1
|
Arinze NV, Yin W, Lotfollahzadeh S, Napoleon MA, Richards S, Walker JA, Belghasem M, Ravid JD, Hassan Kamel M, Whelan SA, Lee N, Siracuse JJ, Anderson S, Farber A, Sherr D, Francis J, Hamburg NM, Rahimi N, Chitalia VC. Tryptophan metabolites suppress Wnt pathway and promote adverse limb events in CKD patients. J Clin Invest 2021; 132:142260. [PMID: 34752422 PMCID: PMC8718145 DOI: 10.1172/jci142260] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Chronic kidney disease (CKD) imposes a strong and independent risk for peripheral artery disease (PAD). While solutes retained in CKD patients (uremic solutes) inflict vascular damage, their role in PAD remains elusive. Here, we show that the dietary tryptophan-derived uremic solutes including indoxyl sulfate (IS) and kynurenine (Kyn) at concentrations corresponding to those in CKD patients suppress β-catenin in several cell types, including microvascular endothelial cells (ECs), inhibiting Wnt activity and proangiogenic Wnt targets in ECs. Mechanistic probing revealed that these uremic solutes downregulated β-catenin in a manner dependent on serine 33 in its degron motif and through the aryl hydrocarbon receptor (AHR). Hindlimb ischemia in adenine-induced CKD and IS solute–specific mouse models showed diminished β-catenin and VEGF-A in the capillaries and reduced capillary density, which correlated inversely with blood levels of IS and Kyn and AHR activity in ECs. An AHR inhibitor treatment normalized postischemic angiogenic response in CKD mice to a non-CKD level. In a prospective cohort of PAD patients, plasma levels of tryptophan metabolites and plasma’s AHR-inducing activity in ECs significantly increased the risk of future adverse limb events. This work uncovers the tryptophan metabolite/AHR/β-catenin axis as a mediator of microvascular rarefaction in CKD patients and demonstrates its targetability for PAD in CKD models.
Collapse
Affiliation(s)
- Nkiruka V Arinze
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - Wenqing Yin
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Saran Lotfollahzadeh
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Marc Arthur Napoleon
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Sean Richards
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Joshua A Walker
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Mostafa Belghasem
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, United States of America
| | - Jonathan D Ravid
- School of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Mohamed Hassan Kamel
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Stephen A Whelan
- Department of Chemistry, Boston University, Boston, United States of America
| | - Norman Lee
- Department of Chemistry, Boston University, Boston, United States of America
| | - Jeffrey J Siracuse
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - Stephan Anderson
- Department of Radiology, Boston University School of Medicine, Boston, United States of America
| | - Alik Farber
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - David Sherr
- Boston University, Boston, United States of America
| | - Jean Francis
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, United States of America
| | - Nader Rahimi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, United States of America
| | - Vipul C Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| |
Collapse
|
2
|
Fibrosis, the Bad Actor in Cardiorenal Syndromes: Mechanisms Involved. Cells 2021; 10:cells10071824. [PMID: 34359993 PMCID: PMC8307805 DOI: 10.3390/cells10071824] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiorenal syndrome is a term that defines the complex bidirectional nature of the interaction between cardiac and renal disease. It is well established that patients with kidney disease have higher incidence of cardiovascular comorbidities and that renal dysfunction is a significant threat to the prognosis of patients with cardiac disease. Fibrosis is a common characteristic of organ injury progression that has been proposed not only as a marker but also as an important driver of the pathophysiology of cardiorenal syndromes. Due to the relevance of fibrosis, its study might give insight into the mechanisms and targets that could potentially be modulated to prevent fibrosis development. The aim of this review was to summarize some of the pathophysiological pathways involved in the fibrotic damage seen in cardiorenal syndromes, such as inflammation, oxidative stress and endoplasmic reticulum stress, which are known to be triggers and mediators of fibrosis.
Collapse
|