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Jia PP, Li Y, Zhang LC, Wu MF, Li TY, Pei DS. Metabolome evidence of CKDu risks after chronic exposure to simulated Sri Lanka drinking water in zebrafish. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 273:116149. [PMID: 38412632 DOI: 10.1016/j.ecoenv.2024.116149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024]
Abstract
It is still a serious public health issue that chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka poses challenges in identification, prevention, and treatment. What environmental factors in drinking water cause kidney damage remains unclear. This study aimed to investigate the risks of various environmental factors that may induce CKDu, including water hardness, fluoride (HF), heavy metals (HM), microcystin-LR (MC-LR), and their combined exposure (HFMM). The research focused on comprehensive metabolome analysis, and correlation with transcriptomic and gut microbiota changes. Results revealed that chronic exposure led to kidney damage and pancreatic toxicity in adult zebrafish. Metabolomics profiling showed significant alterations in biochemical processes, with enriched metabolic pathways of oxidative phosphorylation, folate biosynthesis, arachidonic acid metabolism, FoxO signaling pathway, lysosome, pyruvate metabolism, and purine metabolism. The network analysis revealed significant changes in metabolites associated with renal function and diseases, including 20-Hydroxy-LTE4, PS(18:0/22:2(13Z,16Z)), Neuromedin N, 20-Oxo-Leukotriene E4, and phenol sulfate, which are involved in the fatty acyls and glycerophospholipids class. These metabolites were closely associated with the disrupted gut bacteria of g_ZOR0006, g_Pseudomonas, g_Tsukamurella, g_Cetobacterium, g_Flavobacterium, which belonged to dominant phyla of Firmicutes and Proteobacteria, etc., and differentially expressed genes (DEGs) such as egln3, ca2, jun, slc2a1b, and gls2b in zebrafish. Exploratory omics analyses revealed the shared significantly changed pathways in transcriptome and metabolome like calcium signaling and necroptosis, suggesting potential biomarkers for assessing kidney disease.
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Affiliation(s)
- Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yan Li
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Lan-Chen Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Fei Wu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Nieves MC, Powers A, Anand S, Vlahos P. Kidney disease hotspots and water balance in a warming world. Curr Opin Nephrol Hypertens 2024; 33:122-129. [PMID: 37889529 PMCID: PMC11027962 DOI: 10.1097/mnh.0000000000000938] [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] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California. RECENT FINDINGS Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents' exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots. SUMMARY Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.
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Affiliation(s)
| | - Angelina Powers
- Division of Nephrology, Stanford University School of Medicine
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut
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Hewavitharana P, Schensul S, Lee E, Montez-Rath M, Senarathne S, Liu S, Harold K, Hewapathiranage S, Erandika N, Abeysundara HT, Yu X, Bhalla V, Fire A, Levin A, Anand S, Vlahos P, Chandrajith R, Nanayakkara N. Describing Natural History and Exploring Risk Factors for Kidney Function Decline in Persons With CKD of Uncertain Etiology in Sri Lanka. Kidney Int Rep 2023; 8:1430-1438. [PMID: 37441476 PMCID: PMC10334401 DOI: 10.1016/j.ekir.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is a leading cause of death of adults in Sri Lanka's dry region. Methods We initiated the Kidney Progression Project (KiPP) to prospectively follow 292 persons with Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) 20 to 60 ml/min per 1.73 m2 living in a CKDu endemic area. Using data from 3-year follow-up, we assessed kidney function decline (>30% from baseline eGFR), and the composite outcome of >30% eGFR decline, eGFR <15 ml/min or death, and explored the association of the 2 outcomes with baseline demographic, residential, and clinical parameters accounting for baseline eGFR. Results Median eGFR at enrollment was 28 ml/min among 71 women; 30 ml/min among 221 men; 91% to 99% had trace or no proteinuria during follow-up. At enrollment, median serum sodium, uric acid, and potassium were 143 mmol/l, 6.3 mg/dl, 4.5 meq/l, respectively among women; and 143 mmol/l, 6.9 mg/dl, 4.3 meq/l among men. Mean slope of eGFR decline was -0.5 (SD 4.9) ml/min/yr. In exploratory analyses, men with greater years of education and those living in northern region of the study area experienced lower likelihood of disease progression (hazard ratios [HR] 0.87 [0.77-0.98] per additional year and 0.33 [0.12-0.89] for northern versus other subregions, respectively). There was a suggestion that men drinking well water had higher likelihood and men living further away from reservoirs had lower likelihood of >30% decline in eGFR (HR 2.07 [0.95-4.49] for drinking well water versus not, and HR 0.58 [0.32-1.05] per kilometer distance, respectively). Conclusions The overall rate of kidney function decline was slow in this CKDu cohort, similar to other nonalbuminuric CKD, and event rates were similar among men and women. Further etiologic investigations could focus on specific residence locale and water use.
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Affiliation(s)
- Pasan Hewavitharana
- Center for Research, National Hospital Kandy, Sri Lanka
- Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Kandy, Sri Lanka
| | - Stephen Schensul
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Edison Lee
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Maria Montez-Rath
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Sai Liu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Kaitlin Harold
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | | | | | - Hemalika T.K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Xue Yu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Vivek Bhalla
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Andrew Fire
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Shuchi Anand
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut, USA
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Nishantha Nanayakkara
- Center for Research, National Hospital Kandy, Sri Lanka
- Nephrology and Kidney Transplant Unit, National Hospital Kandy, Sri Lanka
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Jia PP, Chandrajith R, Junaid M, Li TY, Li YZ, Wei XY, Liu L, Pei DS. Elucidating environmental factors and their combined effects on CKDu in Sri Lanka using zebrafish. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023:121967. [PMID: 37290634 DOI: 10.1016/j.envpol.2023.121967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
Chronic kidney disease with uncertain etiology (CKDu) in Sri Lanka has attracted much attention as a global health issue. However, how environmental factors in local drinking water induce kidney damage in organisms is still elusive. We investigated multiple environmental factors including water hardness and fluoride (HF), heavy metals (HM), microcystin-LR (MC-LR), and their combined exposure (HFMM) to elucidate their toxic effects on CKDu risk in zebrafish. Acute exposure affected renal development and inhibited the fluorescence of Na, K-ATPase alpha1A4:GFP zebrafish kidney. Chronic exposure influenced the body weight of both genders of adult fish and induced kidney damage by histopathological analyses. Furthermore, the exposure significantly disturbed differential expression genes (DEGs), diversity and richness of gut microbiota, and critical metabolites related to renal functions. The transcriptomic analysis revealed that kidney-related DEGs were linked with renal cell carcinoma, proximal tubule bicarbonate reclamation, calcium signaling pathway, and HIF-1 signaling pathway. The significantly disrupted intestinal microbiota was closely related to the environmental factors and H&E score, which demonstrated the mechanisms of kidney risks. Notably, the Spearman correlation analysis indicated that the changed bacteria such as Pseudomonas, Paracoccus, and ZOR0006, etc were significantly connected to the DEGs and metabolites. Therefore, the assessment of multiple environmental factors provided new insights on "bio-markers" as potential therapies of the target signaling pathways, metabolites, and gut bacteria to monitor or protect residents from CKDu.
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Affiliation(s)
- Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Rohana Chandrajith
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China; Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Muhammad Junaid
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Yong-Zhi Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Xing-Yi Wei
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Li Liu
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Shi Q, Gao Z, Guo H, Zeng X, Sandanayake S, Vithanage M. Hydrogeochemical factors controlling the occurrence of chronic kidney disease of unknown etiology (CKDu). ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:2611-2627. [PMID: 36063240 DOI: 10.1007/s10653-022-01379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) has posed a serious threat to human health around the world. The link between the prevalence of CKDu and groundwater geochemistry is not well understood. To identify the potential geogenic risk factors, we collected 52 groundwater samples related to CKDu (CKDu groundwater) and 18 groundwater samples related to non-CKDu (non-CKDu groundwater) from the typical CKDu prevailing areas in Sri Lanka. Results demonstrated that CKDu groundwater had significantly higher Si (average 30.1 mg/L, p < 0.05) and F- (average 0.80 mg/L, p < 0.05) concentrations than those of non-CKDu groundwater (average 21.0 and 0.45 mg/L, respectively), indicating that Si and F- were the potential risk factors causing CKDu. The principal hydrogeochemical process controlling local groundwater chemistry was chemical weathering of silicates in Precambrian metamorphic rocks. Groundwater samples were mostly undersaturated with respect to amorphous silica and clay minerals such as talc and sepiolite, which was conducive to silicate weathering and elevated Si concentrations in groundwater. Decreased Ca2+ being facilitated by calcite precipitation and cation exchange between Ca2+ and Na+ favored fluorite dissolution and thus led to high groundwater F- concentrations. Competitive adsorption between [Formula: see text] and F- also enhanced the release of F- from solid surfaces. This study highlights the CKDu potential risk factors regarding groundwater geochemistry and their enrichment factors, which helps in preventing the prevalence of CKDu.
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Affiliation(s)
- Qiutong Shi
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Zhipeng Gao
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Huaming Guo
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China.
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China.
| | - Xianjiang Zeng
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Sandun Sandanayake
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Meththika Vithanage
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
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Premarathne SS, Gamage C, Chandrajith R, Ratnatunge NV, Wijetunge S, Wazil A, Chou LF, Ko YC, Huang CT, Yang HY, Fonseka A, Sonnadara T, Herath D, Hewavitharane P, Yang CW, Nanayakkara N. Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology. Nephron Clin Pract 2023; 147:510-520. [PMID: 36809758 PMCID: PMC10568603 DOI: 10.1159/000528703] [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: 05/20/2022] [Accepted: 10/23/2022] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu. METHOD This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]). RESULTS The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and NEC groups, respectively, from the rapid IgM test. Among 19 serovars tested, the highest seroprevalence was observed at 72.9, 38.9, and 21.1% in the AIN (AINu), EC, and NEC groups, respectively, by microscopic agglutination test (MAT), particularly for serovar Leptospira santarosai serovar Shermani. This emphasizes the presence of infection in AINu patients, and this also suggests that Leptospira exposure might play an important role in AINu. CONCLUSION These data suggest that exposure to Leptospira infection could be one of the possible causative factors for the occurrence of AINu, which may lead to CKDu in Sri Lanka.
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Affiliation(s)
- Shakila Sudarshani Premarathne
- Centre for Research, National Hospital, Kandy, Sri Lanka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Rohana Chandrajith
- Depatment of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Abdul Wazil
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
| | - Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ching Ko
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Huang-Yu Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Amanda Fonseka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | | | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Banjong D, Pongking T, Tran NTD, Pinlaor S, Dangtakot R, Intuyod K, Anutrakulchai S, Cha’on U, Pinlaor P. Slight Changes in the Gut Microbiome in Early-stage Chronic Kidney Disease of Unknown Etiology. Microbes Environ 2023; 38:ME22097. [PMID: 37635077 PMCID: PMC10522841 DOI: 10.1264/jsme2.me22097] [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: 11/22/2022] [Accepted: 06/23/2023] [Indexed: 08/29/2023] Open
Abstract
Gut dysbiosis and changes in short-chain fatty acids (SCFAs) occur in end-stage chronic kidney disease (CKD); however, the degree of these changes in the gut microbiome and serum SCFA profiles in the early stages of CKD, particularly in CKD of unknown etiology (CKDu), is unclear. We herein investigated the gut microbiome and SCFA profiles of early-stage CKD patients (CKD stages 1-3) in a community in Khon Kaen Province, Thailand. Seventy-two parasite-free participants were distributed among a healthy control group (HC, n=18) and three patient groups (an underlying disease group [UD, n=18], early-stage CKD with underlying disease [CKD-UD, n=18], and early-stage CKD of unknown etiology, [CKDu, n=18]). Fecal DNA was individually extracted and pooled for groups of six individuals (three pools in each group) to examine the composition of the gut microbiome using next-generation sequencing. A SCFA ana-lysis was performed on serum samples from each individual using gas chromatography-mass spectrometry. The results revealed that microbial abundance differed between the healthy group and all patient groups (UD, CKD-UD, and CKDu). [Eubacterium]_coprostanoligenes_group was more abundant in the CKDu group than in the HC and CKD-UD groups. Furthermore, serum concentrations of acetate, a major SCFA component, were significantly lower in all patient groups than in the HC group. The present results indicate that minor changes in the gut microbiome and a significant decrease in serum acetate concentrations occur in early-stage CKDu, which may be important for the development of prevention strategies for CKD patients.
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Affiliation(s)
- Ditsayathan Banjong
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Thatsanapong Pongking
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Na T. D. Tran
- Faculty of Medical Laboratory Science, Danang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Somchai Pinlaor
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Rungtiwa Dangtakot
- Faculty of Medical Technology, Nakhonratchasima College, Nakhon Ratchasima, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Kitti Intuyod
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Sirirat Anutrakulchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Ubon Cha’on
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
| | - Porntip Pinlaor
- Center for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Chronic Kidney Disease Prevention in Northeastern Thailand, Khon Kaen, Thailand
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Citizen-science reveals changes in the oral microbiome in Spain through age and lifestyle factors. NPJ Biofilms Microbiomes 2022; 8:38. [PMID: 35585074 PMCID: PMC9117221 DOI: 10.1038/s41522-022-00279-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
The relevance of the human oral microbiome to our understanding of human health has grown in recent years as microbiome studies continue to develop. Given the links of the oral cavity with the digestive, respiratory and circulatory systems, the composition of the oral microbiome is relevant beyond just oral health, impacting systemic processes across the body. However, we still have a very limited understanding about intrinsic and extrinsic factors that shape the composition of the healthy oral microbiome. Here, we followed a citizen-science approach to assess the relative impact on the oral microbiome of selected biological, social, and lifestyle factors in 1648 Spanish individuals. We found that the oral microbiome changes across age, with middle ages showing a more homogeneous composition, and older ages showing more diverse microbiomes with increased representation of typically low abundance taxa. By measuring differences within and between groups of individuals sharing a given parameter, we were able to assess the relative impact of different factors in driving specific microbial compositions. Chronic health disorders present in the analyzed population were the most impactful factors, followed by smoking and the presence of yeasts in the oral cavity. Finally, we corroborate findings in the literature that relatives tend to have more similar oral microbiomes, and show for the first time a similar effect for classmates. Multiple intrinsic and extrinsic factors jointly shape the oral microbiome. Comparative analysis of metabarcoding data from a large sample set allows us to disentangle the individual effects.
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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Hettithanthri O, Sandanayake S, Magana-Arachchi D, Wanigatunge R, Rajapaksha AU, Zeng X, Shi Q, Guo H, Vithanage M. Risk factors for endemic chronic kidney disease of unknown etiology in Sri Lanka: Retrospect of water security in the dry zone. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 795:148839. [PMID: 34328928 DOI: 10.1016/j.scitotenv.2021.148839] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The prevalence of chronic kidney disease of unknown etiology (CKDu) is receiving considerable attention due to the serious threat to human health throughout the world. However, the roles of geo-socio-environmental factors in the prevalence of the CKDu endemic areas are still unknown. Sri Lanka is one of the countries most seriously affected by CKDu, where 10 out of 25 districts have been identified as the areas with the high prevalence of CKDu (10-20%). This review summarizes the geographical distribution of CKDu and its probable geochemical, behavioral, sociological, and environmental risk factors based on research related to hydrogeochemical influences on CKDu in Sri Lanka. More than 98% of CKDu patients have consumed groundwater as their primary water source in daily life, indicating the interactions of geogenic contaminants (such as F-, total dissolved solids, Hofmeister ions) in groundwater is responsible for the disease. Apart from the hydrogeochemical factors, mycotoxins, cyanotoxins, use of some herbal medicines, dehydration, and exposure to agrochemicals were alleged as risk factors. Sociological factors, including poverty, living habits and anthropogenic activities, may also provoke the emergence of CKDu. Therefore, the interaction of geo-socio environmental risk factors should be sociologically and scientifically considered to prevent the prevalence of CKDu. Future in-depth studies are required to reveal the individual role of each of the postulated etiological factors, possibly using machine learning and advanced statistics.
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Affiliation(s)
- Oshadi Hettithanthri
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rasika Wanigatunge
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Sri Lanka
| | - Anushka Upamali Rajapaksha
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Xianjiang Zeng
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Qiutong Shi
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Huaming Guo
- School of Water Resources and Environment, China University of Geosciences, Beijing, China.
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
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Imbulana S, Oguma K. Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review. JOURNAL OF WATER AND HEALTH 2021; 19:393-410. [PMID: 34152294 DOI: 10.2166/wh.2021.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The cause of Chronic Kidney Disease of unknown etiology (CKDu) in the rural dry zone of Sri Lanka remains unidentified, despite vast research efforts that brought about an extensive list of potential risk factors. Among these, the long-term exposure to various nephrotoxic elements through drinking groundwater was widely suspected owing to the unique geographical distribution of the disease. This review focuses on such well-known hypotheses suspecting the relations with fluoride, hardness, major ions, heavy metals, metalloids, organic matter, agrochemical residues, pathogens, and bacterial toxins in the groundwaters of the CKDu-endemic region. It was comprehensively discussed why each of these constituents was considered a risk factor of CKDu, how could they possibly trigger the pathogenesis of the disease, what was the evidence that supported or failed each hypothesis, and whether providing safe drinking water had been effective at mitigating the progression of the disease. Although plenty of circumstantial evidence supported an etiology related to groundwater for CKDu, it was impossible to elucidate the cause-effect relationships between drinking impaired groundwater and the occurrence of the disease. Future research should be effectively designed to clarify the role of groundwater in the onset of CKDu by taking into account the gaps in past research.
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Affiliation(s)
- Sachithra Imbulana
- Department of Urban Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan E-mail:
| | - Kumiko Oguma
- Department of Urban Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan E-mail:
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