeling, obtained results could indicate that risk factors intertwine in long-term treatment of HD patients and therefore careful and continuous correction of mineral metabolism disorders is undoubtedly of the utmost importance.
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Chen HC, Wang WT, Hsi CN, Chou CY, Lin HJ, Huang CC, Chang CT. Abdominal aortic calcification score can predict future coronary artery disease in hemodialysis patients: a 5-year prospective cohort study. BMC Nephrol 2018; 19:313. [PMID: 30409161 PMCID: PMC6225627 DOI: 10.1186/s12882-018-1124-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis. However, the association between AAC and future coronary artery disease (CAD) occurrence is not clear. We aimed to clarify the association of AAC severity and the occurrence of future CAD events in hemodialysis patients. METHODS Hemodialysis (HD) patients were recruited in this prospective cohort study. AAC severity was quantified by AAC score, which was measured by lateral lumbar radiography. We used receiver operation curve (ROC) analysis to find the cutoff AAC value for CAD prediction. CAD-free survival was analyzed by Kaplan-Meier study. RESULTS There were 303 patients recruited for study with a median (interquartile range) follow-up of 95 (65-146) months. The AAC score in patients with occurrence of new CAD [9 (3-15.25), n = 114] was higher than in patients without new CAD occurrence [5 (1-9) n = 189], p < 0.001. Multivariate hazard ratio of AAC score for CAD was 1.039 (p = 0.016). ROC study showed that an AAC score of 5.5 had a sensitivity of 0.658 and a specificity of 0.587 in the prediction of new CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5. Age, diabetes, prior history of CAD, and longer dialysis vintage were major factors associated with higher AAC score. CONCLUSIONS AAC score can predict the occurrence of future CAD events in HD patients. The best cut-off value of AAC score is 5.5. AAC score greater than 5.5 is a reliable abdominal aortic calcification marker, and can predict future CAD in ESRD patients. Major contributive factors for higher AAC score were age, presence of diabetes, prior history of CAD, and longer dialysis vintage.
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Affiliation(s)
- Hung-Chih Chen
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Wei-Ting Wang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chieh-Ning Hsi
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Hsuan-Jen Lin
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
| | - Chiz-Tzung Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
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20
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Schantl AE, Ivarsson ME, Leroux JC. Investigational Pharmacological Treatments for Vascular Calcification. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Antonia E. Schantl
- Institute of Pharmaceutical Sciences; ETH Zurich; Vladimir-Prelog-Weg 3 8093 Zurich Switzerland
| | | | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences; ETH Zurich; Vladimir-Prelog-Weg 3 8093 Zurich Switzerland
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21
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The interplay between bone and vessels in pediatric CKD: lessons from a single-center study. Pediatr Nephrol 2018; 33:1565-1575. [PMID: 29872964 DOI: 10.1007/s00467-018-3978-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Mineral and bone disorders associated to chronic kidney disease (CKD-MBD) are a daily challenge for pediatric nephrologists, with a significant risk of long-term bone and vascular comorbidities. METHODS This single-center study is a prospective transversal evaluation of pediatric CKD patients of our center, part of the European 4C study. In addition to clinical and biochemical data, vascular and bone evaluation was performed: 24-h blood pressure assessment, carotid intima-media thickness (cIMT), pulse wave velocity (PWV), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the ultra-distal tibia. Results are presented as median (range). RESULTS At a median age of 12.9 years (10.2-17.9), SDS height of - 1.0 (- 3.3-1.2) and estimated glomerular filtration rate (eGFR) of 33 mL/min/1.73m2 (11-72), 32 patients (8 girls) were evaluated. Median calcium, phosphate, parathyroid hormone (PTH), and 25 OHD3 levels were 2.44 mmol/L (2.24-2.78), 1.43 mmol/L (1.0-2.7), 80 pg/mL (9-359), and 70 nmol/L (32-116), respectively. Bivariate Spearman and backward multivariable analyses showed that calcium and bone trabecular thickness (Tb.Th), were positively associated with diastolic and mean arterial blood pressure (both for the 24 h, day and night assessment), whereas PTH and vitamin D did not predict blood pressure. CONCLUSIONS We show that the greater the serum levels of calcium, the greater the (diastolic and mean) blood pressure; moreover, the greater the Tb. Th, the greater the (diastolic and mean) blood pressure. The role of calcium supplements to explain such findings in early pediatric CKD can be discussed.
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Marx N, Noels H, Jankowski J, Floege J, Fliser D, Böhm M. Mechanisms of cardiovascular complications in chronic kidney disease: research focus of the Transregional Research Consortium SFB TRR219 of the University Hospital Aachen (RWTH) and the Saarland University. Clin Res Cardiol 2018; 107:120-126. [PMID: 29728829 DOI: 10.1007/s00392-018-1260-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
Patients with chronic kidney disease (CKD) exhibit a massively increased risk for cardiovascular (CV) events, and traditional strategies to improve CV outcome have largely failed in the context of CKD. This review article summarizes the current understanding of the pathophysiology of CVD in patients with CKD, defines the gaps in knowledge and describes the structure of the German Transregional Research Consortium SFB TRR219 which addresses "Mechanisms of Cardiovascular Complications in Chronic Kidney Disease".
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Affiliation(s)
- Nikolaus Marx
- Department of Internal Medicine I, University Hospital, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research, RWTH Aachen University, Aachen, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Department of Internal Medicine II, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Danilo Fliser
- Internal Medicine IV, Saarland University Medical Centre, Homburg, Germany
| | - Michael Böhm
- Internal Medicine III, Saarland University Medical Centre, Homburg, Germany
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Petković N, Ristić S, Marinković J, Marić R, Kovačević M, Djukanović L. Differences in Risk Factors and Prevalence of Vascular Calcification between Pre-Dialysis and Hemodialysis Balkan Nephropathy Patients. ACTA ACUST UNITED AC 2018; 54:medicina54010004. [PMID: 30344235 PMCID: PMC6037237 DOI: 10.3390/medicina54010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/03/2022]
Abstract
Aims: The aim of this study was to compare the risk factors and prevalence of vascular calcification (VC) in pre-dialysis and hemodialysis (HD) patients with Balkan endemic nephropathy (BEN) or other kidney diseases (non-BEN). Materials and Methods: The study involved 115 patients, 32 pre-dialysis and 83 HD patients, separated into groups of BEN and non-BEN patients. In addition to interviews, objective examinations and laboratory analyses, VC was assessed using Adragao score. Results: Patients with BEN were significantly older in both groups, while pre-dialysis BEN patients had significantly lower systolic blood pressure, serum cholesterol and phosphorus levels, but higher urinary excretion of phosphorus than non-BEN patients. These differences were lost in HD groups. In pre-dialysis patients, prevalence of VC was lower in BEN than in non-BEN group and mean VC score differed significantly between them (2.8 (1.7) vs. 4.6 (1.8); p = 0.009). No significant difference in VC score was found between BEN and non-BEN patients on HD. Multivariate analysis showed that in pre-dialysis patients VC score >4 was associated with lower iPTH and higher serum cholesterol level, but in the HD group with higher serum triglyceride level and longer HD vintage. Conclusions: Lower prevalence of risk factors for VC in the BEN than non-BEN patients was found in pre-dialysis but not in HD group and this was reflected in the prevalence and severity of VC in the groups. Prevalence of VC and mean VC score were significantly lower in pre-dialysis BEN than in non-BEN patients but not for those on HD.
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Affiliation(s)
- Nenad Petković
- Fresenius Medical Care Dialysis Center, 76230 Šamac, The Republic of Srpska, Bosnia and Herzegovina.
| | - Siniša Ristić
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
| | | | - Radmil Marić
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
| | - Marijana Kovačević
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
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Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study. Int Urol Nephrol 2018; 50:939-946. [PMID: 29441480 DOI: 10.1007/s11255-018-1821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/04/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment. METHODS We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6-160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q). RESULTS Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles. CONCLUSION Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.
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Zhang D, Bi X, Liu Y, Huang Y, Xiong J, Xu X, Xiao T, Yu Y, Jiang W, Huang Y, Zhang J, Zhang B, Zhao J. High Phosphate-Induced Calcification of Vascular Smooth Muscle Cells is Associated with the TLR4/NF-κb Signaling Pathway. Kidney Blood Press Res 2017; 42:1205-1215. [PMID: 29227975 DOI: 10.1159/000485874] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hyperphosphatemia is one of the most notable features of chronic kidney disease (CKD). Numerous epidemiological and clinical studies have found that high serum phosphate concentrations are associated with calcification in the coronary arteries. However, the mechanisms underlying the vascular calcification induced by high phosphate have not been understood fully. METHODS Vascular smooth muscle cells (VSMCs) were cultured in high-phosphate media to induce vascular calcification, which was detected by Alizarin red S staining. Gene expression and protein levels of differentiation markers were determined by real-time RT-PCR and western blotting, respectively. Protein levels of phosphorylated NF-κB and TLR4 were detected by western blotting, and the role of NF-κB/TLR4 was further confirmed by using an NF-κB inhibitor or TLR4 siRNA. RESULTS Our results showed that high-phosphate media induced obvious calcification of VSMCs. Simultaneously, VSMC differentiation was confirmed by the increased expression of bone morphogenetic protein-2 and Runt-related transcription factor 2 and decreased expression of the VSMC-specific marker SM22α, which was accompanied by the increased expression of inflammatory cytokines. Moreover, a significant upregulation of TLR4 and phosphorylated NF-κB was also detected in VSMCs with high-phosphate media. In contrast, VSMC calcification and the increased expression of inflammatory cytokines were markedly attenuated by pretreatment with TLR4 siRNA and pyrrolidine dithiocarbamic acid, an NF-κB inhibitor. CONCLUSION These data suggest that high-phosphate conditions directly induce vascular calcification via the activation of TLR4/NF-κB signaling in VSMCs. Moreover, inhibition of the TLR4/NF-κB signaling pathway might be a key intervention to prevent vascular calcification in patients with CKD.
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Extraosseous Calcification of the Esophagus: Clinicopathologic Correlates of Esophageal Mucosal Calcinosis. ACG Case Rep J 2017; 4:e108. [PMID: 28932755 PMCID: PMC5599692 DOI: 10.14309/crj.2017.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022] Open
Abstract
Esophageal mucosal calcinosis (EMC) is a rare cause of dysphagia with high morbidity. We present a patient who experienced melena and 3 months of solid and liquid dysphagia along with bilateral lower extremity pain, erythema, and edema later determined to be calcific uremic arteriolopathy (CUA), or calciphylaxis. An esophagogastroduodenoscopy revealed nodularity and linear ulcerations in the upper third of the esophagus. Histology showed active inflammation and ulceration with small foci of subepithelial and intraepithelial calcification consistent with EMC. There is no known treatment for this disorder. Sodium thiosulfate, typically used to treat CUA, did not improve her dysphagia.
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Hypertension in the Kidney Transplant Recipient: Overview of Pathogenesis, Clinical Assessment, and Treatment. Cardiol Rev 2017; 25:102-109. [PMID: 27548684 DOI: 10.1097/crd.0000000000000126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease is the leading cause of death in patients with chronic renal disease and the most common cause of death and allograft loss among kidney transplant recipients. Transplant patients often have multiple cardiovascular risk factors antedating transplantation. Among the most prominent is hypertension (HTN), which affects at least 90% of transplant patients. Uncontrolled HTN is an independent risk factor for allograft loss. The etiology of HTN in transplant recipients is complex and multifactorial, including the use of essential immunosuppressive medications. Post-transplant HTN management requires a systematic and individualized approach with nonpharmacologic and pharmacologic therapies. There is no single ideal agent or treatment algorithm. Patients should regularly monitor and record their blood pressure at home. Often, multiple antihypertensive drugs are needed to achieve a goal blood pressure of 120-140/70-90 mm Hg. As transplant recipients commonly must take 8 to 12 different medications daily, adherence must be continually encouraged and monitored. Special attention must be paid to potential drug side effects and drug interactions with immunosuppressive medications.
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Sun HM, Chen F, Yin HL, Xu XY, Liu HB, Zhao BL. Rapid development of metastatic pulmonary calcifications in primary hyperparathyroidism: a case report and literature review. Diagn Pathol 2017; 12:38. [PMID: 28482911 PMCID: PMC5423015 DOI: 10.1186/s13000-017-0628-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/20/2017] [Indexed: 01/31/2023] Open
Abstract
Background Metastatic pulmonary calcification (MPC) is rarely reported in primary hyperparathyroidism, especially MPC develops quickly. We report such a case here with a literature review. Case presentation A 41-year-old woman presented with cough and dyspnea. Data from clinical, radiological, pathological, technetium (99mTc)-methylene diphosphonate (MDP) bone scintillation imaging, and 99mTc-methoxy isobutyl isonitrile (MIBI) thyroid imaging were studied. 99mTc-MIBI thyroid imaging indicated hyperparathyroidism. Chest computed tomography (CT) scans showed rapidly progressive bilateral pulmonary multiple high-density shadows with mass consolidation and exudation in only five days. 99mTc-MDP bone scintillation imaging indicated bilateral pulmonary calcifications. CT-guided lung biopsy showed multifocal irregularities of calcium deposition and calcified bodies in the pulmonary interstitium. The patient showed gradually clinical and radiological improvement after surgical removal of the parathyroid adenoma. Conclusion Rapidly progressive MPC tends to be misdiagnosed as many primary pulmonary diseases. 99mTc-MDP bone scintillation imaging and pulmonary biopsy could be performed to differentiate metastatic pulmonary calcification from other diseases. Surgical resection of the parathyroid gland is helpful for treatment of MPC in patients with primary hyperparathyroidism and is regularly recommended.
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Affiliation(s)
- Hui-Ming Sun
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China
| | - Fei Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China
| | - Hong-Lin Yin
- Department of Pathology, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China
| | - Xiao-Yong Xu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China
| | - Hong-Bing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China
| | - Bei-Lei Zhao
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, 210002, China.
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Abstract
In contrast to existing EAS/ESC guidelines on the management of lipid disorders, current recommendations from nephrological societies are very conservative and restrictive with respect to any escalation of lipid lowering/statin therapy. Furthermore, lipoprotein(a) (Lp(a)) - an established cardiovascular risk factor - has not even been mentioned. While a number of retrospective and prospective studies suggested that Lp(a) has relevant predictive value and might have - at least in stage-3 chronic kidney disease (CKD) - the same negative effects if draged along in non-CKD patients, there is no guidance on diagnostic or therapeutic procedures. The persistent lack of recognition automatically leads to therapeutic nihilism, which might pose a number of relatively young patients to a significantly increased risk for adverse cardiovascular events. Further evaluation of Lp(a) in CKD is very important to provide appropriate treatment to patients with high Lp(a) levels, even in the presence of CKD.
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Rothe H, Brandenburg V, Haun M, Kollerits B, Kronenberg F, Ketteler M, Wanner C. Ecto-5' -Nucleotidase CD73 (NT5E), vitamin D receptor and FGF23 gene polymorphisms may play a role in the development of calcific uremic arteriolopathy in dialysis patients - Data from the German Calciphylaxis Registry. PLoS One 2017; 12:e0172407. [PMID: 28212442 PMCID: PMC5315275 DOI: 10.1371/journal.pone.0172407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/03/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Calciphylaxis/calcific uremic arteriolopathy affects mainly end-stage kidney disease patients but is also associated with malignant disorders such as myeloma, melanoma and breast cancer. Genetic risk factors of calciphylaxis have never been studied before. Methods We investigated 10 target genes using a tagging SNP approach: the genes encoding CD73/ ecto-5'-nucleotidase (purinergic pathway), Matrix Gla protein, Fetuin A, Bone Gla protein, VKORC1 (all related to intrinsic calcification inhibition), calcium-sensing receptor, FGF23, Klotho, vitamin D receptor, stanniocalcin 1 (all related to CKD-MBD). 144 dialysis patients from the German calciphylaxis registry were compared with 370 dialysis patients without history of CUA. Genotyping was performed using iPLEX Gold MassARRAY(Sequenom, San Diego, USA), KASP genotyping chemistry (LGC, Teddington, Middlesex, UK) or sequencing. Statistical analysis comprised logistic regression analysis with adjustment for age and sex. Results 165 SNPs were finally analyzed and 6 SNPs were associated with higher probability for calciphylaxis (OR>1) in our cohort. Nine SNPs of three genes (CD73, FGF23 and Vitamin D receptor) reached nominal significance (p< 0.05), but did not reach statistical significance after correction for multiple testing. Of the CD73 gene, rs4431401 (OR = 1.71, 95%CI 1.08–2.17, p = 0.023) and rs9444348 (OR = 1.48, 95% CI 1.11–1.97, p = 0.008) were associated with a higher probability for CUA. Of the FGF23 and VDR genes, rs7310492, rs11063118, rs13312747 and rs17882106 were associated with a higher probability for CUA. Conclusion Polymorphisms in the genes encoding CD73, vitamin D receptor and FGF23 may play a role in calciphylaxis development. Although our study is the largest genetic study on calciphylaxis, it is limited by the low sample sizes. It therefore requires replication in other cohorts if available.
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Affiliation(s)
- Hansjörg Rothe
- Klinikum Coburg, Coburg, Germany
- Department of Medicine, Division of Nephrology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- * E-mail:
| | | | - Margot Haun
- Division for Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kollerits
- Division for Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Kronenberg
- Division for Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Christoph Wanner
- Department of Medicine, Division of Nephrology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Kaesler N, Immendorf S, Ouyang C, Herfs M, Drummen N, Carmeliet P, Vermeer C, Floege J, Krüger T, Schlieper G. Gas6 protein: its role in cardiovascular calcification. BMC Nephrol 2016; 17:52. [PMID: 27230889 PMCID: PMC4880820 DOI: 10.1186/s12882-016-0265-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/16/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiovascular calcifications can be prevented by vitamin K and are accelerated by vitamin K antagonists. These effects are believed to be mainly mediated by the vitamin K-dependent matrix Gla protein. Another vitamin K-dependent protein, Gas6, is also expressed in vascular smooth muscle cells (VSMC). In vitro Gas6 expression was shown to be regulated in VSMC calcification and apoptotic processes. METHODS We investigated the role of Gas6 in vitro using VSMC cultures and in vivo in young and old Gas6-deficient (Gas6(-/-)) and wildtype (WT) mice. In addition, Gas6(-/-) and WT mice were challenged by (a) warfarin administration, (b) uninephrectomy (UniNX) plus high phosphate diet, or (c) UniNX plus high phosphate plus electrocautery of the residual kidney. RESULTS In vitro VSMC from WT and Gas6(-/-) mice exposed to warfarin showed increased apoptosis and calcified similarly. In vivo, aortic, cardiac and renal calcium content in all groups was similar, except for a lower cardiac calcium content in Gas6(-/-) mice (group a). Von Kossa staining revealed small vascular calcifications in both WT and Gas6(-/-) mice (groups a-c). In aging, non-manipulated mice, no significant differences in vascular calcification were identified between Gas6(-/-) and WT mice. Gas6(-/-) mice exhibited no upregulation of matrix Gla protein in any group. Cardiac output was similar in all treatment groups. CONCLUSIONS Taken together, in our study Gas6 fails to aggravate calcification against the previous assumption.
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Affiliation(s)
| | | | - Chun Ouyang
- Uniklinik RWTH Aachen, Nephrology, Aachen, Germany
| | - Marjolein Herfs
- University of Maastricht, R&D Group, Maastricht, Netherlands
| | - Nadja Drummen
- University of Maastricht, R&D Group, Maastricht, Netherlands
| | - Peter Carmeliet
- University of Leuven, Vesalius Research Center, VIB, Leuven, Belgium
| | - Cees Vermeer
- University of Maastricht, R&D Group, Maastricht, Netherlands
| | | | - Thilo Krüger
- Uniklinik RWTH Aachen, Nephrology, Aachen, Germany
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Liang Z, Qiu T, Zhao Z, Chen L, She D. Metastatic pulmonary calcification misdiagnosed as a fungal infection: A case report. Mol Clin Oncol 2015; 4:409-412. [PMID: 26998293 PMCID: PMC4774441 DOI: 10.3892/mco.2015.723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/17/2015] [Indexed: 12/29/2022] Open
Abstract
Metastatic pulmonary calcification is a rare lesion, characterized by calcium salt depositing in normal lung tissue. The clinical profile of a case of metastatic pulmonary calcification following renal transplantation was described. A computed tomography scan of the chest revealed ground-glass opacities in bilateral lungs and a node exhibiting a halo in the right upper lobe, which were suspected aspergillus infection. Following examination and therapy, the results of lung biopsy revealed metastatic pulmonary calcification. Although metastatic pulmonary calcification was reported in renal failure patients previously, metastatic pulmonary calcification with cavity lesions has never, to the best of our knowledge, been previously reported. The aim of the present report was to improve the understanding of metastatic pulmonary calcification.
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Affiliation(s)
- Zhixin Liang
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Tian Qiu
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Zhigang Zhao
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Liang'an Chen
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Danyang She
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Krishnasamy R, Hawley CM, Stanton T, Pascoe EM, Campbell KL, Rossi M, Petchey W, Tan KS, Beetham KS, Coombes JS, Leano R, Haluska BA, Isbel NM. Left ventricular global longitudinal strain is associated with cardiovascular risk factors and arterial stiffness in chronic kidney disease. BMC Nephrol 2015; 16:106. [PMID: 26187506 PMCID: PMC4506621 DOI: 10.1186/s12882-015-0098-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 06/25/2015] [Indexed: 11/29/2022] Open
Abstract
Background Global longitudinal strain (GLS) has emerged as a superior method for detecting left ventricular (LV) systolic dysfunction compared to ejection fraction (EF) on the basis that it is less operator dependent and more reproducible. The 2-dimensional strain (2DS) method is easily measured and integrated into a standard echocardiogram. This study aimed to determine the relationship between GLS and traditional and chronic kidney disease (CKD)-related risk factors of cardiovascular disease (CVD) in patients with CKD. Methods A cross sectional study of patients with moderate CKD stages 3 and 4 (n = 136). Clinical characteristics, anthropometric, biochemical data including markers of inflammation [C-reactive protein (CRP)], uremic toxins [indoxyl sulphate (IS), p-cresyl sulphate (PCS)], and arterial stiffness [pulse wave velocity (PWV)] were measured. Inducible ischemia was detected using exercise stress echocardiogram. GLS was determined from 3 standard apical views using 2-dimensional speckle tracking and EF was measured using Simpson’s rule. Associations between GLS and traditional and CKD-related risk factors were explored using multivariate models. Results The study population parameters included: age 59.4 ± 9.8 years, 58 % male, estimated glomerular filtration rate (eGFR) 44.4 ± 10.1 ml/min/1.73 m2, GLS −18.3 ± 3.6 % and EF 65.8 % ± 7.8 %. This study demonstrated that GLS correlated with diabetes (r = 0.21, p = 0.01), history of heart failure (r = 0.20, p = 0.01), free IS (r = 0.24, p = 0.005) free PCS (r = 0.23, p = 0.007), body mass index (BMI) (r = 0.28, p < 0.001), and PWV (r = 0.24, p = 0.009). Following adjustment for demographic, baseline co-morbidities and laboratory parameters,GLS was independently associated with free IS, BMI and arterial stiffness (R2 for model = 0.30, p < 0.0001). Conclusions In the CKD cohort, LV systolic function assessed using GLS was associated with uremic toxins, obesity and arterial stiffness. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0098-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rathika Krishnasamy
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Carmel M Hawley
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia. .,Translational Research Institute, Brisbane, Australia.
| | - Tony Stanton
- Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
| | - Elaine M Pascoe
- School of Medicine, The University of Queensland, Brisbane, Australia. .,Translational Research Institute, Brisbane, Australia.
| | - Katrina L Campbell
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia. .,Translational Research Institute, Brisbane, Australia.
| | - Megan Rossi
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia. .,Translational Research Institute, Brisbane, Australia.
| | - William Petchey
- Department of Renal Medicine, Cambridge University Hospital, Cambridge, England.
| | - Ken-Soon Tan
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia. .,School of Medicine, Griffith University, Brisbane, Australia.
| | - Kassia S Beetham
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
| | - Jeff S Coombes
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
| | - Rodel Leano
- Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
| | - Brian A Haluska
- Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
| | - Nicole M Isbel
- Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. .,School of Medicine, The University of Queensland, Brisbane, Australia.
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Schlieper G, Schurgers L, Brandenburg V, Reutelingsperger C, Floege J. Vascular calcification in chronic kidney disease: an update. Nephrol Dial Transplant 2015; 31:31-9. [PMID: 25916871 DOI: 10.1093/ndt/gfv111] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/17/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular calcification is both a risk factor and contributor to morbidity and mortality. Patients with chronic kidney disease (and/or diabetes) exhibit accelerated calcification of the intima, media, heart valves and likely the myocardium as well as the rare condition of calcific uraemic arteriolopathy (calciphylaxis). Pathomechanistically, an imbalance of promoters (e.g. calcium and phosphate) and inhibitors (e.g. fetuin-A and matrix Gla protein) is central in the development of calcification. Next to biochemical and proteinacous alterations, cellular processes are also involved in the pathogenesis. Vascular smooth muscle cells undergo osteochondrogenesis, excrete vesicles and show signs of senescence. Therapeutically, measures to prevent the initiation of calcification by correcting the imbalance of promoters and inhibitors appear to be essential. In contrast to prevention, therapeutic regression of cardiovascular calcification in humans has been rarely reported. Measures to enhance secondary prevention in patients with established cardiovascular calcifications are currently being tested in clinical trials.
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Affiliation(s)
- Georg Schlieper
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Leon Schurgers
- Department of Biochemistry, Faculty of Medicine, Health and Life Science, Maastricht, The Netherlands
| | | | - Chris Reutelingsperger
- Department of Biochemistry, Faculty of Medicine, Health and Life Science, Maastricht, The Netherlands
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
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Abstract
Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. For patients affected by these processes, radiologic imaging plays a central role in diagnosis, monitoring treatment, and risk stratification. Radiologists should be familiar with the diseases, intimately aware of the imaging findings, and possessive of multimodality expertise to wisely guide the best practice of medicine. The purpose of this paper is to review the imaging features and characteristics of the most common types of metabolic bone disease with highlights of clinically relevant information so that readers can better generate appropriate differential diagnoses and recommendations. For this review, a thorough literature search for the most up-to-date information was performed on several key types of metabolic bone disease: osteoporosis, osteomalacia, rickets, scurvy, renal osteodystrophy, hyperparathyroidism, Paget’s disease, osteogenesis imperfecta, acromegaly, and osteopetrosis. Although they all affect the bone, these diseases have both shared characteristic features that can be discerned through imaging.
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Brimble KS, Ingram AJ, Eikelboom JW, Hart RG. Anticoagulants in Patients with Atrial Fibrillation and End-Stage Renal Disease. Postgrad Med 2015; 124:17-25. [DOI: 10.3810/pgm.2012.11.2609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schlieper G, Hess K, Floege J, Marx N. The vulnerable patient with chronic kidney disease. Nephrol Dial Transplant 2015; 31:382-90. [DOI: 10.1093/ndt/gfv041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/25/2015] [Indexed: 11/14/2022] Open
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Viegas CSB, Rafael MS, Enriquez JL, Teixeira A, Vitorino R, Luís IM, Costa RM, Santos S, Cavaco S, Neves J, Macedo AL, Willems BAG, Vermeer C, Simes DC. Gla-rich protein acts as a calcification inhibitor in the human cardiovascular system. Arterioscler Thromb Vasc Biol 2015; 35:399-408. [PMID: 25538207 DOI: 10.1161/atvbaha.114.304823] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Vascular and valvular calcifications are pathological processes regulated by resident cells, and depending on a complex interplay between calcification promoters and inhibitors, resembling skeletal metabolism. Here, we study the role of the vitamin K-dependent Gla-rich protein (GRP) in vascular and valvular calcification processes. APPROACH AND RESULTS Immunohistochemistry and quantitative polymerase chain reaction showed that GRP expression and accumulation are upregulated with calcification simultaneously with osteocalcin and matrix Gla protein (MGP). Using conformation-specific antibodies, both γ-carboxylated GRP and undercarboxylated GRP species were found accumulated at the sites of mineral deposits, whereas undercarboxylated GRP was predominant in calcified aortic valve disease valvular interstitial cells. Mineral-bound GRP, MGP, and fetuin-A were identified by mass spectrometry. Using an ex vivo model of vascular calcification, γ-carboxylated GRP but not undercarboxylated GRP was shown to inhibit calcification and osteochondrogenic differentiation through α-smooth muscle actin upregulation and osteopontin downregulation. Immunoprecipitation assays showed that GRP is part of an MGP-fetuin-A complex at the sites of valvular calcification. Moreover, extracellular vesicles released from normal vascular smooth muscle cells are loaded with GRP, MGP, and fetuin-A, whereas under calcifying conditions, released extracellular vesicles show increased calcium loading and GRP and MGP depletion. CONCLUSIONS GRP is an inhibitor of vascular and valvular calcification involved in calcium homeostasis. Its function might be associated with prevention of calcium-induced signaling pathways and direct mineral binding to inhibit crystal formation/maturation. Our data show that GRP is a new player in mineralization competence of extracellular vesicles possibly associated with the fetuin-A-MGP calcification inhibitory system. GRP activity was found to be dependent on its γ-carboxylation status, with potential clinical relevance.
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Affiliation(s)
- Carla S B Viegas
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Marta S Rafael
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - José L Enriquez
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Alexandra Teixeira
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Rui Vitorino
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Inês M Luís
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Rúben M Costa
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Sofia Santos
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Sofia Cavaco
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - José Neves
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Anjos L Macedo
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Brecht A G Willems
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Cees Vermeer
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.)
| | - Dina C Simes
- From the Centre of Marine Sciences (CCMAR) (C.S.B.V., M.S.R., I.M.L., R.M.C., S.S., S.C., D.C.S.), GenoGla Diagnostics (C.S.B.V., D.C.S.), University of Algarve, Faro, Portugal; Department of Histopathology, Algarve Medical Centre, Faro, Portugal (J.L.E., A.T.); Department of Chemistry, QOPNA, Mass Spectrometry Center, University of Aveiro, Aveiro, Portugal (R.V.); Service of Cardiothoracic Surgery, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (J.N.); UCIBIO@REQUIMTE, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal (A.L.M.); VitaK, Maastricht University, Maastricht, The Netherlands (B.A.G.W., C.V.); and Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands (B.A.G.W.).
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Buscher K, Gabriëls G, Barth P, Pavenstädt H. Breast pain in a patient on dialysis: a rare manifestation of calcific uraemic arteriolopathy. BMJ Case Rep 2015; 2015:bcr-2014-207946. [PMID: 25576525 DOI: 10.1136/bcr-2014-207946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A 63-year-old woman presented with progredient bilateral breast pain. Her medical history included rheumatoid arthritis, AA amyloidosis and end-stage renal disease treated by peritoneal dialysis. Inflamed skin alterations of the breast and laboratory values suggested mastitis non-puerpuralis but antibiotics did not resolve the symptoms. Sonography and mammography showed severe vessel calcification suggesting calcific uraemic arteriolopathy (calciphylaxis) as a rare complication of chronic kidney disease. Treatment included intensified haemodialysis, thiosulfate application, analgaesia and wound management leading to significant improvement, however, without complete remission.
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Affiliation(s)
- Konrad Buscher
- Department of Nephrology, University Clinic Muenster, Muenster, Germany
| | - Gert Gabriëls
- Department of Nephrology, University Clinic Muenster, Muenster, Germany
| | - Peter Barth
- Department of Pathology, University Clinic Muenster, Muenster, Germany
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40
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Schlieper G. Vascular calcification in chronic kidney disease: not all arteries are created equal. Kidney Int 2014; 85:501-3. [PMID: 24583982 DOI: 10.1038/ki.2013.423] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular calcifications are associated with an increased cardiovascular risk. Different regions of the arterial tree show a variable susceptibility to cardiovascular calcification. O'Neill and Adams investigated breast arteries with vascular calcification in chronic kidney disease patients. They found no evidence for osteogenic transdifferentiation or apoptosis of vascular smooth muscle cells in these arteries, suggesting that the pathogenesis of medial calcification differs between arterial regions.
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Affiliation(s)
- Georg Schlieper
- Department of Nephrology and Clinical Immunology, University Hospital of RWTH Aachen, Aachen, Germany
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Lu KC, Wu CC, Yen JF, Liu WC. Vascular calcification and renal bone disorders. ScientificWorldJournal 2014; 2014:637065. [PMID: 25136676 PMCID: PMC4127293 DOI: 10.1155/2014/637065] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/15/2014] [Accepted: 06/28/2014] [Indexed: 12/11/2022] Open
Abstract
At the early stage of chronic kidney disease (CKD), the systemic mineral metabolism and bone composition start to change. This alteration is known as chronic kidney disease-mineral bone disorder (CKD-MBD). It is well known that the bone turnover disorder is the most common complication of CKD-MBD. Besides, CKD patients usually suffer from vascular calcification (VC), which is highly associated with mortality. Many factors regulate the VC mechanism, which include imbalances in serum calcium and phosphate, systemic inflammation, RANK/RANKL/OPG triad, aldosterone, microRNAs, osteogenic transdifferentiation, and effects of vitamins. These factors have roles in both promoting and inhibiting VC. Patients with CKD usually have bone turnover problems. Patients with high bone turnover have increase of calcium and phosphate release from the bone. By contrast, when bone turnover is low, serum calcium and phosphate levels are frequently maintained at high levels because the reservoir functions of bone decrease. Both of these conditions will increase the possibility of VC. In addition, the calcified vessel may secrete FGF23 and Wnt inhibitors such as sclerostin, DKK-1, and secreted frizzled-related protein to prevent further VC. However, all of them may fight back the inhibition of bone formation resulting in fragile bone. There are several ways to treat VC depending on the bone turnover status of the individual. The main goals of therapy are to maintain normal bone turnover and protect against VC.
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Affiliation(s)
- Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City 23148, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Jen-Fen Yen
- Division of Nephrology, Department of Internal Medicine, Yonghe Cardinal Tien Hospital, 80 Zhongxing Street, Yonghe District, New Taipei City 23445, Taiwan
| | - Wen-Chih Liu
- Division of Nephrology, Department of Internal Medicine, Yonghe Cardinal Tien Hospital, 80 Zhongxing Street, Yonghe District, New Taipei City 23445, Taiwan
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Ketteler M, Rothe H, Brandenburg VM, Westenfeld R. The K-factor in chronic kidney disease: biomarkers of calcification inhibition and beyond. Nephrol Dial Transplant 2014; 29:1267-70. [PMID: 24753462 DOI: 10.1093/ndt/gfu053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Affiliation(s)
- Markus Ketteler
- Division of Nephrology, Klinikum Coburg GmbH, Coburg, Germany
| | - Hansjörg Rothe
- Division of Nephrology, Klinikum Coburg GmbH, Coburg, Germany
| | | | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Leonard O, Spaak J, Goldsmith D. Regression of vascular calcification in chronic kidney disease - feasible or fantasy? a review of the clinical evidence. Br J Clin Pharmacol 2014; 76:560-72. [PMID: 23110527 DOI: 10.1111/bcp.12014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/23/2012] [Indexed: 12/19/2022] Open
Abstract
The complex relationships between cardiovascular, renal, and bone disease are increasingly recognized but not yet clearly understood. Vascular calcification (VC) represents a common end point between these interlinked systems. It is highly prevalent in chronic kidney disease (CKD) and may be responsible for some of the excess cardiovascular events seen in this condition. There is much interest in developing therapeutic agents to stop its development or reverse its progression. Traditionally considered to be due to abnormalities in calcium and phosphate metabolism alone, VC is now known to be the product of active, dynamic processes within the vessel wall. Primary prevention of VC is possible through successful prevention or reversal of progressive renal dysfunction, hypertension and hyperlipidaemia, but is challenging given the increasing global prevalence of these risk factors. Secondary prevention of VC through tight control of calcium and phosphate, can be achieved by dietary or pharmacological means. Both the modification of haemodialysis duration or methods and the use of renal transplantation have an effect. Novel drugs such as cinacalcet were hoped to halt calcification but results have been mixed, and no intervention has yet been shown to reverse calcification reliably. A new range of experimental targets involved in the putative mediatory pathways between bone and vascular disease has emerged. Aiming to manipulate the active mechanisms involved in calcium deposition, these hold hope for reversal of calcification, but are still theoretical or in early animal or human experimentation.
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Gujadhur A, Smith ER, McMahon LP, Spanger M, Chuen J, Holt SG. Large vessel calcification in Takayasu arteritis. Intern Med J 2014; 43:584-7. [PMID: 23668269 DOI: 10.1111/imj.12116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 11/11/2012] [Indexed: 12/22/2022]
Abstract
We report the novel case of a young woman with Takayasu arteritis, with extensive large vessel disease. The case demonstrates that while mechanisms of vascular calcification are poorly understood, inflammation per se might be sufficient to mediate increased mineral stress leading to vessel calcification, even in the absence of renal impairment.
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Affiliation(s)
- A Gujadhur
- Department of Renal Medicine, Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Victoria, Australia
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High peritoneal KT/V and peritonitis rates are associated with peritoneal calcification. PLoS One 2013; 8:e71636. [PMID: 23977097 PMCID: PMC3747216 DOI: 10.1371/journal.pone.0071636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022] Open
Abstract
Background Peritoneal calcification (PC) is a specific finding in patients undergoing peritoneal dialysis (PD), but its prevalence, risk factors, and impacts in PD patients remain unclear. The present study investigated these issues and provided information useful for the management of PC. Methods The study included 183 PD patients. The severity of PC was determined using abdominal computed tomography (CT), and we summed up all scores from slices obtained from the diaphragm to the pelvic floor normalized to body surface area. We analyzed the associations between PC and demographic and clinical characteristics, and between PC and levels of biomarkers, including C-reactive protein (CRP), osteoprotegrin and fetuin-A. The determinants of PC were examined using multiple regression analysis. Results Patients were categorized into group 1 (without PC, n = 133) and group 2 (with PC, n = 50). Group 2 patients showed different degrees of PC with a mean of 160±769 mm2/m2. Group 1 patients had higher fetuin-A levels than group 2 patients (861±309 vs. 760±210 µg/mL; p = 0.021). The independent risk factors for the presence of PC included male gender, previous peritonitis, and PD adequacy (KT/V). Further analysis performed in group 2 patients showed that the dosage of vitamin D, serum levels of CRP, and dialysate calcium load were the independent determinants of PC. However, the presence of PC did not affect patients’ technique survival, peritonitis incidence, or mortality in the mean follow up period of 28±12 months. Conclusions The presence and severity of PC were associated with inflammation, peritoneal KT/V, and mineral metabolism. The impact of PC on the outcomes of PD patients requires further study with a longer follow-up.
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Choi JI, Han DS, Kim HS, Lee YH, Kim HS, Ahn SE, Jeon YC, Yi JH. [A case of isolated small intestinal wall calcification on patient with continuous ambulatory peritoneal dialysis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 62:55-8. [PMID: 23954961 DOI: 10.4166/kjg.2013.62.1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The metastatic calcification is defined as the deposition of calcium salt in normal tissue with an abnormal serum biochemical environment, such as chronic kidney disease, hyperparathyroidism, and hypercalcemia related with malignancy. Although the metastatic calcification can develop in any organs and tissues, presenting its symptoms and complications are rare. Thus a few cases have been reported. This case shows the metastatic calcification of the small intestine without any peritoneal and mesenteric vascular calcification which was early diagnosed by computed tomography and mesenteric angiography in a patient with abdominal pain, receiving continuous ambulatory peritoneal dialysis due to end stage renal disease. The clinician should early consider the metastatic calcification as differential diagnosis when unidentified calcifications are noted in simple abdominal X-ray such as in the present case, and promptly confirm it by using appropriate diagnostic tests in order to prevent its complications and progression.
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Affiliation(s)
- Jeong Im Choi
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Agarwal B, Walecka A, Shaw S, Davenport A. Is Parenteral Phosphate Replacement in the Intensive Care Unit Safe? Ther Apher Dial 2013; 18:31-6. [DOI: 10.1111/1744-9987.12053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Banwari Agarwal
- Intensive Care Unit; Royal Free Hospital; University College London Medical School; London UK
| | - Agnieszka Walecka
- Intensive Care Unit; Royal Free Hospital; University College London Medical School; London UK
| | - Steve Shaw
- Intensive Care Unit; Royal Free Hospital; University College London Medical School; London UK
| | - Andrew Davenport
- Centre for Nephrology; Royal Free Hospital; University College London Medical School; London UK
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Drüeke TB, Olgaard K. Report on 2012 ISN Nexus Symposium: ‘Bone and the Kidney’. Kidney Int 2013; 83:557-62. [DOI: 10.1038/ki.2012.453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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49
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Zhang K, Cheng G, Cai X, Chen J, Jiang Y, Wang T, Wang J, Huang H. Malnutrition, a new inducer for arterial calcification in hemodialysis patients? J Transl Med 2013; 11:66. [PMID: 23506394 PMCID: PMC3608064 DOI: 10.1186/1479-5876-11-66] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/12/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Arterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear. METHODS 68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods. RESULTS 66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP. CONCLUSIONS Malnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients.
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Affiliation(s)
- Kun Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China
| | - Gang Cheng
- Plastic and reconstructive surgery department, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Xue Cai
- Department of nephrology, the second hospital of Nanchang, Nanchang, 330003, China
| | - Jie Chen
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, China
| | - Ying Jiang
- School of Mathematics and Computational Science, Sun Yat-sen University, Guangzhou, 510275, China
| | - Tong Wang
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China
| | - Hui Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China
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50
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Quinn SJ, Thomsen ARB, Pang JL, Kantham L, Bräuner-Osborne H, Pollak M, Goltzman D, Brown EM. Interactions between calcium and phosphorus in the regulation of the production of fibroblast growth factor 23 in vivo. Am J Physiol Endocrinol Metab 2013; 304:E310-20. [PMID: 23233539 PMCID: PMC3566433 DOI: 10.1152/ajpendo.00460.2012] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/04/2012] [Indexed: 11/22/2022]
Abstract
Calcium and phosphorus homeostasis are highly interrelated and share common regulatory hormones, including FGF23. However, little is known about calcium's role in the regulation of FGF23. We sought to investigate the regulatory roles of calcium and phosphorus in FGF23 production using genetic mouse models with targeted inactivation of PTH (PTH KO) or both PTH and the calcium-sensing receptor (CaSR; PTH-CaSR DKO). In wild-type, PTH KO, and PTH-CaSR DKO mice, elevation of either serum calcium or phosphorus by intraperitoneal injection increased serum FGF23 levels. In PTH KO and PTH-CaSR DKO mice, however, increases in serum phosphorus by dietary manipulation were accompanied by severe hypocalcemia, which appeared to blunt stimulation of FGF23 release. Increases in dietary phosphorus in PTH-CaSR DKO mice markedly decreased serum 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] despite no change in FGF23, suggesting direct regulation of 1,25(OH)(2)D(3) synthesis by serum phosphorus. Calcium-mediated increases in serum FGF23 required a threshold level of serum phosphorus of about 5 mg/dl. Analogously, phosphorus-elicited increases in FGF23 were markedly blunted if serum calcium was less than 8 mg/dl. The best correlation between calcium and phosphorus and serum FGF23 was found between FGF23 and the calcium × phosphorus product. Since calcium stimulated FGF23 production in the PTH-CaSR DKO mice, this effect cannot be mediated by the full-length CaSR. Thus the regulation of FGF23 by both calcium and phosphorus appears to be fundamentally important in coordinating the serum levels of both mineral ions and ensuring that the calcium × phosphorus product remains within a physiological range.
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Affiliation(s)
- Stephen J Quinn
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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