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Yamamoto M, Izuhara Y, Kakuta T, Takizawa S, Fujita A, Higaki T, van Ypersele de Strihou C, Miyata T. Carbonyl Stress Reduction in Peritoneal Dialysis Fluid: Development of a Novel High-Affinity Adsorption Bead. Perit Dial Int 2020. [DOI: 10.1177/089686080702700316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Heat sterilization of glucose peritoneal dialysis (PD) fluid generates reactive carbonyl compounds (RCOs), which have been implicated in the formation of advanced glycation end products (AGEs) on peritoneal proteins, with an attendant deterioration of peritoneal permeability in PD patients. To reduce their levels in PD fluid, we had previously devised beads coupled with RCO-trapping agents. The hazards linked to the diffusion of RCO-trapping compounds in the systemic circulation are avoided. Hydrazine-epoxy beads proved the most effective. Still, the amount needed to trap all RCOs remained relatively large. Methods We developed a novel agent linking a powerful RCO-trapping AGE inhibitor, pyrazolinone-polyethyleneimine, with cellulose beads (PPCBs). We tested its effectiveness to lower RCOs and AGE formation. Results Mixed with glucose PD fluid, PPCBs markedly lowered RCOs (α–dicarbonyls and aldehydes) and inhibited the generation of pentosidine, an AGE, to levels similar to those of filter-sterilized PD fluid. Their effectiveness is more than one order of magnitude above those of previously developed beads. The PPCBs markedly improved PD fluid biocompatibility. Incubation of 1 L commercial glucose PD fluid at 25°C for 24 hours with 10 or 30 g of wet PPCBs reduced RCO content by 75% – 90% and 100% respectively, without altering the pH or glucose and electrolyte contents of the PD fluid. Conclusions We developed a high-affinity adsorption bead to reduce the toxic RCO content and AGE formation potential (carbonyl stress) of PD fluid.
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Affiliation(s)
- Makoto Yamamoto
- Institute of Medical Sciences and
Division of Nephrology, Hypertension and Metabolism, Tokai University School of
Medicine, Isehara, Kanagawa
| | - Yuko Izuhara
- Institute of Medical Sciences and
Division of Nephrology, Hypertension and Metabolism, Tokai University School of
Medicine, Isehara, Kanagawa
| | - Takatoshi Kakuta
- Institute of Medical Sciences and
Division of Nephrology, Hypertension and Metabolism, Tokai University School of
Medicine, Isehara, Kanagawa
| | - Shunya Takizawa
- Institute of Medical Sciences and
Division of Nephrology, Hypertension and Metabolism, Tokai University School of
Medicine, Isehara, Kanagawa
| | - Akio Fujita
- Kuraray Research Laboratories,
Okayama, Japan
| | | | | | - Toshio Miyata
- Institute of Medical Sciences and
Division of Nephrology, Hypertension and Metabolism, Tokai University School of
Medicine, Isehara, Kanagawa
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2
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Goossen K, Becker M, Marshall MR, Bühn S, Breuing J, Firanek CA, Hess S, Nariai H, Sloand JA, Yao Q, Chang TI, Chen J, Paniagua R, Takatori Y, Wada J, Pieper D. Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2020; 75:830-846. [PMID: 32033860 DOI: 10.1053/j.ajkd.2019.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
Abstract
RATIONALE & OBJECTIVE The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. STUDY DESIGN Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. SETTING & STUDY POPULATIONS Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. SELECTION CRITERIA FOR STUDIES Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. DATA EXTRACTION 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTIC APPROACH Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. RESULTS 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, -40.84 [95% CI, -48.09 to-33.59] g/long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (-0.50 [95% CI, -1.19 to 0.18] mmol/L; low certainty) and hemoglobin A1c levels (-0.14% [95% CI, -0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. LIMITATIONS Trial quality was variable. The follow-up period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. CONCLUSIONS Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and cost-effectiveness associated with icodextrin is needed.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Mark R Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore; School of Medicine, University of Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, New Zealand.
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Jessica Breuing
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | - Simone Hess
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | | | - Qiang Yao
- Baxter (China) Investment Co. Ltd, China
| | - Tae Ik Chang
- Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Korea
| | - JinBor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Ramón Paniagua
- Research Unit, Unidad de Investigación Médica en Enfermedades Nefrológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México
| | - Yuji Takatori
- Internal Medicine, Rijinkai Medical Foundation, Socio-Medical Corporation, Kohsei General Hospital, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
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3
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Pischetsrieder M, Gensberger-Reigl S, Atzenbeck L, Weigel I. Chemistry and clinical relevance of carbohydrate degradation in drugs. Drug Discov Today 2016; 21:1620-1631. [PMID: 27320689 DOI: 10.1016/j.drudis.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/29/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
Carbohydrate degradation products are formed during heat sterilization in drugs containing (poly-)glucose as osmotic agents. Given this situation, peritoneal dialysis fluids (PDFs) and infusion fluids are of particular clinical relevance, because these drugs deliver process contaminants either over a longer period or directly into the circulation of patients who are critically ill. For the development of suitable mitigation strategies, it is important to understand the reaction mechanisms of carbohydrate degradation during sterilization and how the resulting products interact with physiological targets at the molecular level. Furthermore, reliable, comprehensive, and highly sensitive quantification methods are required for product control and toxicological evaluation.
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Affiliation(s)
- Monika Pischetsrieder
- Food Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052, Erlangen, Germany.
| | - Sabrina Gensberger-Reigl
- Food Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052, Erlangen, Germany
| | - Lisa Atzenbeck
- Food Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052, Erlangen, Germany
| | - Ingrid Weigel
- Food Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052, Erlangen, Germany
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4
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Gensberger S, Knabner C, Waibel R, Huppert J, Pischetsrieder M. Qualitative Profiling of Polyglucose Degradation Products in Peritoneal Dialysis Fluids. Anal Chem 2015; 87:6103-11. [DOI: 10.1021/acs.analchem.5b00665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sabrina Gensberger
- Food
Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer
Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052 Erlangen, Germany
| | - Carina Knabner
- Food
Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer
Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052 Erlangen, Germany
| | - Reiner Waibel
- Medicinal
Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer
Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052 Erlangen, Germany
| | - Jochen Huppert
- Fresenius Medical Care Deutschland GmbH, Frankfurter Str. 6-8, 66606 St. Wendel, Germany
| | - Monika Pischetsrieder
- Food
Chemistry Unit, Department of Chemistry and Pharmacy, Emil Fischer
Center, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Schuhstr. 19, 91052 Erlangen, Germany
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5
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Mittelmaier S, Niwa T, Pischetsrieder M. Chemical and physiological relevance of glucose degradation products in peritoneal dialysis. J Ren Nutr 2012; 22:181-5. [PMID: 22200439 DOI: 10.1053/j.jrn.2011.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 10/13/2011] [Indexed: 01/25/2023] Open
Abstract
Fibrosis and vascular sclerosis are main complications that limit the long-term application of peritoneal dialysis (PD). Low biocompatibility has been largely attributed to the presence of glucose degradation products (GDPs), which are formed during the heat sterilization of PD fluids. GDPs readily modify proteins in the peritoneum, leading to a decline of their biological function. After absorption, GDPs can also promote systemic protein glycation. Additionally, GDPs may augment DNA glycation, a process enhanced in uremia. Apart from their glycating activity, GDPs induce cytotoxicity and interfere with cell signaling in peritoneal mesothelial cells. Targeted screening revealed the nature of the 6 major GDPs with α-dicarbonyl structure as 3-deoxyglucosone, 3-deoxygalactosone, glucosone, glyoxal, methylglyoxal, and 3,4-dideoxyglucosone-3-ene. Valid quantification of these GDPs was achieved by ultrahigh-performance liquid chromatography/diode array detector/tandem mass spectrometry. Identification and quantification of single GDPs allow a structure-dependent risk evaluation. As a consequence, PD fluids and processes can be improved to reduce the GDP burden of patients undergoing PD.
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Affiliation(s)
- Stefan Mittelmaier
- Department of Chemistry and Pharmacy, Food Chemistry, Emil Fischer Center, University of Erlangen-Nuremberg, Erlangen, Germany
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6
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Alhamdani MSS, Al-Kassir AHAM, Abbas FKH, Jaleel NA, Al-Taee MF. Antiglycation and antioxidant effect of carnosine against glucose degradation products in peritoneal mesothelial cells. Nephron Clin Pract 2007; 107:c26-34. [PMID: 17664891 DOI: 10.1159/000106509] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 04/24/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Toxicity with advanced glycation end products (AGEs) is a major problem in uremic patients. Treatment with peritoneal dialysis (PD) exacerbates AGE formation as a result of bioincompatibility of the conventional peritoneal dialysis fluid (PDF). The presence of glucose degradation products (GDPs) in PDF is the main cause of its bioincompatibility. Carnosine is an endogenous dipeptide with a powerful antiglycation/antioxidant activity. In an attempt to improve PDF biocompatibility, we evaluated the effect of carnosine in human peritoneal mesothelial cells (HPMC) incubated with PDF or GDPs in vitro. METHODS HPMC were incubated for short or prolonged time with PDF in the presence or absence of carnosine. Similarly, HPMC were incubated in the same condition but with a combination of GDPs. Following the incubation, cells were tested for their viability, protein carbonyl content and reactive oxygen species (ROS) production. RESULTS Results demonstrated a significant protective effect of carnosine to HPMC in both acute and chronic conditions with PDF or GDPs as judged by the enhancement of cell viability, preserved protein from modification and decreased ROS production. CONCLUSION Carnosine enhanced HPMC viability against the toxic effect of GDPs probably through protection of cellular protein from modification and from ROS-mediated oxidative damage. The salutary effect of carnosine may render it a desirable candidate for improving PDF biocompatibility and reducing AGE complications in PD patients.
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7
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Krishnan M, Tam P, Wu G, Breborowicz A, Oreopoulos DG. Glucose degradation products (GDP's) and peritoneal changes in patients on chronic peritoneal dialysis: will new dialysis solutions prevent these changes? Int Urol Nephrol 2006; 37:409-18. [PMID: 16142577 DOI: 10.1007/s11255-004-1392-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As peritonitis rates are declining, the rate of technique failure due to ultrafiltration failure and inadequate solute removal is becoming more important. The failure of the peritoneal membrane to provide adequate dialysis increases with longer duration on PD and correlates with the structural changes in the peritoneal membrane. The exact mechanism responsible for these structural changes is unclear. Conventional PD fluids with glucose as the osmotic agent and more importantly the glucose degradation products (GDP) generated during the heat sterilization of these solutions seems to be responsible for inducing many of these changes in the peritoneum. GDP's in addition to causing structural and functional alterations of the peritoneal cells is also a leading cause of advanced glycation end-products (AGE) production. There is evidence to suggest that the GDP's and AGE's are not limited to the peritoneal cavity and the membrane. They have been shown to get deposited in the vascular walls. In addition they also interact with receptors on endothelial cells and smooth muscle. Thus they could contribute to the vascular dysfunction similar to that seen in diabetes. Formation of GDP's can be reduced and even be avoided with the use of newer "biocompatible" solutions by sterilizing the glucose and the buffer in separate chambers. These newer solutions have been shown to have several local and systemic advantages over the conventional PD solutions. It remains to be seen whether their chronic use from the start of peritoneal dialysis will prevent the development of peritoneal damage thus allowing these patients to remain on this modality for longer periods.
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Affiliation(s)
- Murali Krishnan
- The Division of Nephrology, University Health Network and University of Toronto, Toronto, ON, Canada
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8
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Lapolla A, Flamini R, Lupo A, Aricò NC, Rugiu C, Reitano R, Tubaro M, Ragazzi E, Seraglia R, Traldi P. Evaluation of Glyoxal and Methylglyoxal Levels in Uremic Patients under Peritoneal Dialysis. Ann N Y Acad Sci 2006; 1043:217-24. [PMID: 16037242 DOI: 10.1196/annals.1333.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Advanced glycation end products (AGEs) accumulate in serum and tissues of patients with chronic renal failure, even in the absence of diabetes, and a different clearance of these species has been observed by hemodialysis and peritoneal dialysis (CAPD). Furthermore, it has been shown that not only AGE but also 1,2-dicarbonyl compounds are formed during heat sterilization of glucose-based peritoneal dialysis fluids. Therefore, we investigated the level of some AGEs (pentosidine and free pentosidine) and dicarbonyl compounds (glyoxal and methylglyoxal) in end-stage renal disease patients subjected to peritoneal dialysis. Samples (20 from healthy subjects, 16 from uremic patients before and after 12 h of peritoneal dialysis) were analyzed, and the plasma and dialysate levels of glyoxal, methylglyoxal, pentosidine, and free pentosidine were determined. In plasma of uremic patients, mean values of pentosidine showed a small decrease after dialysis and were always higher than those of healthy control subjects. An analogous trend was observed for free pentosidine. In the case of peritoneal dialysate, no pentosidine and free pentosidine were found at time zero, whereas both compounds were detected after 12 h of dialysis. Glyoxal and methylglyoxal mean levels showed a decrease in plasma after dialysis even if their values were always higher than those of healthy control subjects. Surprisingly, an analogous trend was observed also in dialysate. These results might indicate that glyoxal and methylglyoxal already present in the dialysis fluid react with the peritoneal matrix proteins, accounting for the gradual loss of peritoneal membrane function that is often observed in patients subjected to CAPD for a long time.
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Affiliation(s)
- A Lapolla
- Dipartimento di Scienze Mediche e Chirurgiche, Cattedra di Malattie del Metabolismo, Via Giustiniani 2, 35100 Padova, Italy.
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9
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Kakuta T, Tanaka R, Satoh Y, Izuhara Y, Inagi R, Nangaku M, Saito A, Miyata T. Pyridoxamine improves functional, structural, and biochemical alterations of peritoneal membranes in uremic peritoneal dialysis rats. Kidney Int 2005; 68:1326-36. [PMID: 16105068 DOI: 10.1111/j.1523-1755.2005.00531.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We previously suggested that biochemical alterations of peritoneal membrane associated with long-term peritoneal dialysis might be, at least in part, accounted for by reactive carbonyl compounds overload originating both from uremic circulation and heat sterilization of glucose peritoneal dialysis fluid. In the present study, we utilized a uremic rat model on peritoneal dialysis and evaluated the protective effects of pyridoxamine, a recently developed inhibitor of advanced glycation end product (AGE), on structural, functional, and biochemical alterations of peritoneal membrane. METHODS Uremic rats were generated by subtotal nephrectomy, some of which were undergone peritoneal dialysis with dialysate and/or given intraperitoneal pyridoxamine. Functional [dialysate/plasma ratio (D/P)(urea, creatinine), D/D(0 glucose)], structural (density of blood vessels in peritoneal membrane tissues), and molecular biochemical [formation of pentosidine, an AGE, by high-performance liquid chromatography (HPLC) assay and expressions of vascular endothelial growth factor (VEGF), and fibroblast growth factor 2 (FGF-2), by semiquantitative polymerase chain reaction (PCR) and/or immunohistochemistry] alterations of peritoneal membrane were assessed. RESULTS Uremic peritoneal membrane was characterized by an increased functional area of exchange for small solutes between blood and dialysate, vascular proliferation, increased AGE genesis, and up-regulated expressions of angiogenic cytokines. The peritoneal membrane alterations associated with peritoneal dialysis are similar but more severe than those in uremia without peritoneal dialysis. Pyridoxamine given in uremic rats with peritoneal dialysis significantly improved functional and structural alterations. This improvement was accompanied by reduction of AGE accumulation and of angiogenic cytokines expressions. CONCLUSION Peritoneal carbonyl stress derived from uremia as well as peritoneal dialysis procedure might contribute to the vascular proliferation through induction of bioactive molecules and to an increased functional area, eventually leading to ultrafiltration failure. Pyridoxamine may be beneficial in protection of uremic peritoneal membrane on peritoneal dialysis.
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Affiliation(s)
- Takatoshi Kakuta
- Department of Internal Medicine and Institute of Medical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
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10
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Lapolla A, Reitano R, Seraglia R, Sartore G, Ragazzi E, Traldi P. Evaluation of advanced glycation end products and carbonyl compounds in patients with different conditions of oxidative stress. Mol Nutr Food Res 2005; 49:685-90. [PMID: 15926142 DOI: 10.1002/mnfr.200400093] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advanced glycation end products (AGE) and dicarbonyl compounds accumulate in serum and tissues of patients with diabetes and chronic renal failure. Pentosidine, free pentosidine, glyoxal and methylglyoxal have been evaluated in plasma of diabetic patients with poor metabolic control at baseline and after the improvement of glycemic levels, and in plasma and peritoneal dialysate of patients with renal failure before and after 12 h of peritoneal dialysis. In diabetic patients, acceptable metabolic control was unable to normalize levels of pentosidine (after 2 and 10 months), glyoxal and methylglyoxal (after 2 months). In patients with end-stage renal disease, mean values of pentosidine, free pentosidine, glyoxal and methylglyoxal decreased in plasma after dialysis. No pentosidine or free pentosidine were present in the peritoneal dialysate at time 0, but were found after 12 h of peritoneal dialysis; glyoxal and methylglyoxal decreased after 12 h of dialysis. So, glyoxal and methylglyoxal, already present in the dialysis fluid, can react with the peritoneal matrix protein, giving a reason for the gradual loss of peritoneal membrane function often observed in patients undergoing long-term peritoneal dialysis.
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Affiliation(s)
- Annunziata Lapolla
- Dipartimento di Scienze Mediche e Chirurgiche - Cattedra di Malattie del Metabolismo, Università di Padova, Padova, Italy.
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Floccari F, Aloisi C, Crascì E, Sofi T, Campo S, Tripodo D, Criseo M, Frisina N, Buemi M. Oxidative stress and uremia. Med Res Rev 2005; 25:473-86. [PMID: 15660443 DOI: 10.1002/med.20028] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Oxidative stress is a pathogenic element of great importance in uremic patients, with a great impact on their survival. The cause of oxidative stress in patients on hemodialysis is traditionally attributed to the recurrent activation of polymorphonucleate neutrophils and monocytes. The effects of oxidative stress are evident on all biochemical components of biological tissues: lipids, proteins, carbohydrates, and nucleic acids. This study briefly reviews the effects of different dialytic techniques and of kidney transplant on several parameters of oxidative stress. Many different modalities of pharmaceutical intervention are then analyzed, and the clinical evidences reported.
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Affiliation(s)
- Fulvio Floccari
- Chair of Nephrology, Department of Internal Medicine, University of Messina, Italy
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12
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Breborowicz A, Witowski J, Polubinska A, Pyda M, Oreopoulos D. L-2-oxothiazolidine-4-carboxylic acid reduces in vitro cytotoxicity of glucose degradation products. Nephrol Dial Transplant 2004; 19:3005-11. [PMID: 15507476 DOI: 10.1093/ndt/gfh539] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Glucose degradation products (GDP) are an important factor that contribute to bioincompatibility of peritoneal dialysis fluids. These substances are generated in the dialysis fluid during heat sterilization. Several approaches have been proposed to reduce the content or toxicity, or both, of GDP present in the dialysis fluid. We examined whether L-2-oxothiazolidine-4-carboxylic acid (OTZ), a precursor for glutathione synthesis, reduces the cytotoxicity of GDP in human peritoneal mesothelial cells. METHODS Experiments were performed on primary mesothelial cell cultures. Free radical generation in these cells after exposure to acetaldehyde (ACT), glyoxal (GLYO) or methylglyoxal (M-GLYO) was detected with a fluorescent probe. Cell viability measurements were based on release of LDH from cell cytosol, and synthesis of IL-6 and proliferation after exposure to GDP. Effects of individual GDPs and of dialysis fluid free of GDP (GDP-free PDF) or containing GDP (GDP-high PDF) on cell viability were also studied in the presence of OTZ (1 mmol/l). RESULTS All of the GDPs as well as the autoclaved dialysis fluid caused increased free radical generation. ACT increased LDH release from the cells by 374% (P < 0.001), and this effect was abolished by OTZ. All of the GDPs inhibited cell growth (ACT, 47%, P < 0.01; GLYO, 52%, P < 0.01; M-GLYO, 26%, P < 0.05) and this effect was reversed in presence of OTZ. ACT inhibited Il-6 synthesis in mesothelial cells by 74% P < 0.01 and this effect was prevented by OTZ. GDP-high PDF but not GDP-free PDF reduced synthesis of IL-6 in mesothelial cells by 40% (P < 0.01) an effect that was reversed by OTZ. Mesothelial cell growth was more strongly inhibited by GDP-high PDF (76%, P < 0.01) than by GDP-free PDF (31%, P < 0.05). OTZ improved growth of mesothelial cells in the presence of GDP-high PDF (+150%, P < 0.01) and in presence of GDP-low PDF (+38%, P < 0.05). OTZ prevented the cytotoxic effect of GDP-high PDF on mesothelial cells. CONCLUSIONS The GDP-induced stimulation of free radicals in mesothelial cells in the present study may provide a possible mechanism of GDP cytotoxicity. Because OTZ reduced the toxic effects of GDP on mesothelial cells, this compound may improve biocompatibility of peritoneal dialysis fluids.
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Affiliation(s)
- Andrzej Breborowicz
- Department of Pathophysiology, Poznan Medical School, Ul. Swiecickiego 6, 60-781 Poznan, Poland.
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Abstract
The term "advanced glycation end products" (AGEs) stands for a heterogeneous group of amino acid derivatives that are formed via glycation processes between peptide-bound lysine or arginine derivatives and carbonyl compounds, processes originally known from food systems as "Maillard reactions." AGEs accumulate in plasma and tissues with advancing age, diabetes, and particular renal failure. In vivo and in vitro studies indicate that AGEs represent an important class of uremic toxins. This review focuses on the chemistry behind the formation of AGEs, possible mechanisms underlying the accumulation of AGEs in uremia, clinical and therapeutic implications, and possible nutritional consequences.
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Affiliation(s)
- Thomas Henle
- Institute of Food Chemistry, Technical University of Dresden, Germany
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14
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Miyata T, Ishikawa N, van Ypersele de Strihou C. Carbonyl Stress and Diabetic Complications. Clin Chem Lab Med 2003; 41:1150-8. [PMID: 14598864 DOI: 10.1515/cclm.2003.178] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advanced glycation irreversibly and progressively modifies proteins over time and yields the advanced glycation end-products (AGE). AGEs are thought to contribute to the development of atherosclerosis and of diabetic and uremic complications. Their inhibition has thus become a therapeutic goal. In this article, we discuss the role of various reactive carbonyl compound (RCOs) in the genesis of AGEs, postulate the existence of "carbonyl stress" in complicated diabetes and, finally, discuss therapeutic perspectives.
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Affiliation(s)
- Toshio Miyata
- Institute of Medical Sciences, Department of Medicine, Tokai University School of Medicine, Bohseidai Isehara, Kanagawa, Japan.
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