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Noh K, Chow ECY, Quach HP, Groothuis GMM, Tirona RG, Pang KS. Significance of the Vitamin D Receptor on Crosstalk with Nuclear Receptors and Regulation of Enzymes and Transporters. AAPS J 2022; 24:71. [PMID: 35650371 DOI: 10.1208/s12248-022-00719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
The vitamin D receptor (VDR), in addition to other nuclear receptors, the pregnane X receptor (PXR) and constitutive androstane receptor (CAR), is involved in the regulation of enzymes, transporters and receptors, and therefore intimately affects drug disposition, tissue health, and the handling of endogenous and exogenous compounds. This review examines the role of 1α,25-dihydroxyvitamin D3 or calcitriol, the natural VDR ligand, on activation of the VDR and its crosstalk with other nuclear receptors towards the regulation of enzymes and transporters, notably many of the cytochrome P450s including CYP3A4 and sulfotransferase 2A1 (SULT2A1) as well as cholesterol 7α-hydroxylase (CYP7A1). Moreover, the VDR upregulates the intestinal channel, TRPV6, for calcium absorption, LDL receptor-related protein 1 (LRP1) and receptor for advanced glycation end products (RAGE) in brain for β-amyloid peptide efflux and influx, the sodium phosphate transporters (NaPi), the apical sodium-dependent bile acid transporter (ASBT) and organic solute transporters (OSTα-OSTβ) for bile acid absorption and efflux, respectively, the renal organic anion transporter 3 (OAT3) and several of the ATP-binding cassette protein transporters-the multidrug resistance protein 1 (MDR1) and the multidrug resistance-associated proteins (MRPs). Hence, the role of the VDR is increasingly being recognized for its therapeutic potential and pharmacologic activity, giving rise to drug-drug interactions (DDI). Therapeutically, ligand-activated VDR shows anti-inflammatory effects towards the suppression of inflammatory mediators, improves cognition by upregulating amyloid-beta (Aβ) peptide clearance in brain, and maintains phosphate, calcium, and parathyroid hormone (PTH) balance and kidney function and bone health, demonstrating the crucial roles of the VDR in disease progression and treatment of diseases.
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Affiliation(s)
- Keumhan Noh
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.,Drug Metabolism and Pharmacokinetics, Biogen, 225 Binney Street, Cambridge, Massachusetts, 02142, USA
| | - Edwin C Y Chow
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Holly P Quach
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| | - Geny M M Groothuis
- Pharmacokinetics, Toxicology and Targeting, Department of Pharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Rommel G Tirona
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A 5C1, Canada
| | - K Sandy Pang
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.
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Association between Fok1 and TaqI polymorphisms of vitamin D receptor gene with the severity of stenosis and calcification in carotid bulb in patients with ischemic stroke. J Clin Neurosci 2022; 97:115-120. [DOI: 10.1016/j.jocn.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 01/19/2023]
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Zettervall SL, Wang X, Monk S, Lin T, Cai Y, Guzman RJ. Recovery of limb perfusion and function after hindlimb ischemia is impaired by arterial calcification. Physiol Rep 2021; 9:e15008. [PMID: 34405571 PMCID: PMC8371346 DOI: 10.14814/phy2.15008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022] Open
Abstract
Medial artery calcification results from deposition of calcium hydroxyapatite crystals on elastin layers, and osteogenic changes in vascular smooth muscle cells. It is highly prevalent in patients with chronic kidney disease, diabetes, and peripheral artery disease (PAD), and when identified in lower extremity vessels, it is associated with increased amputation rates. This study aims to evaluate the effects of medial calcification on perfusion and functional recovery after hindlimb ischemia in rats. Medial artery calcification and acute limb ischemia were induced by vitamin D3 (VitD3 ) injection and femoral artery ligation in rats. VitD3 injection robustly induced calcification in the medial layer of femoral arteries in vivo. Laser Doppler perfusion imaging revealed that perfusion decreased and then partially recovered after hindlimb ischemia in vehicle-injected rats. In contrast, VitD3 -injected rats showed markedly impaired recovery of perfusion following limb ischemia. Accordingly, rats with medial calcification showed worse ischemia scores and delayed functional recovery compared with controls. Immunohistochemical and histological staining did not show differences in capillary density or muscle morphology between VitD3 - and vehicle-injected rats at 28 days after femoral artery ligation. The evaluation of cardiac and hemodynamic parameters showed that arterial stiffness was increased while cardiac function was preserved in VitD3 -injected rats. These findings suggest that medial calcification may contribute to impaired perfusion in PAD by altering vascular compliance, however, the specific mechanisms remain poorly understood. Reducing or slowing the progression of arterial calcification in patients with PAD may improve clinical outcomes.
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Affiliation(s)
- Sara L. Zettervall
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Xue‐Lin Wang
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Stephanie Monk
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Tonghui Lin
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Yujun Cai
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Raul J. Guzman
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryYale University School of MedicineNew HavenConnecticutUSA
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Polymorphism rs2762939 of CYP24A1 enzyme and coronary artery disease: angiographic results from a large prospective cohort of patients. Blood Coagul Fibrinolysis 2020; 31:366-371. [PMID: 32516167 DOI: 10.1097/mbc.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: Recent attention has been focused on the regulation of vitamin D metabolism as modulating the cardiovascular benefits of vitamin D. The aim of the current study was to evaluate the functional impact of the genetic polymorphism rs2762939 of CYP24A1, the hydroxylase-enzyme modulating the inactivation of vitamin D, on the prevalence and extent of coronary artery disease (CAD).A consecutive cohort of patients undergoing coronary angiography in a single centre was included. Significant CAD was defined as at least one stenosis more than 50%, severe CAD as left main and/or three-vessel disease. Among 1204 patients, 673 (55.8%) carried the C allele. Baseline features showed a lower use of beta-blockers among the C-carriers (P = 0.01) and higher levels of C-reactive protein (P = 0.05). The prevalence of CAD and severe CAD was not conditioned by CYP24A1 genetic status [78.7%-GG vs. 81.2%-C-carriers; P = 0.31; adjusted odds ratio (95% confidence interval ) = 0.71(0.20-2.56), P = 0.60 and 29.1%-GG vs. 29.5%-C carriers P = 0.95; adjusted odds ratio (95% confidence interval) = 0.87 (0.73-1.04), P = 0.13, respectively]. Coronary calcifications were significantly higher among GG homozygotes (P = 0.005). This study showed that the polymorphisms rs2762939 of CYP24A1 is not associated with the prevalence and extent of CAD. However, the C-allele carriage significantly lowers the rate of coronary calcifications.
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Desbiens LC, Mac-Way F. Does alfacalcidol reduce cardiovascular complications in hemodialysis patients? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:167. [PMID: 31168448 PMCID: PMC6526273 DOI: 10.21037/atm.2019.03.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Louis-Charles Desbiens
- CHU de Québec Research Center, L’Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Canada
- Department and Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L’Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Canada
- Department and Faculty of Medicine, Université Laval, Quebec City, Canada
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Wang J, Zhou JJ, Robertson GR, Lee VW. Vitamin D in Vascular Calcification: A Double-Edged Sword? Nutrients 2018; 10:nu10050652. [PMID: 29786640 PMCID: PMC5986531 DOI: 10.3390/nu10050652] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/13/2023] Open
Abstract
Vascular calcification (VC) as a manifestation of perturbed mineral balance, is associated with aging, diabetes and kidney dysfunction, as well as poorer patient outcomes. Due to the current limited understanding of the pathophysiology of vascular calcification, the development of effective preventative and therapeutic strategies remains a significant clinical challenge. Recent evidence suggests that traditional risk factors for cardiovascular disease, such as left ventricular hypertrophy and dyslipidaemia, fail to account for clinical observations of vascular calcification. Therefore, more complex underlying processes involving physiochemical changes to mineral balance, vascular remodelling and perturbed hormonal responses such as parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) are likely to contribute to VC. In particular, VC resulting from modifications to calcium, phosphate and vitamin D homeostasis has been recently elucidated. Notably, deregulation of vitamin D metabolism, dietary calcium intake and renal mineral handling are associated with imbalances in systemic calcium and phosphate levels and endothelial cell dysfunction, which can modulate both bone and soft tissue calcification. This review addresses the current understanding of VC pathophysiology, with a focus on the pathogenic role of vitamin D that has provided new insights into the mechanisms of VC.
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Affiliation(s)
- Jeffrey Wang
- Centre for Transplantation and Renal Research, Westmead Institute of Medical Research, Westmead, NSW 2145, Australia.
| | - Jimmy J Zhou
- Centre for Transplantation and Renal Research, Westmead Institute of Medical Research, Westmead, NSW 2145, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
| | | | - Vincent W Lee
- Centre for Transplantation and Renal Research, Westmead Institute of Medical Research, Westmead, NSW 2145, Australia.
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Cruzado JM, Lauzurica R, Pascual J, Marcen R, Moreso F, Gutierrez-Dalmau A, Andrés A, Hernández D, Torres A, Beneyto MI, Melilli E, Manonelles A, Arias M, Praga M. Paricalcitol Versus Calcifediol for Treating Hyperparathyroidism in Kidney Transplant Recipients. Kidney Int Rep 2018; 3:122-132. [PMID: 29340322 PMCID: PMC5762965 DOI: 10.1016/j.ekir.2017.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) and vitamin D deficiency are common at kidney transplantation and are associated with some early and late complications. This study was designed to evaluate whether paricalcitol was more effective than nutritional vitamin D for controlling SHPT in de novo kidney allograft recipients. METHODS This was a 6-month, investigator-initiated, multicenter, open-label, randomized clinical trial. Patients with pretransplantation iPTH between 250 and 600 pg/ml and calcium <10 mg/dl were randomized to paricalcitol (PAR) or calcifediol (CAL). The intention-to-treat population (PAR: n = 46; CAL: n = 47) was used for the analysis. The primary endpoint was the percentage of patients with serum iPTH >110 pg/ml at 6 months. Secondary endpoints were bone mineral metabolism, renal function, and allograft protocol biopsies. RESULTS The primary outcome occurred in 19.6% of patients in the PAR group and 36.2% of patients in the CAL group (P = 0.07). However, there was a higher percentage of patients with iPTH <70 pg/ml in the PAR group than in the CAL group (63.4% vs. 37.2%; P = 0.03). No differences were observed in bone turnover biomarkers and bone mineral density. The estimated glomerular filtration rate was significantly higher in the CAL group than in the PAR group without differences in albuminuria. In protocol biopsies, interstitial fibrosis and tubular atrophy tended to be higher in the PAR group than in the CAL group (48% vs. 23.8%; P = 0.09). Both medications were well tolerated. CONCLUSION Both PAR and CAL reduced iPTH, but PAR was associated with a higher proportion of patients with iPTH <70 pg/ml. These results do not support the use of PAR to treat posttransplantation hyperparathyroidism.
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Affiliation(s)
- Josep M. Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ricardo Lauzurica
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Roberto Marcen
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francesc Moreso
- Hospital Universitari Vall d'Hebron, Nephrology, Barcelona, Spain
| | | | - Amado Andrés
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | - Armando Torres
- Department of Nephrology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Arias
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
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Yu L, Tomlinson JE, Alexander ST, Hensley K, Han CY, Dwyer D, Stolina M, Dean C, Goodman WG, Richards WG, Li X. Etelcalcetide, A Novel Calcimimetic, Prevents Vascular Calcification in A Rat Model of Renal Insufficiency with Secondary Hyperparathyroidism. Calcif Tissue Int 2017; 101:641-653. [PMID: 29038882 PMCID: PMC5660836 DOI: 10.1007/s00223-017-0319-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023]
Abstract
Etelcalcetide, a novel peptide agonist of the calcium-sensing receptor, prevents vascular calcification in a rat model of renal insufficiency with secondary hyperparathyroidism. Vascular calcification occurs frequently in patients with chronic kidney disease (CKD) and is a consequence of impaired mineral homeostasis and secondary hyperparathyroidism (SHPT). Etelcalcetide substantially lowers parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) levels in SHPT patients on hemodialysis. This study compared the effects of etelcalcetide and paricalcitol on vascular calcification in rats with adenine-induced CKD and SHPT. Uremia and SHPT were induced in male Wistar rats fed a diet supplemented with 0.75% adenine for 4 weeks. Rats were injected with vehicle, etelcalcetide, or paricalcitol for 4 weeks from the beginning of adenine diet. Rats fed an adenine-free diet were included as nonuremic controls. Similar reductions in plasma PTH and parathyroid chief cell proliferation were observed in both etelcalcetide- and paricalcitol-treated rats. Serum calcium and phosphorus were significantly lower in etelcalcetide-treated uremic rats and was unchanged in paricalcitol-treated rats. Both serum FGF23 and aortic calcium content were significantly lower in etelcalcetide-treated uremic rats compared with either vehicle- or paricalcitol-treated uremic rats. The degree of aortic calcium content for etelcalcetide-treated rats was similar to that in nonuremic controls and corroborated findings of lack of histologic aortic mineralization in those groups. In conclusion, etelcalcetide and paricalcitol similarly attenuated progression of SHPT in an adenine rat model of CKD. However, etelcalcetide differentially prevented vascular calcification, at least in part, due to reductions in serum FGF23, calcium, and phosphorus levels.
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Affiliation(s)
- Longchuan Yu
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - James E Tomlinson
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Shawn T Alexander
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Kelly Hensley
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Chun-Ya Han
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Denise Dwyer
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Marina Stolina
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Charles Dean
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - William G Goodman
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - William G Richards
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA
| | - Xiaodong Li
- Departments of Cardiometabolic Disorders and Comparative Biology and Safety Sciences, Amgen Inc., One Amgen Center Drive, MS: 36-2-A, Thousand Oaks, CA, 91320, USA.
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Egido J, Martínez-Castelao A, Bover J, Praga M, Torregrosa JV, Fernández-Giráldez E, Solozábal C. Efectos pleiotrópicos del paricalcitol, más allá del metabolismo óseo-mineral. Nefrologia 2016; 36:10-8. [DOI: 10.1016/j.nefro.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 10/30/2015] [Indexed: 12/20/2022] Open
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Liu T, Lin J, Ju T, Chu L, Zhang L. Vascular smooth muscle cell differentiation to an osteogenic phenotype involves matrix metalloproteinase-2 modulation by homocysteine. Mol Cell Biochem 2015; 406:139-49. [DOI: 10.1007/s11010-015-2432-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
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Links between Vitamin D Deficiency and Cardiovascular Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:109275. [PMID: 26000280 PMCID: PMC4427096 DOI: 10.1155/2015/109275] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
The aim of the present paper was to review the most important mechanisms explaining the possible association of vitamin D deficiency and cardiovascular diseases, focusing on recent experimental and clinical data. Low vitamin D levels favor atherosclerosis enabling vascular inflammation, endothelial dysfunction, formation of foam cells, and proliferation of smooth muscle cells. The antihypertensive properties of vitamin D include suppression of the renin-angiotensin-aldosterone system, renoprotective effects, direct effects on endothelial cells and calcium metabolism, inhibition of growth of vascular smooth muscle cells, prevention of secondary hyperparathyroidism, and beneficial effects on cardiovascular risk factors. Vitamin D is also involved in glycemic control, lipid metabolism, insulin secretion, and sensitivity, explaining the association between vitamin D deficiency and metabolic syndrome. Vitamin D deficit was associated in some studies with the number of affected coronary arteries, postinfarction complications, inflammatory cytokines and cardiac remodeling in patients with myocardial infarction, direct electromechanical effects and inflammation in atrial fibrillation, and neuroprotective effects in stroke. In peripheral arterial disease, vitamin D status was related to the decline of the functional performance, severity, atherosclerosis and inflammatory markers, arterial stiffness, vascular calcifications, and arterial aging. Vitamin D supplementation should further consider additional factors, such as phosphates, parathormone, renin, and fibroblast growth factor 23 levels.
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Bose S, Khanna A, You J, Arora L, Qavi S, Turan A. Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study. Can J Anaesth 2015; 62:770-6. [DOI: 10.1007/s12630-015-0357-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/25/2015] [Indexed: 02/08/2023] Open
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Messa P, Curreri M, Regalia A, Alfieri CM. Vitamin D and the cardiovascular system: an overview of the recent literature. Am J Cardiovasc Drugs 2014; 14:1-14. [PMID: 24122604 DOI: 10.1007/s40256-013-0047-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the discovery that the enzyme catalyzing the synthesis of the most active natural vitamin D metabolite(calcitriol) and the vitamin D-specific receptor (VDR)were expressed in a wide range of tissues and organs, not only involved in the mineral metabolism (MM), there has been increasing interest on the putative ‘non classical’ roles of vitamin D metabolites, particularly on their possible effects on the cardiovascular (CV) system. These hypothetical CV effects of vitamin D gained particular interesting the nephrology field, given the high prevalence of CV disease in patients affected by either acute or chronic kidney diseases. However, notwithstanding a huge amount of experimental data suggesting a possible protective role of vitamin D on the CV system, the conclusions of two recent meta-analyses from the Cochrane group and a recent statement from the Institute of Medicine, based on a complete revision of the available data, concluded that there is no clear evidence for a role of vitamin D other than that strictly associated with bone health. However, a continuous and increasing flow of new studies still continues to add information on this topic. In the present review, we have tried to critically address the data added on this topicin the last 2 years, considering separately the experimental,observational, and intervention studies that have appeared in PubMed in the last 2 years, discussing the data providing proof, pro or contra, the involvement of vitamin D in CV disease, both in the absence or presence of kidney function impairment.
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Cozzolino M, Stucchi A, Rizzo MA, Soldati L, Cusi D, Ciceri P, Brenna I, Elli F, Gallieni M. Reprint of: Vitamin D receptor activation and prevention of arterial ageing. Nutr Metab Cardiovasc Dis 2013; 23 Suppl 1:S31-S36. [PMID: 23199645 DOI: 10.1016/j.numecd.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 01/02/2023]
Abstract
In chronic kidney disease (CKD) patients, cardiovascular (CV) morbidity and mortality rate is higher than in the general population, because of frequently concomitant hypertension, peripheral vascular disease, heart failure, vascular calcification (VC), diabetes and mineral bone disease. Recently, another important factor associated to CV risk in CKD has been deeply investigated: vitamin D deficiency. Vitamin D Receptors (VDRs) are present in several systems and tissues and VDR activation is associated to positive effects, resulting in better blood pressure control and prevention of diabetic nephropathy. Unfortunately, the natural, non-selective vitamin D receptor activator (VDRA), calcitriol, is associated to higher serum calcium and phosphate levels, thus worsening CV risk in CKD. Recent data showed that the selective VDRA paricalcitol might have ameliorative CV effects. The potential positive impact of the use of paricalcitol on diabetic nephropathy, cardiac disease, hypertension, and VC may open new paths in the fight against CV disease in CKD patients.
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Affiliation(s)
- M Cozzolino
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy.
| | - A Stucchi
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - M A Rizzo
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy
| | - L Soldati
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - D Cusi
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - P Ciceri
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - I Brenna
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - F Elli
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy
| | - M Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy
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Galassi A, Bellasi A, Auricchio S, Papagni S, Cozzolino M. Which vitamin D in CKD-MBD? The time of burning questions. BIOMED RESEARCH INTERNATIONAL 2013; 2013:864012. [PMID: 23991423 PMCID: PMC3749554 DOI: 10.1155/2013/864012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 01/16/2023]
Abstract
Vitamin D is a common treatment against secondary hyperparathyroidism in renal patients. However, the rationale for the prescription of vitamin D sterols in chronic kidney disease (CKD) is rapidly increasing due to the coexistence of growing expectancies close to unsatisfactory evidences, such as (1) the lack of randomized controlled trials (RCTs) proving the superiority of any vitamin D sterol against placebo on patients centered outcomes, (2) the scanty clinical data on head to head comparisons between the multiple vitamin D sterols currently available, (3) the absence of RCTs confirming the crescent expectations on nutritional vitamin D pleiotropic effects even in CKD patients, (4) the promising effects of vitamin D receptors activators (VDRA) against proteinuria and myocardial hypertrophy in diabetic CKD cohorts, and (5) the conflicting data on the impact on mortality of VDRA versus calcimimetic centered regimens to control CKD-MBD. The present review arguments these issues focusing on the opened questions that nephrologists should consider dealing with the prescription of nutritional vitamin D or VDRA and with the choice of a VDRA versus a calcimimetic based regimen in CKD-MBD patients.
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Affiliation(s)
- Andrea Galassi
- Medical Department, Nephrology Unit, AO Desio Vimercate, Desio Hospital, 20832 Desio, Italy
| | - Antonio Bellasi
- Department of Nephrology, Sant'Anna Hospital, 22020 Como, Italy
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Sara Auricchio
- Medical Department, Nephrology Unit, AO Desio Vimercate, Desio Hospital, 20832 Desio, Italy
| | - Sergio Papagni
- Division of Nephrology, Dialysis Center CBH-Città di Bisceglie, 70052 Bisceglie, Italy
| | - Mario Cozzolino
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
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Gonzalez-Parra E, Rojas-Rivera J, Tuñón J, Praga M, Ortiz A, Egido J. Vitamin D receptor activation and cardiovascular disease. Nephrol Dial Transplant 2013; 27 Suppl 4:iv17-21. [PMID: 23258805 DOI: 10.1093/ndt/gfs534] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vitamin D has been recently associated with several renal, cardiovascular and inflammatory diseases, beyond mineral metabolism and bone health. This is due in part to widespread expression of vitamin D receptor (VDR) on tissues and cells such as heart, kidney, immune cells, brain and muscle. In chronic kidney disease (CKD) and other chronic disorders, vitamin D deficiency [serum 25(OH)D <20 ng/mL] is very common and is associated with adverse outcomes. Paricalcitol, a selective activator of VDR, has demonstrated in several experimental and clinical studies of diabetic and non-diabetic CKD a favourable profile compared to other VDR activators, alone or as add-on to standard therapy. These beneficial effects are mediated by different actions such as reduction of oxidative stress, inflammation, downregulation of cardiac and renal renin expression, downregulation of calcifying genes and direct vascular protective effects. Furthermore, paricalcitol beneficial effects may be independent of baseline serum parathyroid hormone (PTH), calcium and phosphate levels. These benefits should be confirmed in large and well-designed ongoing clinical trials.
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Affiliation(s)
- Emilio Gonzalez-Parra
- Division of Nephrology and Hypertension, IIS Fundación Jiménez Díaz Autonoma University and FRIAT, Madrid, Spain
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17
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Wu-Wong JR, Kawai M, Chen YW, Wessale JL, Huang CJ, Wu MT, Nakane M. Two novel vitamin D receptor modulators with similar structures exhibit different hypercalcemic effects in 5/6 nephrectomized uremic rats. Am J Nephrol 2013; 37:310-9. [PMID: 23548814 DOI: 10.1159/000348755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/07/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Vitamin D receptor modulators (VDRMs) are indicated for secondary hyperparathyroidism in chronic kidney disease (CKD). Clinical observations demonstrate that VDRM therapy provides cardiovascular (CV) benefit in CKD. Current on-market VDRMs have a narrow therapeutic index at 1- to 4-fold [hypercalcemic toxicity vs. parathyroid hormone (PTH)-suppressing efficacy]. Hypercalcemia leads to the need for frequent drug dose titration and serum calcium (Ca) monitoring. A VDRM with a wider therapeutic index and beneficial CV effects will be clinically useful. METHODS Two structurally similar VDRMs were tested in the 5/6 nephrectomized (NX) rats with elevated PTH, endothelial dysfunction and left ventricular hypertrophy. RESULTS VS-110 and VS-411 at 0.01-1 μg/kg (i.p. 3 times/week for 2 weeks) suppressed serum PTH effectively. VS-411 raised serum Ca with an 11% increase at 0.01 μg/kg (therapeutic index = ~1-fold), while VS-110 did not raise serum Ca even at 1 μg/kg (therapeutic index >50-fold). VS-110 improved endothelium-dependent aortic relaxation in a dose-dependent manner and significantly reduced left ventricular fibrosis without affecting serum Ca. VS-411 also exhibited effects on the CV parameters, but was less potent at the high doses with severe hypercalcemia. VS-110 and VS-411 specifically activated the reporter gene via a chimeric receptor containing the VDR ligand binding domain with EC(50) <0.1 nM. CONCLUSIONS Structurally similar VDRMs can exhibit distinctly different hypercalcemic effects in 5/6 NX uremic rats. While differences exist for the Ca and CV effects of VS-110 and VS-411, the clinical implications are unclear. VS-110's results are promising but clinical outcome studies need to be performed.
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18
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Wu-Wong JR, Nakane M, Chen YW. Mapping the time-dependent effects of paricalcitol on serum calcium, phosphorus and parathyroid hormone levels in 5/6 nephrectomized uremic rats. Life Sci 2012; 92:161-6. [PMID: 23261531 DOI: 10.1016/j.lfs.2012.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/24/2012] [Accepted: 11/20/2012] [Indexed: 01/20/2023]
Abstract
AIMS To investigate whether the frequency of monitoring paricalcitol's impact on serum calcium (Ca), phosphorus and PTH in current clinical practice is sufficient by mapping the time-dependent effects of paricalcitol on these parameters. MAIN METHODS The 5/6 nephrectomized (NX) male, Sprague-Dawley rats with established uremia were treated with vehicle or paricalcitol (0.16 μg/kg, i.p., 3×/week). On Day 0 (before treatment), Days 12 and 13 after treatment, and also at 0, 1, 4, 8, 16, 24 h after the last dosing, blood and small intestine samples were collected. KEY FINDINGS Serum creatinine and blood urea nitrogen levels were significantly elevated in 5/6 NX rats. Significant increases were observed in serum Ca while PTH decreased by >90% when the parameters were determined at 12 or 13 days after paricalcitol dosing. Paricalcitol caused a step-wise increase in serum Ca levels at 1-24 h following dosing, reduced serum PTH levels with PTH values ranging from 1.06±0.06 to 26.7±25.7 pg/ml (vs. 152±15 pg/ml in Sham rats), but did not affect serum phosphorus in a time-dependent manner. Consistent with the serum Ca data, paricalcitol significantly induced the intestinal expression of Calb3 and TRPV6, genes involved in intestinal Ca transport, and also significantly induced the intestinal calcium absorption. SIGNIFICANCE Our results suggest that the frequency of monitoring paricalcitol's effect on serum Ca, phosphorus and PTH in current clinical practice seems adequate. Additional clinical trials may be needed to resolve the inconsistent clinical observations about the impact of paricalcitol on serum Ca.
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Affiliation(s)
- J Ruth Wu-Wong
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
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19
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Piskorz D. Effects of activation of vitamin D receptor and phosphorus on left ventricular hypertrophy in chronic kidney disease. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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[Vitamin D hormone system and diabetes mellitus: lessons from selective activators of vitamin D receptor and diabetes mellitus]. ACTA ACUST UNITED AC 2012; 60:87-95. [PMID: 22763025 DOI: 10.1016/j.endonu.2012.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/13/2012] [Accepted: 04/10/2012] [Indexed: 11/21/2022]
Abstract
The vitamin D hormone system has significant skeletal and extra-skeletal effects. Vitamin D receptor occurs in different tissues, and several cells other than renal cells are able to locally produce active vitamin D, which is responsible for transcriptional control of hundreds of genes related to its pleiotropic effects. There is increasing evidence relating vitamin D to development and course of type 1 and 2 diabetes mellitus. Specifically, influence of vitamin D on the renin-angiotensin-aldosterone system, inflammatory response, and urinary albumin excretion could explain the relevant impact of vitamin D status on diabetic nephropathy. Selective vitamin D receptor activators are molecules able to reproduce agonistic or antagonistic effects of active vitamin D depending on the tissue or even on the cell type. Specifically, paricalcitol has a beneficial profile because of its potency to reduce parathyroid hormone, with lower effects on serum calcium or phosphate levels. Moreover, in patients with diabetes and renal disease, paricalcitol decreases microalbuminuria, hospitalization rates, and cardiovascular mortality. Therefore, these molecules represent an attractive new option to improve prognosis of renal disease in patients with diabetes.
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21
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Cozzolino M, Stucchi A, Rizzo MA, Soldati L, Cusi D, Ciceri P, Brenna I, Elli F, Gallieni M. Vitamin D receptor activation and prevention of arterial ageing. Nutr Metab Cardiovasc Dis 2012; 22:547-552. [PMID: 22633189 DOI: 10.1016/j.numecd.2012.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 01/10/2023]
Abstract
In chronic kidney disease (CKD) patients, cardiovascular (CV) morbidity and mortality rate is higher than in the general population, because of frequently concomitant hypertension, peripheral vascular disease, heart failure, vascular calcification (VC), diabetes and mineral bone disease. Recently, another important factor associated to CV risk in CKD has been deeply investigated: vitamin D deficiency. Vitamin D Receptors (VDRs) are present in several systems and tissues and VDR activation is associated to positive effects, resulting in better blood pressure control and prevention of diabetic nephropathy. Unfortunately, the natural, non-selective vitamin D receptor activator (VDRA), calcitriol, is associated to higher serum calcium and phosphate levels, thus worsening CV risk in CKD. Recent data showed that the selective VDRA paricalcitol might have ameliorative CV effects. The potential positive impact of the use of paricalcitol on diabetic nephropathy, cardiac disease, hypertension, and VC may open new paths in the fight against CV disease in CKD patients.
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Affiliation(s)
- M Cozzolino
- Renal Division, DMCO, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, Milan, Italy.
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22
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Birmingham DJ, Hebert LA, Song H, Noonan WT, Rovin BH, Nagaraja HN, Yu CY. Evidence that abnormally large seasonal declines in vitamin D status may trigger SLE flare in non-African Americans. Lupus 2012; 21:855-64. [PMID: 22433915 PMCID: PMC3839052 DOI: 10.1177/0961203312439640] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cross-sectional studies have shown that low vitamin D (25-hydroxyvitamin D (25(OH)D)) is associated with increased systemic lupus erythematosus (SLE) activity. This study is the first to assess the temporal relationship between 25(OH)D levels and onset of SLE flare. This assessment was made possible because of the specimen bank and database of the Ohio SLE Study (OSS), a longitudinal study of frequently relapsing SLE that involved regular bimonthly patient follow-up. We identified for this study 82 flares from 46 patients that were separated by at least 8 months from previous flares. Serum 25(OH)D levels were measured at 4 and 2 months before flare, and at the time of flare (a flare interval). We found that for flares occurring during low daylight months (LDM, Oct-Mar), 25(OH)D levels were decreased at the time of flare, but only in non-African American (non-AA) patients (32% decrease at flare, compared to 4 months prior, p < 0.001). To control for seasonal effects, we also measured 25(OH)D levels in the LDM "no-flare" intervals, which were intervals that matched to the same calendar months of the patients' LDM flare intervals, but that didn't end in flare (n = 24). For these matches, a significant decrease occurred in 25(OH)D levels during the flare intervals (18.1% decrease, p < 0.001), but not during the matching no-flare intervals (6.2% decrease, p = 0.411). For flares occurring during high daylight months (HDM), 25(OH)D levels changed only in non-AA patients, increasing slightly (5.6%, p = 0.010). Analysis of flare rates for the entire OSS cohort (n = 201 flares) revealed a tendency for higher flare rates during LDM compared to HDM, but again only in non-AA patients (p = 0.060). Flare rates were lower during HDM for non-AA patients compared to AA patients (p = 0.028). In conclusion, in non-AA SLE patients, unusually large declines in 25(OH)D during LDM may be mechanistically related to SLE flare, whereas relatively high 25(OH)D levels during HDM may protect against flare.
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Affiliation(s)
- D J Birmingham
- Department of Medicine and Davis Heart and Lung Research Institute, Ohio State University Medical Center, Columbus, OH 43210, USA.
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23
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Rodriguez M, Martinez-Moreno JM, Rodríguez-Ortiz ME, Muñoz-Castañeda JR, Almaden Y. Vitamin D and vascular calcification in chronic kidney disease. Kidney Blood Press Res 2011; 34:261-8. [PMID: 21691129 DOI: 10.1159/000326903] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Vascular calcification is common in patients with chronic kidney disease (CKD) and contributes to the increased rate of cardiovascular morbidity and mortality. The mechanisms regulating vascular calcification are under investigation; it is accepted that vascular calcification is an active and complex process involving many factors that promote or inhibit calcification. Vascular smooth muscle cells undergo transformation into osteogenic cells. This transformation is being stimulated by high phosphate, and more recently the role of the calcium phosphate nanocrystals has gained attention. Experimental models of uremia and in vitro studies have shown that an excess of calcitriol accelerates vascular calcification. However, observational studies suggest that vitamin D provides a survival advantage for patients with CKD. Experimental work shows that for similar serum concentrations of calcium and phosphate paricalcitol produces less vascular calcification than calcitriol suggesting a differential effect at the cellular level. Important issues regarding the role of vitamin D compounds on vascular calcification will be commented in this review.
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Affiliation(s)
- Mariano Rodriguez
- Unidad de Investigación, Servicio de Nefrología, Red in ren, Instituto Maimónides de Investigación Biomédica de Córdoba, Departamento de Medicina, Hospital Universitario Reina Sofia, Córdoba, España.
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24
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Rezai MR, Wallace AM, Sattar N, Finn JD, Wu FCW, Cruickshank JK. Ethnic differences in aortic pulse wave velocity occur in the descending aorta and may be related to vitamin D. Hypertension 2011; 58:247-53. [PMID: 21670413 DOI: 10.1161/hypertensionaha.111.174425] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied aortic pulse wave velocity (aPWV), a predictor of cardiovascular events independent of blood pressure, in a multiethnic sample of British men, to investigate the roles for blood levels of vitamin D and aldosterone in total and regional aortic stiffness. Total aPWV was estimated noninvasively by the Arteriograph device (aPWV(AG)) in 198 men, with its length measure calibrated by magnetic resonance. PWVs over the aortic arch and descending aorta were measured by magnetic resonance in a subsample (n=47). Mean (SE) aPWV(AG) in South Asians (n=68; age 55±10 years), at known higher coronary disease risk than other groups, was 0.5 m/s (0.2 m/s) higher than in African Caribbeans (n=67; 55±10 years), at lowest coronary disease risk here, and Europeans (n=63; 57±8 years), adjusted for age, systolic blood pressure, and diabetes mellitus (P=0.01). By magnetic resonance, PWV over the descending aorta in South Asians was 0.7 m/s (0.3 m/s) and 0.8 m/s (0.3 m/s) higher than in African Caribbeans and Europeans, respectively; PWV over the aortic arch was not different. South Asians and African Caribbeans had 21 nmol/L (3 nmol/L) and 14 nmol/L (3 nmol/L) lower mean (SE) 25(OH)D than Europeans (P<0.001). Unlike aldosterone, 25(OH)D was negatively correlated with aPWV(AG) adjusted for age and systolic blood pressure, as well as weakened or removed ethnic differences in aPWV(AG) in regression models. These data suggest that aortic stiffness as aPWV parallels coronary disease risk in ethnic groups, descending aortic but not arch PWV has this feature, and serum 25(OH)D is an independent negative correlate of aPWV and may partly account for ethnicity-related differences in aPWV and coronary disease risk.
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Affiliation(s)
- Mohammad-Reza Rezai
- Diabetes, Nutrition & Cardiovascular Medicine Research Group, Franklin-Wilkins Building level 4, King's College University of London & King's Health Partners, 150 Stamford Street, London SE1 9NH, UK
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25
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Al-Baaj F, Yadav P, Al-Rifai A. Paricalcitol in secondary hyperparathyroidism and the survival benefit in patients with chronic kidney disease. J Ren Care 2011; 37:75-9. [PMID: 21561542 DOI: 10.1111/j.1755-6686.2011.00230.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Secondary hyperparathyroidism is a characteristic feature of chronic kidney disease, which develops early in the course of chronic kidney disease, often in a progressive way. It occurs as the renal function continues to decline and is encountered following a series of biochemical abnormalities, which are responsible for initiation and maintenance of increased parathyroid hormone (PTH) secretion. Several agents are used in the management of secondary hyperparathyroidism. Paricalcitol is a new generation selective vitamin D receptor activator that lowers PTH levels by exerting a less hypercalcaemic and hyperphosphataemic effect. In addition, there is emerging evidence of the benefit of paricalcitol in preventing intravascular calcification and proteinuria.
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26
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Sutliff RL, Walp ER, El-Ali AM, Elkhatib S, Lomashvili KA, O'Neill WC. Effect of medial calcification on vascular function in uremia. Am J Physiol Renal Physiol 2011; 301:F78-83. [PMID: 21478480 DOI: 10.1152/ajprenal.00533.2010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The contribution of medial calcification to vascular dysfunction in renal failure is unknown. Vascular function was measured ex vivo in control, noncalcified uremic, and calcified uremic aortas from rats with adenine-induced renal failure. Plasma urea was 16 ± 4, 93 ± 14, and 110 ± 25 mg/dl, and aortic calcium content was 27 ± 4, 29 ± 2, and 4,946 ± 1,616 nmol/mg dry wt, respectively, in the three groups. Maximal contraction by phenylephrine (PE) or KCl was reduced 53 and 63% in uremic aortas, and sensitivity to KCl but not PE was increased. Maximal relaxation to acetylcholine was impaired in uremic aortas (30 vs. 65%), and sensitivity to nitroprusside was also reduced, indicating some impairment of endothelium-independent relaxation as well. None of these parameters differed between calcified and noncalcified uremic aortas. However, aortic compliance was reduced in calcified aortas, ranging from 17 to 61% depending on the severity of calcification. We conclude that uremic vascular calcification, even when not severe, significantly reduces arterial compliance. Vascular smooth muscle and endothelial function are altered in renal failure but are not affected by medial calcification, even when severe.
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Affiliation(s)
- Roy L Sutliff
- Department of Medicine, Emory University, Renal Div., WMB 338, 1639 Pierce Dr., Atlanta, GA 30322, USA
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27
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Abstract
Accelerated atherosclerotic plaque calcification and extensive medial calcifications are common and highly detrimental complications of chronic kidney disease. Valid murine models have been developed to investigate both pathologically distinguishable complications, which allow for better insight into the cellular mechanisms underlying these vascular pathologies and evaluation of compounds that might prevent or retard the onset or progression of vascular calcification. This review describes various experimental models that have been used for the study of arterial intimal and/or medial calcification and discusses the extent to which this experimental research has contributed to our current understanding of vascular calcification, particularly in the setting of chronic renal failure.
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Affiliation(s)
- Ellen Neven
- From the Department of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - Patrick C. D'Haese
- From the Department of Pathophysiology, University of Antwerp, Antwerp, Belgium
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28
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Querfeld U, Mak RH. Vitamin D deficiency and toxicity in chronic kidney disease: in search of the therapeutic window. Pediatr Nephrol 2010; 25:2413-30. [PMID: 20567854 DOI: 10.1007/s00467-010-1574-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 01/14/2023]
Abstract
Both vitamin D deficiency and vitamin D toxicity are associated with cardiovascular complications in chronic kidney disease (CKD). Clinical and experiment data indicate that the association of vitamin D levels with cardiovascular disease is best illustrated as a biphasic, or U-shaped, curve. Children and adolescents with CKD need vitamin D due to the demands of a growing skeleton, to prevent renal rickets. However, this therapy carries the risk of severe side effects and chronic toxicity. Observational studies show that vitamin D deficiency and toxicity are frequently present in patients with CKD. In view of the importance of cardiovascular complications for the long-term survival of young patients, these findings demand a judicious use of vitamin D preparations. In clinical practice, the therapeutic window is rather small, presenting a therapeutic challenge to avoid both vitamin D deficiency and toxicity.
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Affiliation(s)
- Uwe Querfeld
- Department of Pediatric Nephrology, Charite Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.
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29
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Montezano AC, Zimmerman D, Yusuf H, Burger D, Chignalia AZ, Wadhera V, van Leeuwen FN, Touyz RM. Vascular smooth muscle cell differentiation to an osteogenic phenotype involves TRPM7 modulation by magnesium. Hypertension 2010; 56:453-62. [PMID: 20696983 DOI: 10.1161/hypertensionaha.110.152058] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Arterial calcification, common in vascular diseases, involves vascular smooth muscle cell (VSMC) transformation to an osteoblast phenotype. Clinical studies suggest that magnesium may prevent this, but mechanisms are unclear. We assessed whether increasing magnesium levels reduce VSMC calcification and differentiation and questioned the role of the Mg(2+) transporter, transient receptor potential melastatin (TRPM)7 cation channels in this process. Rat VSMCs were exposed to calcification medium in the absence and presence of magnesium (2.0 to 3.0 mmol/L) or 2-aminoethoxy-diphenylborate (2-APB) (TRPM7 inhibitor). VSMCs from mice with genetically low (MgL) or high-normal (MgH) [Mg(2+)](i) were also studied. Calcification was assessed by von Kossa staining. Expression of osteocalcin, osteopontin, bone morphogenetic protein (BMP)-2, BMP-4, BMP-7, and matrix Gla protein and activity of TRPM7 (cytosol:membrane translocation) were determined by immunoblotting. Calcification medium induced osteogenic differentiation, reduced matrix Gla protein content, and increased expression of the sodium-dependent cotransporter Pit-1. Magnesium prevented calcification and decreased osteocalcin expression and BMP-2 activity and increased expression of calcification inhibitors, osteopontin and matrix Gla protein. TRPM 7 activation was decreased by calcification medium, an effect reversed by magnesium. 2-APB recapitulated the VSMC osteoblastic phenotype in VSMCs. Osteocalcin was increased by calcification medium in VSMCs and intact vessels from MgL but not MgH, whereas osteopontin was increased in MgH, but not in MgL mice. Magnesium negatively regulates vascular calcification and osteogenic differentiation through increased/restored TRPM7 activity and increased expression of anticalcification proteins, including osteopontin, BMP-7, and matrix Gla protein. New molecular insights are provided whereby magnesium could protect against VSMC calcification.
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30
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Cozzolino M, Ketteler M, Zehnder D. The vitamin D system: a crosstalk between the heart and kidney. Eur J Heart Fail 2010; 12:1031-41. [PMID: 20605845 DOI: 10.1093/eurjhf/hfq112] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease (CKD) independently increases the rates of cardiovascular disease, whereas the severity of kidney disease correlates with increased cardiovascular morbidity and death. Vitamin D is modified in the liver and the kidney to its active form (1,25-dihydroxyvitamin D) by the 25-hydroxy vitamin D 1-hydroxylase enzyme (CYP27B1). The activated vitamin D brings about its actions through the vitamin D receptor (VDR). The VDRs and CYP27B1 have recently been shown to be expressed in several tissues, not directly involved in mineral homeostasis, including the cardiovascular, immune, and epithelial systems. The action of vitamin D in these tissues is implicated in the regulation of endothelial, vascular smooth muscle, and cardiac cell function, the renin-angiotensin system, inflammatory and fibrotic pathways, and immune response. Impaired VDR activation and signalling results in cellular dysfunction in several organs and biological systems, which leads to reduced bone health, an increased risk for epithelial cancers, metabolic disease, and uncontrolled inflammatory responses. Failure of cardiovascular VDR activation results in hypertension, accelerated atherosclerosis and vascular calcification, cardiac hypertrophy with vascular rarification and fibrosis, and progressive renal dysfunction. An emerging body of evidence has prompted attention to the relationship between CKD, mineral bone disorder (CKD-MBD), and cardiovascular disease in the new guidelines from Kidney Disease: Improving Global Outcomes. Vitamin D receptor activators, commonly used to treat CKD-MBD, and an appropriate treatment of vitamin D hormonal system failure in patients with CKD, may help to reduce cardiovascular morbidity and mortality in these patients.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, S. Paolo Hospital, University of Milan, Via A. di Rudin'ı, 8-20142 Milan, Italy.
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Abstract
VC (vascular calcification) is highly prevalent in patients with CKD (chronic kidney disease), but its mechanism is multifactorial and incompletely understood. In addition to increased traditional risk factors, CKD patients also have a number of non-traditional cardiovascular risk factors, which may play a prominent role in the pathogenesis of arterial calcification, such as duration of dialysis and disorders of mineral metabolism. The transformation of vascular smooth muscle cells into chondrocytes or osteoblast-like cells seems to be a key element in VC pathogenesis, in the context of passive calcium and phosphate deposition due to abnormal bone metabolism and impaired renal excretion. The process may be favoured by the low levels of circulating and locally produced VC inhibitors. VC determines increased arterial stiffness, left ventricular hypertrophy, a decrease in coronary artery perfusion, myocardial ischaemia and increased cardiovascular morbidity and mortality. Although current therapeutic strategies focus on the correction of phosphate, calcium, parathyroid hormone or vitamin D, a better understanding of the mechanisms of abnormal tissue calcification may lead to development of new therapeutic agents, which could reduce VC and improve cardiovascular outcome in CKD patients. The present review summarizes the following aspects: (i) the pathophysiological mechanism responsible for VC and its promoters and inhibitors, (ii) the methods for detection of VC in patients with CKD, including evaluation of arterial stiffness, and (iii) the management of VC in CKD patients.
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Wu-Wong JR, Noonan W, Nakane M, Brooks KA, Segreti JA, Polakowski JS, Cox B. Vitamin d receptor activation mitigates the impact of uremia on endothelial function in the 5/6 nephrectomized rats. Int J Endocrinol 2010; 2010:625852. [PMID: 20169119 PMCID: PMC2821638 DOI: 10.1155/2010/625852] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 09/29/2009] [Accepted: 10/28/2009] [Indexed: 01/21/2023] Open
Abstract
Endothelial dysfunction increases cardiovascular disease risk in chronic kidney disease (CKD). This study investigates whether VDR activation affects endothelial function in CKD. The 5/6 nephrectomized (NX) rats with experimental chronic renal insufficiency were treated with or without paricalcitol, a VDR activator. Thoracic aortic rings were precontracted with phenylephrine and then treated with acetylcholine or sodium nitroprusside. Uremia significantly affected aortic relaxation (-50.0 +/- 7.4% in NX rats versus -96.2 +/- 5.3% in SHAM at 30 muM acetylcholine). The endothelial-dependent relaxation was improved to -58.2 +/- 6.0%, -77.5 +/- 7.3%, and -90.5 +/- 4.0% in NX rats treated with paricalcitol at 0.021, 0.042, and 0.083 mug/kg for two weeks, respectively, while paricalcitol at 0.042 mug/kg did not affect blood pressure and heart rate. Parathyroid hormone (PTH) suppression alone did not improve endothelial function since cinacalcet suppressed PTH without affecting endothelial-dependent vasorelaxation. N-omega-nitro-L-arginine methyl ester completely abolished the effect of paricalcitol on improving endothelial function. These results demonstrate that VDR activation improves endothelial function in CKD.
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Affiliation(s)
- J. Ruth Wu-Wong
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL 60612-7230, USA
- *J. Ruth Wu-Wong:
| | - William Noonan
- Abbott Laboratories, Renal Care, Abbott Park, IL 60048, USA
| | | | | | | | | | - Bryan Cox
- Abbott Laboratories, Renal Care, Abbott Park, IL 60048, USA
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Sochorová K, Budinský V, Rozková D, Tobiasová Z, Dusilová-Sulková S, Spísek R, Bartůnková J. Paricalcitol (19-nor-1,25-dihydroxyvitamin D2) and calcitriol (1,25-dihydroxyvitamin D3) exert potent immunomodulatory effects on dendritic cells and inhibit induction of antigen-specific T cells. Clin Immunol 2009; 133:69-77. [PMID: 19660988 DOI: 10.1016/j.clim.2009.06.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 06/01/2009] [Accepted: 06/30/2009] [Indexed: 12/11/2022]
Abstract
Paricalcitol (19-nor-1,25/OH(2)/D(2)), a second generation vitamin D receptor (VDR) activator, is a synthetic analogue of vitamin D3. In contrast to calcitriol, paricalcitol has a reduced effect on intestinal calcium resorption thus avoiding undesirable hypercalcemia. Information about immunomodulatory activity of paricalcitol is scarce. In this study we show that, in all investigated aspects, paricalcitol retains significant immunomodulatory activity, comparable to calcitriol. Both VDR agonists impaired differentiation of immature dendritic cells (DCs) from monocytes. The presence of VDR agonists during DC differentiation abolished their capacity to be activated and, despite potent Toll-like receptor mediated stimulation, VDR agonist-treated DCs remained in the immature state. In accordance with these findings, VDR-treated DCs produced no bioactive IL-12 and had a significantly decreased capacity to induce antigen-specific T cells while the capacity to induce functional Tregs remained unchanged when compared to control DCs. As DCs and T cells play an important role in the pathogenesis of atherosclerosis, in end-stage renal disease patients, paricalcitol should be a VDR agonist of choice for the reduction of the risk of atherosclerosis due to its immunomodulatory effect proven in this study and known limited hypercalcemic effect. The immunomodulatory potency of paricalcitol makes it a drug of interest in the therapy of chronic immune-mediated inflammatory diseases.
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Affiliation(s)
- Klára Sochorová
- Institute of Immunology, Charles University, 2nd Faculty of Medicine and University Hospital Motol, V Uvalu 84, 150 06 Prague, Czech Republic
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Mizobuchi M, Ogata H, Koiwa F, Kinugasa E, Akizawa T. Vitamin D and vascular calcification in chronic kidney disease. Bone 2009; 45 Suppl 1:S26-9. [PMID: 19442619 DOI: 10.1016/j.bone.2009.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/13/2008] [Accepted: 01/06/2009] [Indexed: 01/02/2023]
Abstract
Vascular calcification is frequently observed and is closely associated with cardiovascular mortality in patients with chronic kidney disease (CKD). Vascular calcification is largely divided into two types. One is atherosclerotic intimal layer calcification and the other is medial layer calcification (Monckeberg's calcification). The latter is more common in patients with CKD than in general population. Evidence is growing that vascular calcification is a regulated active process as well as a passive process resulting from elevated serum phosphate (P) and an increase in the calcium phosphate (Ca x P) product leading to oversaturated plasma. Proving the active process, in vitro studies have demonstrated that the transformation of vascular smooth muscle cells (VSMCs) into osteoblast-like cells is a crucial mechanism in the progression of vascular calcification. Reduction of the activity of systemic and local inhibitors has also been recognized to be important. The link between vitamin D and vascular calcification is complex. Experimental and clinical researches have revealed that both vitamin D excess and vitamin D deficiency have been shown to be associated with vascular calcification in uremic milieu. On the other hand, although there are some biases, recent large observational studies have demonstrated that vitamin D has beneficial effects on the mortality of patients with CKD independent of serum Ca, P, and parathyroid hormone levels, likely due to its activation of the vitamin D receptor in vasculature and cardiac myocytes. Further prospective studies are necessary to evaluate the direct effect of vitamin D on vascular calcification in order to improve the cardiovascular health of patients with CKD.
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Affiliation(s)
- Masahide Mizobuchi
- Department of Nephrology, School of Medicine, Showa University, Tokyo, Japan.
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Wu-Wong JR. Potential for vitamin D receptor agonists in the treatment of cardiovascular disease. Br J Pharmacol 2009; 158:395-412. [PMID: 19371337 DOI: 10.1111/j.1476-5381.2009.00171.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vitamin D(3) is made in the skin and modified in the liver and kidney to form the active metabolite, 1,25-dihydroxyvitamin D(3) (calcitriol). Calcitriol binds to a nuclear receptor, the vitamin D receptor (VDR), and activates VDR to recruit cofactors to form a transcriptional complex that binds to vitamin D response elements in the promoter region of target genes. During the past three decades the field has focused mainly on the role of VDR in the regulation of parathyroid hormone, intestinal calcium/phosphate absorption and bone metabolism; several VDR agonists (VDRAs) have been developed for the treatment of osteoporosis, psoriasis and hyperparathyroidism secondary to chronic kidney disease (CKD). Emerging evidence suggests that VDR plays important roles in modulating cardiovascular, immunological, metabolic and other functions. For example, data from epidemiological, preclinical and clinical studies have shown that vitamin D and/or 25(OH)D deficiency is associated with increased risk for cardiovascular disease (CVD). However, VDRA therapy seems more effective than native vitamin D supplementation in modulating CVD risk factors. In CKD, where decreasing VDR activation persists over the course of the disease and a majority of the patients die of CVD, VDRA therapy was found to provide a survival benefit in both pre-dialysis and dialysis CKD patients. Although VDR plays an important role in regulating cardiovascular function and VDRAs may be potentially useful for treating CVD, at present no VDRA is approved for CVD, and also no serum markers, beside parathyroid hormone in CKD, exist to indicate the efficacy of VDRA in CVD.
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Abstract
Decline in renal function is related directly to cardiovascular mortality. However, traditional risk factors do not fully account for the high mortality in these patients. Activated vitamin D, a hormone produced by the proximal convoluted tubule of the kidney, appears to have beneficial effects beyond suppressing parathyroid hormone (PTH). However, activated vitamin D also can cause hypercalcemia and hyperphosphatemia in chronic kidney disease. Newer agents such as vitamin D receptor activators (eg, paricalcitol) suppress PTH with reduced risk of hypercalcemia and hyperphosphatemia. Recent evidence from animal and preliminary human studies supports an association between vitamin D receptor activators and reduced risk of cardiovascular disease deaths, irrespective of PTH levels. New pathways of vitamin D regulation also have been discovered, involving fibroblast growth factor-23 and klotho. Although considerable work has been performed to advance our understanding of the effects of vitamin D in health and chronic kidney disease, more investigations and randomized trials need to be performed to elucidate the mechanistic underpinnings of these effects.
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Affiliation(s)
- Tejas V Patel
- Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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