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Coimbra S, Rocha S, Catarino C, Valente MJ, Rocha-Pereira P, Sameiro-Faria M, Oliveira JG, Madureira J, Fernandes JC, Miranda V, Belo L, Bronze-da-Rocha E, Santos-Silva A. Impact of TNFRSF1B (rs3397, rs1061624 and rs1061622) and IL6 (rs1800796, rs1800797 and rs1554606) Gene Polymorphisms on Inflammatory Response in Patients with End-Stage Kidney Disease Undergoing Dialysis. Biomedicines 2024; 12:1228. [PMID: 38927435 PMCID: PMC11200861 DOI: 10.3390/biomedicines12061228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to study the impact of polymorphisms in the genes encoding interleukin-6 (IL6) and tumor necrosis factor receptor-2 (TNFR2), reported to be mortality risk predictors, in patients with end-stage kidney disease (ESKD) undergoing dialysis. TNFRSF1B (rs3397, rs1061624, and rs1061622) and IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms were studied in patients with ESKD and controls; the genotype and allele frequencies and the associations with inflammatory and erythropoiesis markers were determined; deaths were recorded throughout the following two years. The genotype and allele frequencies for the TNFRSF1B rs3397 polymorphism were different in these patients compared to those in the controls and the global and European populations, and patients with the C allele were less common. Patients with the CC genotype for TNFRSF1B rs3397 presented higher hemoglobin and erythrocyte counts and lower TNF-α levels, suggesting a more favorable inflammatory response that seems to be associated with erythropoiesis improvement. Patients with the GG genotype for TNFRSF1B rs1061622 showed lower serum ferritin levels. None of the TNFRSF1B (rs3397, rs1061624, and rs1061622) or IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms had a significant impact on the all-cause mortality rate of Portuguese patients with ESKD.
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Affiliation(s)
- Susana Coimbra
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- 1H-TOXRUN—One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU (Advanced Polytechnic and University Cooperative, CRL), 4585-116 Gandra, Portugal
| | - Susana Rocha
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Cristina Catarino
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria João Valente
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| | - Petronila Rocha-Pereira
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- Health Science Research Centre, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Maria Sameiro-Faria
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- Hemodialysis Clinic Hospital Agostinho Ribeiro, 4610-106 Felgueiras, Portugal
| | - José Gerardo Oliveira
- Hemodialysis Clinic of Porto (CHP), 4200-227 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - José Madureira
- Hemodialysis Unit of Barcelos | Nefroserve, 4750-110 Barcelos, Portugal
| | - João Carlos Fernandes
- Hemodialysis Unit of Viana do Castelo | Nefroserve, 4900-281 Viana do Castelo, Portugal
| | - Vasco Miranda
- Hemodialysis Clinic of Gondomar, 4420-086 Gondomar, Portugal
| | - Luís Belo
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Elsa Bronze-da-Rocha
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Alice Santos-Silva
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
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Xu C, Tsihlis G, Chau K, Trinh K, Rogers NM, Julovi SM. Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease. Int J Mol Sci 2024; 25:2658. [PMID: 38473905 DOI: 10.3390/ijms25052658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic kidney disease (CKD) affects > 10% of the global adult population and significantly increases the risk of cardiovascular disease (CVD), which remains the leading cause of death in this population. The development and progression of CVD-compared to the general population-is premature and accelerated, manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. CKD and CV disease combine to cause multimorbid cardiorenal syndrome (CRS) due to contributions from shared risk factors, including systolic hypertension, diabetes mellitus, obesity, and dyslipidemia. Additional neurohormonal activation, innate immunity, and inflammation contribute to progressive cardiac and renal deterioration, reflecting the strong bidirectional interaction between these organ systems. A shared molecular pathophysiology-including inflammation, oxidative stress, senescence, and hemodynamic fluctuations characterise all types of CRS. This review highlights the evolving paradigm and recent advances in our understanding of the molecular biology of CRS, outlining the potential for disease-specific therapies and biomarker disease detection.
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Affiliation(s)
- Cuicui Xu
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
| | - George Tsihlis
- Renal and Transplantation Medicine, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Katrina Chau
- Department of Renal Services, Blacktown Hospital, Blacktown, NSW 2148, Australia
- Blacktown Clinical School, School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - Katie Trinh
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
- Department of Renal Services, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Natasha M Rogers
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
- Renal and Transplantation Medicine, Westmead Hospital, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Rd., Camperdown, NSW 2050, Australia
| | - Sohel M Julovi
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Rd., Camperdown, NSW 2050, Australia
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Li X, Qureshi AR, Suliman ME, Heimburger O, Barany P, Stenvinkel P, Lindholm B. Interleukin-6-to-Albumin Ratio as a Superior Predictor of Mortality in End-Stage Kidney Disease Patients. Am J Nephrol 2023; 54:268-274. [PMID: 37231796 PMCID: PMC10623391 DOI: 10.1159/000531191] [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: 03/28/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In patients with chronic kidney disease (CKD), high interleukin-6 (IL-6) and low albumin circulating concentrations are associated with worse outcomes. We examined the IL-6-to-albumin ratio (IAR) as a predictor of risk of death in incident dialysis patients. METHODS In 428 incident dialysis patients (median age 56 years, 62% men, 31% diabetes mellitus, 38% cardiovascular disease [CVD]), plasma IL-6 and albumin were measured at baseline to calculate IAR. We compared the discrimination of IAR with other risk factors for predicting 60-month mortality using receiver operating characteristic curve (ROC) and analyzed the association of IAR with mortality using Cox regression analysis. We divided patients into IAR tertiles and analyzed: (1) cumulative incidence of mortality and the association of IAR with mortality risk in Fine-Gray analysis, taking kidney transplantation as competing risk and (2) the restricted mean survival time (RMST) to 60-month mortality and differences of RMST (∆RMST) between IAR tertiles to describe quantitative differences of survival time. RESULTS For all-cause mortality, the area under the ROC curve (AUC) for IAR was 0.700, which was greater than for IL-6 and albumin separately, while for CV mortality, the AUC for IAR (0.658) showed negligible improvement over IL-6 and albumin separately. In Cox regression analysis, IAR was significantly associated with all-cause mortality but not with CV mortality. Both high versus low and middle versus low tertiles of IAR associated with higher risk of all-cause mortality, subdistribution hazard ratio of 2.22 (95% CI 1.40-3.52) and 1.85 (95% CI 1.16-2.95), respectively, after adjusting for age, sex, diabetes mellitus, CVD, smoking, and estimated glomerular filtration rate. ∆RMST at 60 months showed significantly shorter survival time in middle and high IAR tertiles compared with low IAR tertile for all-cause mortality. CONCLUSIONS Higher IAR was independently associated with significantly higher all-cause mortality risk in incident dialysis patients. These results suggest that IAR may provide useful prognostic information in patients with CKD.
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Affiliation(s)
- Xiejia Li
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden,
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, China,
| | - Abdul Rashid Qureshi
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mohamed E Suliman
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimburger
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Abstract
With a global burden of 844 million, chronic kidney disease (CKD) is now considered a public health priority. Cardiovascular risk is pervasive in this population, and low-grade systemic inflammation is an established driver of adverse cardiovascular outcomes in these patients. Accelerated cellular senescence, gut microbiota-dependent immune activation, posttranslational lipoprotein modifications, neuroimmune interactions, osmotic and nonosmotic sodium accumulation, acute kidney injury, and precipitation of crystals in the kidney and the vascular system all concur in determining the unique severity of inflammation in CKD. Cohort studies documented a strong link between various biomarkers of inflammation and the risk of progression to kidney failure and cardiovascular events in patients with CKD. Interventions targeting diverse steps of the innate immune response may reduce the risk of cardiovascular and kidney disease. Among these, inhibition of IL-1β (interleukin-1 beta) signaling by canakinumab reduced the risk for cardiovascular events in patients with coronary heart disease, and this protection was equally strong in patients with and without CKD. Several old (colchicine) and new drugs targeting the innate immune system, like the IL-6 (interleukin 6) antagonist ziltivekimab, are being tested in large randomized clinical trials to thoroughly test the hypothesis that mitigating inflammation may translate into better cardiovascular and kidney outcomes in patients with CKD.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute New York and Institute of Molecular Biology and genetics (BIOGEM), Ariano Irpino, Italy and Associazione Ipertensione, Nefrologia, Trapianto (IPNET), Reggio Calabria Italy (C.Z.)
| | - Francesca Mallamaci
- Division of Nephrology and Transplantation, Grande Ospedale Metropolitano, Reggio Calabria, Italy and National Research Council (CNR), Clinical Epidemiology of Hypertension and Renal Diseases Unit of the Institute of Clinical Physiology, Reggio Calabria, Italy (F.M.)
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Chen Z, Wang Y. Interleukin-6 levels can be used to estimate cardiovascular and all-cause mortality risk in dialysis patients: A meta-analysis and a systematic review. Immun Inflamm Dis 2023; 11:e818. [PMID: 37102647 PMCID: PMC10132186 DOI: 10.1002/iid3.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although previous studies have explored the correlation of interleukin (IL)-6 with mortality risk in dialysis patients, the findings have been conflicting. Hence, this meta-analysis aimed to comprehensively assess the use of IL-6 measurement for estimating cardiovascular mortality and all-cause mortality in dialysis patients. METHODS The Embase, PubMed, Web of Science, and MEDLINE databases were searched to identify relevant studies. After screening out the eligible studies, the data were extracted. RESULTS Twenty-eight eligible studies with 8370 dialysis patients were included. Pooled analyses revealed that higher IL-6 levels were related to increased cardiovascular mortality risk (hazard ratio [HR] = 1.55, 95% confidence interval [CI]: 1.20-1.90) and all-cause mortality risk (HR = 1.11, 95% CI: 1.05-1.17) in dialysis patients. Further subgroup analyses suggested that higher IL-6 levels were associated with elevated cardiovascular mortality in hemodialysis patients (HR = 1.59, 95% CI: 1.36-1.81) but not in peritoneal dialysis patients (HR = 1.56, 95% CI: 0.46-2.67). Moreover, sensitivity analyses indicated that the results were robust. Egger's test revealed potential publication bias among studies exploring the correlation of IL-6 levels with cardiovascular mortality (p = .004) and all-cause mortality (p < .001); however, publication bias was not observed when using Begg's test (both p > .05). CONCLUSIONS This meta-analysis reveals that higher IL-6 levels could indicate higher risks of cardiovascular mortality and all-cause mortality in dialysis patients. These findings suggest that monitoring IL-6 cytokine may help to enhance dialysis management and improve the general prognosis of patients.
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Affiliation(s)
- Zeyu Chen
- Department of Cardiology, The First People's Hospital of Ziyang, Ziyang, China
| | - Yan Wang
- Department of Nephrology, The First People's Hospital of Ziyang, Ziyang, China
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A randomized prospective cross over study on the effects of medium cut-off membranes on T cellular and serologic immune phenotypes in hemodialysis. Sci Rep 2022; 12:16419. [PMID: 36180564 PMCID: PMC9524345 DOI: 10.1038/s41598-022-20818-z] [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: 05/27/2022] [Accepted: 09/19/2022] [Indexed: 11/08/2022] Open
Abstract
Extended cut-off filtration by medium cut-off membranes (MCO) has been shown to be safe in maintenance hemodialysis (HD). The notion of using them for the control of chronic low-grade inflammation and positively influencing cellular immune aberrations seems tempting. We conducted an open label, multicenter, randomized, 90 day 2-phase cross over clinical trial (MCO- vs. high flux-HD). 46 patients underwent randomization of which 34 completed the study. Dialysate- or pre- and post-dialysis serum inflammatory mediators were assayed for each study visit. Ex vivo T cell activation was assessed from cryopreserved leucocytes by flow cytometry. Linear mixed models were used to compare treatment modalities, with difference in pre-dialysis serum MCP-1 levels after 3 months as the predefined primary endpoint. Filtration/dialysate concentrations of most mediators, including MCP-1 (mean ± SD: 10.5 ± 5.9 vs. 5.1 ± 3.8 pg/ml, P < 0.001) were significantly increased during MCO- versus high flux-HD. However, except for the largest mediator studied, i.e., YKL-40, this did not confer any advantages for single session elimination kinetics (post-HD mean ± SD: 360 ± 334 vs. 564 ± 422 pg/ml, P < 0.001). No sustained reduction of any of the studied mediators was found neither. Still, the long-term reduction of CD69+ (P = 0.01) and PD1+ (P = 0.02) activated CD4+ T cells was striking. Thus, MCO-HD does not induce reduction of a broad range of inflammatory mediators studied here. Long-term reduction over a 3-month period was not possible. Increased single session filtration, as evidenced by increased dialysate concentrations of inflammatory mediators during MCO-HD, might eventually be compensated for by compartment redistribution or increased production during dialysis session. Nevertheless, lasting effects on the T-cell phenotype were seen, which deserves further investigation.
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Lin CH, Liu WS, Wan C, Wang HH. Pentraxin 3 mediates early inflammatory response and EMT process in human tubule epithelial cells induced by PM2.5. Int Immunopharmacol 2022; 112:109258. [PMID: 36179417 DOI: 10.1016/j.intimp.2022.109258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022]
Abstract
Pentraxin 3 (PTX3) is a multifunctional molecule that mainly expressed in response to proinflammatory stimuli under physiological and pathological conditions. It is produced in tubule epithelial cells that is involved in the innate immune response and inflammatory reactions in the kidney. However, its role in fine particulate matter (PM2.5)-induced renal injury associated with inflammation remains to be investigated. As a result of PM2.5 exposure, the levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α levels were increased in HK-2 cells. Notably, the mesenchymal phenotypes with migratory abilities of HK-2 cells were found following PM2.5 exposure. The elevated expressions of PTX3 mRNA and protein in response to PM2.5 were tested by RT-PCR and Western blotting respectively. Further determinate the role of PTX3 by siRNA showed lack of PTX3 could increase IL-6 production and promote epithelial-mesenchymal transition (EMT) process, as evidenced by decreased expressions of E-cadherin, and increased expressions of N-cadherin and α-SMA in HK-2 cells following PM2.5 exposure. Our study indicates that PTX3 mediates early inflammatory response and EMT in PM2.5-exposed HK-2 cells, suggesting a counter-regulatory role of PTX3 in the early course of tubule cell injury induced by PM2.5.
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Affiliation(s)
- Chien-Hung Lin
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; College of Science and Engineering, Fu Jen Catholic University, New Taipei, Taiwan.
| | - Wen-Sheng Liu
- College of Science and Engineering, Fu Jen Catholic University, New Taipei, Taiwan; Department of Pediatrics, Taipei City Hospital, Zhongxing Branch, Taiwan
| | - Chuan Wan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Taipei City Hospital, Zhongxing Branch, Taiwan
| | - Hsin-Hui Wang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
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Targeting innate immunity-driven inflammation in CKD and cardiovascular disease. Nat Rev Nephrol 2022; 18:762-778. [PMID: 36064794 DOI: 10.1038/s41581-022-00621-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/08/2022]
Abstract
Mortality among patients with chronic kidney disease (CKD) is largely a consequence of cardiovascular disease (CVD) and is a particular concern given the increasing prevalence of CKD. Sterile inflammation triggered by activation of the innate immune system is an important driver of both CKD and associated CVD. Several endogenous mediators, including lipoproteins, crystals such as silica, urate and cholesterol crystals, or compounds released from dying cells interact with pattern recognition receptors expressed on a variety of different cell types, leading to the release of pro-inflammatory cytokines. Disturbed regulation of the haematopoietic system by damage-associated molecular patterns, or as a consequence of clonal haematopoiesis or trained innate immunity, also contributes to the development of inflammation. In observational and genetic association studies, inflammation is linked to the progression of CKD and cardiovascular events. In 2017, the CANTOS trial of canakinumab provided evidence that inhibiting inflammation driven by NLRP3-IL-1-IL-6-mediated signalling significantly reduced cardiovascular event rates in individuals with and without CKD. Other approaches to target innate immune pathways are now under investigation for their ability to reduce cardiovascular events and slow disease progression among patients with atherosclerosis and stage 3 and 4 CKD. This Review summarizes current understanding of the role of inflammation in the pathogenesis of CKD and its associated CVD, and how this knowledge may translate into novel therapeutics.
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Sun X, Chen J, Huang Y, Zhu S, Wang S, Xu Z, Zhang J, Sun W. Yishen Qingli Heluo Granule Ameliorates Renal Dysfunction in 5/6 Nephrectomized Rats by Targeting Gut Microbiota and Intestinal Barrier Integrity. Front Pharmacol 2022; 13:858881. [PMID: 35814258 PMCID: PMC9258868 DOI: 10.3389/fphar.2022.858881] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic kidney disease (CKD) is often accompanied with imbalanced gut microbiota and impaired intestinal barrier. Hence, efforts to ameliorate renal dysfunction by manipulating gut microbial ecosystem are underway. Yishen Qingli Heluo granule (YQHG) is a representative traditional Chinese medicine (TCM) prescription for clinical treatment of CKD. However, its underlying mechanism has not been well elucidated. This study aimed to explore effects of YQHG on renal dysfunction in 5/6 nephrectomized rats by targeting gut microbiota and intestinal barrier. Here, we found that YQHG provided significant renal protection in 5/6 nephrectomized rats by reducing renal fibrosis and inflammation, reestablishing bacterial communities, and improving intestinal barrier. Our analysis showed that YQHG altered the bacterial community of 5/6 nephrectomized rats. In particular, the prescription significantly increased the relative abundance of SCFA-producing bacteria (i.e., Lactobacillaceae, Lactobacillus and Lactobacillus_gasseri), which was contributed to the improved SCFA concentration (i.e., total SCFA, acetic acid, butyric acid) and intestinal barrier (i.e., the improved permeability and microbial translocation). More critically, microbiota-transfer study showed that the protective effect of YQHG was partly attributed to the mediation of the gut microbiota, especially the SCFA-producing bacteria. Our current findings propose a microbiota-targeted intervention and indicate that YQHG may become a novel promising treatment for CKD.
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Affiliation(s)
- Xian Sun
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Chen
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Hanlin College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yiting Huang
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Sha Zhu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuaishuai Wang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zijing Xu
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Junfeng Zhang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Junfeng Zhang, ; Wei Sun,
| | - Wei Sun
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Junfeng Zhang, ; Wei Sun,
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10
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Wang Y, Gao L. Inflammation and Cardiovascular Disease Associated With Hemodialysis for End-Stage Renal Disease. Front Pharmacol 2022; 13:800950. [PMID: 35222026 PMCID: PMC8867697 DOI: 10.3389/fphar.2022.800950] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic kidney disease (CKD) and cardiac insufficiency often co-exist, particularly in uremic patients on hemodialysis (HD). The occurrence of abnormal renal function in patients with cardiac insufficiency is often indicative of a poor prognosis. It has long been established that in patients with cardiac insufficiency, poorer renal function tends to indicate poorer cardiac mechanics, including left atrial reserve strain, left ventricular longitudinal strain, and right ventricular free wall strain (Unger et al., Eur J Heart Fail, 2016, 18(1), 103-12). Similarly, patients with chronic kidney disease, particularly uremic patients on HD, often have cardiovascular complications in addition to abnormal endothelial function with volume overload, persistent inflammatory states, calcium overload, and imbalances in redox responses. Cardiac insufficiency due to uremia is therefore mainly due to multifaceted non-specific pathological changes rather than pure renal insufficiency. Several studies have shown that the risk of adverse cardiovascular events is greatly increased and persistent in all patients treated with HD, especially in those who have just started HD treatment. Inflammation, as an important intersection between CKD and cardiovascular disease, is involved in the development of cardiovascular complications in patients with CKD and is indicative of prognosis (Chan et al., Eur Heart J, 2021, 42(13), 1244-1253). Therefore, only by understanding the mechanisms underlying the sequential development of inflammation in CKD patients and breaking the vicious circle between inflammation-mediated renal and cardiac insufficiency is it possible to improve the prognosis of patients with end-stage renal disease (ESRD). This review highlights the mechanisms of inflammation and the oxidative stress that co-exists with inflammation in uremic patients on dialysis, as well as the mechanisms of cardiovascular complications in the inflammatory state, and provides clinical recommendations for the anti-inflammatory treatment of cardiovascular complications in such patients.
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Affiliation(s)
| | - Lu Gao
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Jilin, China
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Association of Genetic Variants in IL6 Gene (rs1800795) with the Concentration of Inflammatory Markers (IL-6, hs-CRP) and Superoxide Dismutase in the Blood of Patients with Acute Pancreatitis—Preliminary Findings. Genes (Basel) 2022; 13:genes13020290. [PMID: 35205334 PMCID: PMC8872489 DOI: 10.3390/genes13020290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
In the course of acute pancreatitis, interleukin-6 plays an important role as a mediator in the inflammatory response. The course of inflammatory disease is associated with intensive oxidative stress, which may activate transcription factors leading to gene-expression changes. Isoenzymes of superoxide dismutase are involved in the defense against free radicals. This study aimed to evaluate changes in IL-6 concentration and the concentration/activity of superoxide dismutase isoenzymes (SOD1, SOD2, and SOD3) in the blood of patients with acute pancreatitis (AP) in terms of rs1800795 polymorphism in the IL6 gene. In the smoking AP patients group with the GC and GG genotypes, the plasma SOD1 concentration was significantly higher (p = 0.0146 and p = 0.0250, respectively) than in patients with CC genotype for SNP rs1800795 in the IL6 gene. An increase in SOD1 concentration in erythrocytes of AP patients with GC genotypes was also demonstrated compared to the individuals from the group with GG genotype (p = 0.0408). Furthermore, a positive correlation between IL-6 and SOD1 concentrations in the plasma of AP patients with GC genotype for SNP rs1800795 was shown. These results indicate that SOD1 may play a protective role against oxidative damage induced by inflammation in the group of AP patients with GC genotype.
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Guarneri M, Scola L, Giarratana RM, Bova M, Carollo C, Vaccarino L, Calandra L, Lio D, Balistreri CR, Cottone S. MIF rs755622 and IL6 rs1800795 Are Implied in Genetic Susceptibility to End-Stage Renal Disease (ESRD). Genes (Basel) 2022; 13:226. [PMID: 35205271 PMCID: PMC8872268 DOI: 10.3390/genes13020226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by an increased risk of kidney failure and end-stage renal disease (ESRD). Aging and comorbidities as cardiovascular diseases, metabolic disorders, infectious diseases, or tumors, might increase the risk of dialysis. In addition, genetic susceptibility factors might modulate kidney damage evolution. We have analyzed, in a group of ESRD patients and matched controls, a set of SNPs of genes (Klotho rs577912, rs564481, rs9536314; FGF23 rs7955866; IGF1 rs35767; TNFA rs1800629; IL6 rs1800795; MIF rs755622, rs1007888) chosen in relation to their possible involvement with renal disease and concomitant pathologies. Analysis of the raw data did indicate that IL6 rs180795 and MIF rs755622 SNPs might be markers of genetic susceptibility to ESRD. In particular, the C positive genotypes of MIF rs755622, (dominant model) seem to be an independent risk factor for ESDR patients (data adjusted for age, gender, and associated pathologies). Stratifying results according to age MIF rs755622 C positive genotype frequencies are increased in both the two age classes considered (<59 and ≥59-year-old subjects). Analyses of data according to gender allowed us to observe that ESRD women shoved a significantly reduced frequency of genotypes bearing IL6 rs180795 C allele. In addition, MIF rs755622 might interact with diabetes or hypercholesterolemia in increasing susceptibility to ESRD. In conclusion, our data indicate that some polymorphisms involved in the regulation of both renal function and inflammatory response can influence the evolution of chronic kidney disease and suggest that the modulation of the activities of these and other genes should also be considered as therapeutic targets on to intervene with innovative therapies.
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Affiliation(s)
- Marco Guarneri
- Unit of Nephrology & Hypertension, European Society of Hypertension Excellence Center, Department of Health Promotion Sciences, Maternal & Infant Care, Internal Medicine & Medical Specialties (PROMISE), University of Palermo, “Paolo Giaccone” University Hospital, 90127 Palermo, Italy; (M.G.); (C.C.); (L.C.); (S.C.)
| | - Letizia Scola
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Rosa Maria Giarratana
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Manuela Bova
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Caterina Carollo
- Unit of Nephrology & Hypertension, European Society of Hypertension Excellence Center, Department of Health Promotion Sciences, Maternal & Infant Care, Internal Medicine & Medical Specialties (PROMISE), University of Palermo, “Paolo Giaccone” University Hospital, 90127 Palermo, Italy; (M.G.); (C.C.); (L.C.); (S.C.)
| | - Loredana Vaccarino
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Leonardo Calandra
- Unit of Nephrology & Hypertension, European Society of Hypertension Excellence Center, Department of Health Promotion Sciences, Maternal & Infant Care, Internal Medicine & Medical Specialties (PROMISE), University of Palermo, “Paolo Giaccone” University Hospital, 90127 Palermo, Italy; (M.G.); (C.C.); (L.C.); (S.C.)
| | - Domenico Lio
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Carmela Rita Balistreri
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy; (L.S.); (R.M.G.); (M.B.); (L.V.); (C.R.B.)
| | - Santina Cottone
- Unit of Nephrology & Hypertension, European Society of Hypertension Excellence Center, Department of Health Promotion Sciences, Maternal & Infant Care, Internal Medicine & Medical Specialties (PROMISE), University of Palermo, “Paolo Giaccone” University Hospital, 90127 Palermo, Italy; (M.G.); (C.C.); (L.C.); (S.C.)
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