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Samouilidou EC, Liaouri A, Kostopoulos V, Nikas D, Grapsa E. The importance of paraoxonase 1 activity in chronic kidney disease. Ren Fail 2024; 46:2376930. [PMID: 38982880 PMCID: PMC11238655 DOI: 10.1080/0886022x.2024.2376930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
Paraoxonase 1 (PON1) is one of the most significant antioxidative enzymes associated with high-density lipoprotein (HDL). It has been proved that is involved in the pathogenesis of many diseases including chronic kidney disease (CKD). The association between PON1 and CKD seems to be mutual, such that the disease produces a significant decrease in PON1 activity levels, while the genetics of PON1 may affect the risk of susceptibility to CKD. Recent studies reveal that the decrease in serum PON1 activity observed in non-dialyzed and dialyzed CKD patients as well as in renal transplant (RT) patients is linked to an increased vulnerability to atherosclerosis. We intend to summarize current literature concerning PON1 activity in CKD, highlighting on the main determinants of PON1 activity, its association with oxidative stress, the impact of its genetic polymorphism on the disease development, the effect of drugs and nutritional state. Furthermore, evidence supporting the implication of reduced PON1 activity in the incident of cardiovascular disease in CKD patients, is also examined. It appears that despite the lack of standardization of PON1 activity measurement, PON1 remains a valuable biomarker for the researchers through the last decades, which contributes to the assessment of the antioxidant status having prognostic benefit on adverse clinical outcomes at various stages and etiologies of kidney disease.
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Affiliation(s)
| | | | | | - Dimitris Nikas
- Department of Biochemistry, "Alexandra" Hospital, Athens, Greece
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2
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Szentimrei R, Lőrincz H, Szentpéteri A, Varga VE, Seres I, Varga É, Nemes B, Harangi M, Paragh G. Assessment of amino-terminal C-type natriuretic peptide serum level and its correlation with high-density lipoprotein structure and function in patients with end stage renal disease before and after kidney transplantation. Chem Biol Interact 2023; 385:110749. [PMID: 37802408 DOI: 10.1016/j.cbi.2023.110749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
We aimed to investigate serum amino-terminal C-type natriuretic peptide (NT-proCNP) and its relationship with quantitative and qualitative HDL-parameters in patients with end-stage renal disease (ESRD) before, then 1 and 6 months after kidney transplantation (TX). Seventy patients (47 males, 23 females, mean age 51.7 ± 12.4 years) were enrolled in a prospective follow-up study. We examined serum creatinine, C-reactive protein, procalcitonin, fasting glucose and lipid parameters before, then 1 and 6 months after TX. High-density lipoprotein- (HDL)-associated paraoxonase-1 (PON1) paraoxonase and arylesterase activities were measured spectrophotometrically. Lipoprotein subfractions were determined by Lipoprint. NT-proCNP and oxidized low-density lipoprotein (oxLDL) levels were measured by ELISA. Mean NT-proCNP was 45.8 ± 21.9 pmol/L before renal transplantation and decreased markedly 1 month and 6 months after transplantation (5.3 ± 2.5 and 7.7 ± 4.9 pmol/L, respectively, P = 1 × 10-4). During the 6 months' follow-up, PON1 arylesterase, paraoxonase and salt-stimulated paraoxonase activities improved. NT-proCNP positively correlated with procalcitonin and creatinine and negatively with GFR, LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C). There was a negative correlation between serum NT-proCNP and PON1 arylesterase activity. According to the multiple regression analysis, the best predicting variables of NT-proCNP were serum procalcitonin, creatinine and PON1 arylesterase activity. NT-proCNP might be a novel link between HDL dysfunction and impaired vascular function in ESRD, but not after kidney transplantation. Further studies in larger populations are needed to clarify the exact role of NT-proCNP in the risk prediction for cardiovascular comorbidities and complications in ESRD.
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Affiliation(s)
- Réka Szentimrei
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Health Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Hajnalka Lőrincz
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Anita Szentpéteri
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Viktória Evelin Varga
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Ildikó Seres
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Éva Varga
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary.
| | - Balázs Nemes
- Institute of Surgery, Department of Organ Transplantation, University of Debrecen, Debrecen, Hungary.
| | - Mariann Harangi
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - György Paragh
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Baghdadi G, Shidfar F, Dehnad A. The effect of pomegranate consumption on cardiovascular risk factors in hemodialysis patients: A systematic review of clinical trials. Phytother Res 2023; 37:4963-4975. [PMID: 37485775 DOI: 10.1002/ptr.7961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
Patients undergoing maintenance dialysis have a significantly higher incidence of cardiovascular disease (CVD) compared with the general population. CVD is the most common cause of morbidity and mortality among hemodialysis patients, and has been attributed, among other causes, to increased oxidative stress, inflammation, hypertension and dyslipidemia. Pomegranate, a popular fruit worldwide, has demonstrated health benefits such as antioxidative, antidiabetic, antihypertensive, antihyperlipidemic and anti-inflammatory effects. In this systematic review of clinical trials, we aim to summarize the effect of different parts of pomegranate and the effects of its use on CVD risk factors in hemodialysis patients. PubMed/MEDLINE, EMBASE, Scopus, and Web of Science were searched to identify eligible clinical trials up to December 2021. Ultimately, seven clinical trials were included in this study. Different parts of pomegranate used in these trials were pomegranate juice, pomegranate extract and pomegranate peel extract. The duration of the studies varied from one dialysis session to 1 year. Our results showed that different parts of pomegranate may have anti-hypertensive, antioxidant, anti-inflammatory effects and improve lipid profile by decreasing TG (triglycerides) and increasing HDL-C (high-density lipoprotein cholesterol) in hemodialysis patients. However, due to limited number of studies, more clinical trials need to be performed.
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Affiliation(s)
- Ghazal Baghdadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dehnad
- Department of English Language, School of Health Management and Information Sciences, Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
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Watanabe J, Kotani K, Iwazu Y, Gugliucci A. Paraoxonase 1 Activity and Renal Replacement Therapy for Chronic Renal Failure: A Meta-Analysis. J Clin Med 2023; 12:5123. [PMID: 37568524 PMCID: PMC10419928 DOI: 10.3390/jcm12155123] [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: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic renal failure (CRF) is associated with the development of cardiovascular disease (CVD). Paraoxonase 1 (PON1), an antioxidant enzyme, shows cardioprotective properties and has been proposed as a therapeutic marker for CRF. A systematic analysis of the literature assessing the association between PON1 activity and renal replacement therapy (RRT) of CRF is currently lacking. Therefore, we set out to perform a meta-analysis of the available data on PON1 in RRT of CRF. We searched three electronic databases for studies on PON1 activity in CRF patients with RRT such as hemodialysis (HD), peritoneal dialysis (PD), or renal transplantation (RTx), published before June 2023. A random-effects and network meta-analysis were performed. A total of 53 studies were eligibly identified. Compared to CRF patients without RRT, RTx patients had higher paraoxonase activity (standard mean difference (SMD), 1.76, 95% confidence interval (CI), 0.76-2.75), followed by HD (SMD, 0.73; 95% CI, 0.02-1.45) and PD patients. Likewise, RTx patients had higher arylesterase activity (SMD, 1.84, 95% CI, 0.18-3.50), followed by HD and PD patients. Also, paraoxonase activity was increased after HD (SMD, 0.59, 95% CI, 0.16-1.03). In conclusion, the overall data demonstrated that PON1 activity is higher in CRF patients with RRT, particularly RTx, followed by that of HD and PD. Measuring PON1 activity can also be included to the paraclinical toolbox for the management of RRT, in addition to the understanding of CRF-related pathophysiology. Regarding the selection of RRT types and their potential to prevent CVD, more research is required.
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Affiliation(s)
- Jun Watanabe
- Division of Community and Family Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Yoshitaka Iwazu
- Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Alejandro Gugliucci
- Glycation, Oxidation and Disease Laboratory, Touro University California, Vallejo, CA 94592, USA
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Szentimrei R, Lőrincz H, Szentpéteri A, E Varga V, Harangi M, Seres I, P Szabó R, Nemes B, Paragh G. Changes in serum pigment epithelium-derived factor levels after kidney transplantation in patients with end-stage renal disease. Ren Fail 2022; 44:1649-1659. [PMID: 36217673 PMCID: PMC9559055 DOI: 10.1080/0886022x.2022.2106243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Pigment epithelium-derived factor (PEDF) is a serin protease inhibitor and a potent inhibitor of angiogenesis. Its serum level has significant associations with metabolic parameters. However, little is known about the association between PEDF levels and lipid parameters in renal transplanted (TX) patients. Therefore, our aim was to investigate the relationship between PEDF level and lipid parameters in TX patients. Methods Seventy TX patients (47 males, 23 females, mean age 51.7 ± 12.4 years) and 34 healthy controls were enrolled. We examined the serum creatinine, C-reactive protein, fasting glucose and lipid parameters right before, then 1 and 6 months after TX. High-density lipoprotein (HDL)-associated paraoxonase-1 (PON1) activities were measured spectrophotometrically. Lipoprotein subfractions were determined by Lipoprint. PEDF and oxidized low-density liporotein (oxLDL) levels were measured by ELISA. Results Before transplantation, patients had had a significantly higher PEDF level compared to control subjects (p < 0.001). One month after transplantation, their PEDF level decreased significantly reaching the healthy controls’ level, and this lower level was maintained during the 6 months follow-up period as well. The initial oxLDL level was significantly higher, while PON1 activities were significantly lower in the patient group compared to the control group. We found a significant positive correlation between PEDF and total cholesterol, low-density lipoprotein (LDL)-cholesterol, triglyceride, oxLDL and small HDL subfraction; while negative correlations were found between PEDF and mean LDL size and large HDL subfraction during the entire follow-up period. Conclusion PEDF may play an important role in the increased oxidative stress and enhanced atherogenesis in renal transplant patients.
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Affiliation(s)
- Réka Szentimrei
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Hajnalka Lőrincz
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anita Szentpéteri
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktória E Varga
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Harangi
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Seres
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Réka P Szabó
- Department of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs Nemes
- Department of Organ Transplantation, Faculty of Medicine, Institute of Surgery, University of Debrecen, Debrecen, Hungary
| | - György Paragh
- Division of Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Lamichhane S, Mohammed CJ, Haller ST, Kennedy DJ, Isailovic D. Quantification of Cardiotonic Steroids Potentially Regulated by Paraoxonase 3 in a Rat Model of Chronic Kidney Disease Using UHPLC-Orbitrap-MS. Int J Mol Sci 2022; 23:ijms232113565. [PMID: 36362352 PMCID: PMC9654389 DOI: 10.3390/ijms232113565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Endogenous cardiotonic steroids (CTSs), such as telocinobufagin (TCB) and marinobufagin (MBG) contain a lactone moiety critical to their binding and signaling through the Na+/K+-ATPase. Their concentrations elevate in response to sodium intake and under volume-expanded conditions. Paraoxonase 3 (PON3) is an enzyme that can hydrolyze lactone substrates. Here, we examine the role of PON3 in regulating CTS levels in a rat model of chronic kidney diseases (CKD). TCB and MBG were extracted from rat urine samples, and the analyses were carried out using ultra-high pressure liquid chromatography−Orbitrap-mass spectrometry (UHPLC-Orbitrap-MS). Ten-week-old Dahl salt-sensitive wild type (SS-WT) and Dahl salt-sensitive PON3 knockout (SS-PON3 KO) rats were maintained on a high-salt diet (8% NaCl) for 8 weeks to initiate salt-sensitive hypertensive renal disease characteristic of this model. CTS extraction recovery from urine >80% was achieved. For animals maintained on a normal chow diet, the baseline amount of TCB excreted in 24 h urine of SS-PON3 KO rats (6.08 ± 1.47 ng/24 h; or 15.09 ± 3.25 pmol) was significantly higher than for SS-WT rats (1.48 ± 0.69 ng/24 h; or 3.67 ± 1.54 pmol, p < 0.05). Similarly, for the same animals, the amount of excreted MBG was higher in the urine of SS-PON3 KO rats (4.74 ± 1.30 ng/24 h versus 1.03 ± 0.25 ng/24 h in SS-WT; or 11.83 ± 2.91 pmol versus 2.57 ± 0.56 pmol in SS-WT, p < 0.05). For animals on a high-salt diet, the SS-PON3 KO rats had significantly increased levels of TCB (714.52 ± 79.46 ng/24 h; or 1774.85 ± 175.55 pmol) compared to SS-WT control (343.84 ± 157.54 ng/24 h; or 854.09 ± 350.02 pmol, p < 0.05), and comparatively higher levels of MBG were measured for SS-PON3 KO (225.55 ± 82.61 ng/24 h; or 563.19 ± 184.5 pmol) versus SS-WT (157.56 ± 85.53 ng/24 h; or 393.43 ± 191.01 pmol, p > 0.05) rats. These findings suggest that the presence and absence of PON3 dramatically affect the level of endogenous CTSs, indicating its potential role in CTS regulation.
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Affiliation(s)
- Sabitri Lamichhane
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, OH 43606, USA
| | - Chrysan J. Mohammed
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Steven T. Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - David J. Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
- Correspondence: (D.J.K.); (D.I.); Tel.: +1+419-383-6822 (D.J.K.); +1+419-530-5523 (D.I.)
| | - Dragan Isailovic
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, OH 43606, USA
- Correspondence: (D.J.K.); (D.I.); Tel.: +1+419-383-6822 (D.J.K.); +1+419-530-5523 (D.I.)
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Liu Q, Xiao JJ, Wang S, Li Y, Yang LJ, Lu QY, Wu XY, Cao J, Yu H, Zhang BF. Paraoxonase 1 Ameliorates Renal Lipotoxicity by Activating Lipophagy and Inhibiting Pyroptosis. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1531-1545. [PMID: 35963464 DOI: 10.1016/j.ajpath.2022.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
Several studies in recent years have shown that lipid overload causes lipotoxic damage to the kidney, and oxidative stress, inflammation, and autophagic arrest are all important mechanisms of renal lipotoxicity. However, effective measures with therapeutic effects on renal lipotoxicity are limited. The present study indicated the protective effect of the paraoxonase 1 (PON1) against renal lipotoxicity in high-fat diet-fed scavenger receptor class B type I-deficient (SR-BI-/-) mice. The results showed that SR-BI-/- mice exhibited significant renal pathologic characteristics, such as oxidative stress, inflammation, and fibrosis, under a normal chow diet, and were accompanied by dyslipidemia and reduced plasma PON1 activity and renal PON1 levels. PON1 overexpression significantly attenuated the above pathologic changes in the kidneys of SR-BI-/- mice fed with a high-fat diet. Mechanistically, PON1 may ameliorate renal oxidative stress by reducing reactive oxygen species production, reduce renal lipid accumulation by inhibiting AKT/mechanistic target of rapamycin kinase pathway to activate lipophagy, and reduce the occurrence of inflammation and cell death by inhibiting Nod-like receptor family protein 3 inflammasome-mediated pyroptosis. The present study is the first to show that PON1 overexpression can effectively alleviate renal lipotoxicity injury, and PON1 may be a promising therapeutic strategy for the treatment of renal lipotoxicity-related diseases.
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Affiliation(s)
- Qing Liu
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China
| | - Jing-Jie Xiao
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China
| | - Shan Wang
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China
| | - Ying Li
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China
| | - Li-Jiao Yang
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qian-Yu Lu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Yan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jia Cao
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China
| | - Hong Yu
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China.
| | - Bai-Fang Zhang
- Department of Biochemistry and Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, China.
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Dube P, Khalaf FK, DeRiso A, Mohammed CJ, Connolly JA, Battepati D, Lad A, Breidenbach JD, Kleinhenz AL, Khatib-Shahidi B, Patel M, Tassavvor I, Gohara AF, Malhotra D, Morgan EE, Haller ST, Kennedy DJ. Cardioprotective Role for Paraoxonase-1 in Chronic Kidney Disease. Biomedicines 2022; 10:2301. [PMID: 36140402 PMCID: PMC9496500 DOI: 10.3390/biomedicines10092301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Paraoxonase-1 (PON-1) is a hydrolytic enzyme associated with HDL, contributing to its anti-inflammatory, antioxidant, and anti-atherogenic properties. Deficiencies in PON-1 activity result in oxidative stress and detrimental clinical outcomes in the context of chronic kidney disease (CKD). However, it is unclear if a decrease in PON-1 activity is mechanistically linked to adverse cardiovascular events in CKD. We investigated the hypothesis that PON-1 is cardioprotective in a Dahl salt-sensitive model of hypertensive renal disease. Experiments were performed on control Dahl salt-sensitive rats (SSMcwi, hereafter designated SS-WT rats) and mutant PON-1 rats (SS-Pon1em1Mcwi, hereafter designated SS-PON-1 KO rats) generated using CRISPR gene editing technology. Age-matched 10-week-old SS and SS-PON-1 KO male rats were maintained on high-salt diets (8% NaCl) for five weeks to induce hypertensive renal disease. Echocardiography showed that SS-PON-1 KO rats but not SS-WT rats developed compensated left ventricular hypertrophy after only 4 weeks on the high-salt diet. RT-PCR analysis demonstrated a significant increase in the expression of genes linked to cardiac hypertrophy, inflammation, and fibrosis, as well as a significant decrease in genes essential to left ventricular function in SS-PON-1 KO rats compared to SS-WT rats. A histological examination also revealed a significant increase in cardiac fibrosis and immune cell infiltration in SS-PON-1 KO rats, consistent with their cardiac hypertrophy phenotype. Our data suggest that a loss of PON-1 in the salt-sensitive hypertensive model of CKD leads to increased cardiac inflammation and fibrosis as well as a molecular and functional cardiac phenotype consistent with compensated left ventricular hypertrophy.
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Affiliation(s)
- Prabhatchandra Dube
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Fatimah K. Khalaf
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
- Department of Clinical Pharmacy, University of Alkafeel, Najaf 54001, Iraq
| | - Armelle DeRiso
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Chrysan J. Mohammed
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Jacob A. Connolly
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Dhanushya Battepati
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Apurva Lad
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Joshua D. Breidenbach
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Andrew L. Kleinhenz
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Bella Khatib-Shahidi
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Mitra Patel
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Iman Tassavvor
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Amira F. Gohara
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Deepak Malhotra
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Eric E. Morgan
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Steven T. Haller
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
| | - David J. Kennedy
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA
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9
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Connelly PW, Yan AT, Nash MM, Wald RM, Lok C, Gunaratnam L, Kirpalani A, Prasad GVR. The Increase in Paraoxonase 1 Is Associated With Decrease in Left Ventricular Volume in Kidney Transplant Recipients. Front Cardiovasc Med 2021; 8:763389. [PMID: 34926614 PMCID: PMC8674585 DOI: 10.3389/fcvm.2021.763389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Patients on dialysis have impaired cardiac function, in part due to increased fluid volume and ventricular stress. Restored kidney function through transplantation reduces left ventricular volume in both systole and diastole. We previously reported that the decrease in NT-proB-type natriuretic peptide (NT-proBNP) was associated with a decrease in adiponectin. Paraoxonase 1 (PON1) has been inversely associated with cardiovascular outcomes. We now report the association of changes in PON1 with changes in left ventricular volume and left ventricular mass after kidney transplantation. Design: Patients on dialysis were assessed at baseline and 12 months after kidney transplantation (n = 38). A comparison group of patients on dialysis who were not expected to receive a transplant in the next 24 months were studied (n = 43) to determine if the change of PON1 with kidney transplantation achieved a significance greater than that due to biologic variation. Left ventricular volume and mass were determined by cardiac magnetic resonance imaging. PON1 was measured by arylesterase activity and by mass. Results: PON1 mass and activity were not different between the groups at baseline. Both PON1 mass and activity were increased post-kidney transplantation (p < 0.0001 for change). The change in PON1 mass (p = 0.0062) and PON1 arylesterase activity (p = 0.0254) were inversely correlated with the change in NT-proBNP for patients receiving a kidney transplant. However, only the change in the PON1 mass, and not the change in PON1 arylesterase, was inversely correlated with the change in left ventricular volume (ml/m2.7) (p = 0.0146 and 0.0114 for diastolic and systolic, respectively) and with the change in hemoglobin (p = 0.0042). Conclusion: Both PON1 mass and arylesterase activity are increased by kidney transplantation. The increase in PON1 mass is consistent with a novel relationship to the increase in hemoglobin and decrease in left ventricular volume and NT-proBNP seen when kidney function is restored.
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Affiliation(s)
- Philip W Connelly
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michelle M Nash
- Kidney Transplant Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Rachel M Wald
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Charmaine Lok
- Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto, ON, Canada
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10
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Ponce-Ruiz N, Murillo-González FE, Rojas-García AE, Barrón-Vivanco BS, Bernal-Hernández YY, González-Arias CA, Ortega-Cervantes L, Ponce-Gallegos J, López-Guarnido O, Medina-Díaz IM. PON1 status and homocysteine levels as potential biomarkers for cardiovascular disease. Exp Gerontol 2020; 140:111062. [PMID: 32827712 DOI: 10.1016/j.exger.2020.111062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death. The mainly risks factors for CVD are diabetes, hypertension and high levels of homocysteine (Hcys), among others. Paraoxonase 1 (PON1) has been proposed as an antiatherogenic target for its ability to hydrolyzing oxi-Low-Density-Lipoproteins (LDL) and Hcys-thiolactone. Thus, the aim of the present study was to evaluate the association of Hcys levels, and the activities and concentration of PON1, as well as vitamin B from the diet with a risk for CVD. METHODS A case-control study was carry out in patients with cardiovascular diseases (CVD), Arterial hypertension, but not CVD (AH), and in healthy controls (control group) from the Mexican Institute of Social Security. Lipid profile, intake of vitamin B, Hcys, serum amyloid A (SAA), PON1 concentration, and PON1 activities (Arylesterase activity (ARE), Lactonase activity (LAC), and CMPA activity (CMPA)) were evaluated. RESULTS The CVD group had the highest concentration of Hcys and SAA than in the AH and control groups (p < 0.01). ARE, LAC, and CMPA activities and PON1 concentration were lowest in the CVD group. A positive-independent association between Hcys levels and CVD was found (OR = 2.09; 95% CI: 1.69-2.56) and this increase when it was adjusted by age, BMI, ApoA1, vitamin B intake, SAA, and PON1 (OR = 14.41; 95% CI: 1.75-118.71). LAC and CMPA, as well as PON1 concentration, were inversely associated with CVD. CONCLUSION LAC activity, PON1 concentration, and Hcys levels might be good biomarkers for CVD and their association could be modified by the intake of vitamin B.
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Affiliation(s)
- N Ponce-Ruiz
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico; Posgrado en Ciencias Biológico Agropecuarias, Universidad Autónoma de Nayarit, Tepic, Nayarit, Mexico
| | - F E Murillo-González
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico; Posgrado en Ciencias Biológico Agropecuarias, Universidad Autónoma de Nayarit, Tepic, Nayarit, Mexico
| | - A E Rojas-García
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | - B S Barrón-Vivanco
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | - Y Y Bernal-Hernández
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | - C A González-Arias
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico.
| | - L Ortega-Cervantes
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | | | - O López-Guarnido
- Dept. Legal Medicine and Toxicology, University of Granada School of Medicine, Spain.
| | - I M Medina-Díaz
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología, Secretaría de Investigación y Posgrado, Nayarit, Mexico.
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11
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Zhang S, Breidenbach JD, Khalaf FK, Dube PR, Mohammed CJ, Lad A, Stepkowski S, Hinds TD, Kumarasamy S, Kleinhenz A, Tian J, Malhotra D, Kennedy DJ, Cooper CJ, Haller ST. Renal Fibrosis Is Significantly Attenuated Following Targeted Disruption of Cd40 in Experimental Renal Ischemia. J Am Heart Assoc 2020; 9:e014072. [PMID: 32200719 PMCID: PMC7428653 DOI: 10.1161/jaha.119.014072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Renal artery stenosis is a common cause of renal ischemia, contributing to the development of chronic kidney disease. To investigate the role of local CD40 expression in renal artery stenosis, Goldblatt 2‐kidney 1‐clip surgery was performed on hypertensive Dahl salt‐sensitive rats (S rats) and genetically modified S rats in which CD40 function is abolished (Cd40mutant). Methods and Results Four weeks following the 2‐kidney 1‐clip procedure, Cd40mutant rats demonstrated significantly reduced blood pressure and renal fibrosis in the ischemic kidneys compared with S rat controls. Similarly, disruption of Cd40 resulted in reduced 24‐hour urinary protein excretion in Cd40mutant rats versus S rat controls (46.2±1.9 versus 118.4±5.3 mg/24 h; P<0.01), as well as protection from oxidative stress, as indicated by increased paraoxonase activity in Cd40mutant rats versus S rat controls (P<0.01). Ischemic kidneys from Cd40mutant rats demonstrated a significant decrease in gene expression of the profibrotic mediator, plasminogen activator inhibitor‐1 (P<0.05), and the proinflammatory mediators, C‐C motif chemokine ligand 19 (P<0.01), C‐X‐C Motif Chemokine Ligand 9 (P<0.01), and interleukin‐6 receptor (P<0.001), compared with S rat ischemic kidneys, as assessed by quantitative PCR assay. Reciprocal renal transplantation documented that CD40 exclusively expressed in the kidney contributes to ischemia‐induced renal fibrosis. Furthermore, human CD40‐knockout proximal tubule epithelial cells suggested that suppression of CD40 signaling significantly inhibited expression of proinflammatory and ‐fibrotic genes. Conclusions Taken together, our data suggest that activation of CD40 induces a significant proinflammatory and ‐fibrotic response and represents an attractive therapeutic target for treatment of ischemic renal disease.
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Affiliation(s)
- Shungang Zhang
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Joshua D. Breidenbach
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Fatimah K. Khalaf
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Prabhatchandra R. Dube
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Chrysan J. Mohammed
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Apurva Lad
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Stanislaw Stepkowski
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Terry D. Hinds
- Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Sivarajan Kumarasamy
- Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Andrew Kleinhenz
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Jiang Tian
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Deepak Malhotra
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - David J. Kennedy
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Christopher J. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Steven T. Haller
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
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12
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Murillo-González FE, Ponce-Ruiz N, Rojas-García AE, Rothenberg SJ, Bernal-Hernández YY, Cerda-Flores RM, Mackness M, Barrón-Vivanco BS, González-Arias CA, Ponce-Gallegos J, Medina-Díaz IM. PON1 lactonase activity and its association with cardiovascular disease. Clin Chim Acta 2019; 500:47-53. [PMID: 31626760 DOI: 10.1016/j.cca.2019.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paraoxonase 1 (PON1) is important in the development of atherosclerosis, and it has become the subject of intensive research. Our aim was to evaluate the association of serum PON1 activity and polymorphisms with cardiovascular disease (CVD) using four different substrates. MATERIALS AND METHODS Activity of PON1-related to arylesterase (AREase and 4-CMPAse), paraoxonase (PONase), and lactonase (LACase), and polymorphisms (A-162G, T-108C, L55M, and Q192R) were evaluated in subjects with CVD, cardiovascular risk factor (CFR), and controls. An ordered logistic-regression analysis of PON1 phenotypes was performed in the CVD group with respect to the control group. RESULTS AND CONCLUSIONS Logistic-regression analysis showed that CC-108 genotype was associated with CRF and CVD. The CVD group had the lowest activities of PON1. The LACase might be a better biomarker for CVD (OR, 0.52; 95% CI, 0.44-0.61) followed by CMPAse (OR, 0.82; 95% CI, 0.77-0.86), AREase (OR, 0.98; 95% CI, 0.97-0.99) and PONase (OR, 0.99, 95% CI, 0.99-0.99). Logistic regression of PON1 phenotypes by haplotypes showed that LACase activity was not influenced by the polymorphisms and that it could be a new potential biomarker in the development of CVD. Larger scale longitudinal studies are required.
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Affiliation(s)
- F E Murillo-González
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico; Posgrado en Ciencias Biológico Agropecuarias. Universidad Autónoma de Nayarit. Tepic, Nayarit, Mexico
| | - N Ponce-Ruiz
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico; Posgrado en Ciencias Biológico Agropecuarias. Universidad Autónoma de Nayarit. Tepic, Nayarit, Mexico
| | - A E Rojas-García
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | | | - Y Y Bernal-Hernández
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | - R M Cerda-Flores
- Universidad Autónoma de Nuevo León. Facultad de Enfermería. Nuevo León, Mexico
| | | | - B S Barrón-Vivanco
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | - C A González-Arias
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico
| | | | - I M Medina-Díaz
- Universidad Autónoma de Nayarit, Laboratorio de Contaminación y Toxicología Ambiental, Secretaría de Investigación y Posgrado, Nayarit, Mexico.
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13
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Mohammed CJ, Xie Y, Brewster PS, Ghosh S, Dube P, Sarsour T, Kleinhenz AL, Crawford EL, Malhotra D, James RW, Kalra PA, Haller ST, Kennedy DJ. Circulating Lactonase Activity but Not Protein Level of PON-1 Predicts Adverse Outcomes in Subjects with Chronic Kidney Disease. J Clin Med 2019; 8:jcm8071034. [PMID: 31311140 PMCID: PMC6678354 DOI: 10.3390/jcm8071034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
The burden of cardiovascular disease and death in chronic kidney disease (CKD) outpaces that of the other diseases and is not adequately described by traditional risk factors alone. Diminished activity of paraoxonase (PON)-1 is associated with increased oxidant stress, a common feature underlying the pathogenesis of CKD. We aimed to assess the prognostic value of circulating PON-1 protein and PON lactonase activity on adverse clinical outcomes across various stages and etiologies of CKD. Circulating PON-1 protein levels and PON lactonase activity were measured simultaneously in patients with CKD as well as a cohort of apparently healthy non-CKD subjects. Both circulating PON-1 protein levels and PON lactonase activity were significantly lower in CKD patients compared to the non-CKD subjects. Similarly, across all stages of CKD, circulating PON-1 protein and PON lactonase activity were significantly lower in patients with CKD compared to the non-CKD controls. Circulating PON lactonase activity, but not protein levels, predicted future adverse clinical outcomes, even after adjustment for traditional risk factors. The combination of lower circulating protein levels and higher activity within the CKD subjects were associated with the best survival outcomes. These findings demonstrate that diminished circulating PON lactonase activity, but not protein levels, predicts higher risk of future adverse clinical outcomes in patients with CKD.
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Affiliation(s)
- Chrysan J Mohammed
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Yanmei Xie
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Pamela S Brewster
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Subhanwita Ghosh
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Prabhatchandra Dube
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Tiana Sarsour
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Andrew L Kleinhenz
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Erin L Crawford
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Deepak Malhotra
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Richard W James
- Department of Internal Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Stott Lane, Salford, Greater Manchester M6 8HD, UK
| | - Steven T Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - David J Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA.
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14
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Chang CT, Lim YP, Lee CW, Liao HY, Chen FY, Chang CM, Tang FY, Yang CY, Chen CJ. PON-1 carbamylation is enhanced in HDL of uremia patients. J Food Drug Anal 2019; 27:542-550. [PMID: 30987726 PMCID: PMC9296198 DOI: 10.1016/j.jfda.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/22/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022] Open
Abstract
High-density lipoprotein (HDL) carbamylation has been known in uremia patients. Paraoxonase-1 (PON-1) is an important HDL protein responsible for HDL anti-oxidant, arylesterase and lactonase activities. PON-1 carbamylation in uremic HDL has never been explored. We isolated HDL from uremia patients and control healthy subjects for study. Sandwich ELISA was used to estimate carbamylated PON-1 protein expression in HDL, and nanoflow liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) was applied to identify the amino acid in PON-1 carbamylated. PON-1 enzyme activities were estimated by substrates conversion method. HDL anti-oxidant activity was gauged by fluorescence changes of indicator dye in the presence of H2O2. Our study results proved that the degree of PON-1 carbamylation was higher in uremic HDL than in control HDL. Sandwich ELISA study showed that carbamylated PON-1 concentration in uremic HDL was 1.49 ± 0.08 fold higher than that in HDL from controls (p < 0.05). The nanoLC-MS/MS showed that the carbamylation of lysine 290 (K290) of PON-1, a residue adjacent to PON-1 activity determining site, was detected in uremic HDL but not detected in control HDL. K290 carbamylation leads to local conformation changes that reduce accessible solvent accessibility. The HDL paraoxonase, arylesterase, and lactonase activities were all significantly lower in uremia patients than in control subjects. Additionally, HDL anti-antioxidant ability was also lower in uremia patients. Carbamylation of PON-1 in uremia patients could be one of the factors in impairing PON-1 enzyme activities and HDL anti-oxidation function.
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15
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Marek G, Ściskalska M, Grzebieniak Z, Milnerowicz H. Decreases in Paraoxonase-1 Activities Promote a Pro-inflammatory Effect of Lipids Peroxidation Products in Non-smoking and Smoking Patients with Acute Pancreatitis. Int J Med Sci 2018; 15:1619-1630. [PMID: 30588185 PMCID: PMC6299411 DOI: 10.7150/ijms.27647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/14/2018] [Indexed: 01/06/2023] Open
Abstract
Aim: The study investigated the extent to which tobacco smoke exposure causes changes in lipids biochemistry through measurement blood concentrations of: paraoxonase-1 (PON-1) activities as lipid-bound enzyme into cell membrane, concentration of malonyldialdehyde (MDA), protein adducts of 4-hydroxynonenal (HNE-adducts), oxidized low density lipoproteins (oxLDL), total cholesterol (CH) and high-density lipoprotein cholesterol (HDL). Additionally, the activity of P isoform of glutathione S-transferase (GST-π) was measured. Methods: Investigations were performed in the blood of patients with acute pancreatitis (AP) on the 1st, 3rd and 7th day of hospitalization and in healthy volunteers. The activities of PON-1 forms, GST-π were determined spectrophotometrically. Concentrations of PON-1, MDA, HNE-adducts, oxLDL, HDL, CH were measured using commercial tests. Results: Near 2-fold higher concentrations of MDA, HNE-adducts, oxLDL, correlating with inflammatory markers in AP patients compared to healthy subjects were demonstrated, which were accompanied by gradually increasing CH/HDL ratio during hospitalization. During hospital treatment, decreased activities of all PON-1 subtypes were observed in AP patients compared to healthy subjects, more pronounced in tobacco smokers. A decreased PON-1 phosphotriesterase activity in non-AP control group smokers compared to non-smokers was noted. In non-smoking AP patients GST-π activity normalized during hospitalization in contrast to smokers. Conclusions: GST-π and PON-1 phosphotriesterase activities seem to be a sensitive marker of pro/antioxidative imbalance in smokers. Lipids peroxidation products generated during AP can intensify preexisting inflammation. Increasing stay in the hospital was associated with worsening of lipids peroxidation markers and the parameters of lipid profile, in both non-smoking and smoking AP patients, what can indicate that the oxidative-inflammatory process are not extinguished.
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Affiliation(s)
- Grzegorz Marek
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Milena Ściskalska
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Zygmunt Grzebieniak
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Halina Milnerowicz
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
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16
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Association of serum paraoxonase activity with lipid profile, APO-A and APO-B in subjects with different levels of HDL. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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17
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Assessment of the relationship between serum paraoxonase activity and epicardial adipose tissue in hemodialysis patients. Int Urol Nephrol 2016; 49:329-335. [DOI: 10.1007/s11255-016-1465-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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18
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Chernyavskiy I, Veeranki S, Sen U, Tyagi SC. Atherogenesis: hyperhomocysteinemia interactions with LDL, macrophage function, paraoxonase 1, and exercise. Ann N Y Acad Sci 2016; 1363:138-54. [PMID: 26849408 DOI: 10.1111/nyas.13009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022]
Abstract
Despite great strides in understanding the atherogenesis process, the mechanisms are not entirely known. In addition to diet, cigarette smoking, genetic predisposition, and hypertension, hyperhomocysteinemia (HHcy), an accumulation of the noncoding sulfur-containing amino acid homocysteine (Hcy), is a significant contributor to atherogenesis. Although exercise decreases HHcy and increases longevity, the complete mechanism is unclear. In light of recent evidence, in this review, we focus on the effects of HHcy on macrophage function, differentiation, and polarization. Though there is need for further evidence, it is most likely that HHcy-mediated alterations in macrophage function are important contributors to atherogenesis, and HHcy-countering strategies, such as nutrition and exercise, should be included in the combinatorial regimens for effective prevention and regression of atherosclerotic plaques. Therefore, we also included a discussion on the effects of exercise on the HHcy-mediated atherogenic process.
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Affiliation(s)
- Ilya Chernyavskiy
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Sudhakar Veeranki
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Utpal Sen
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Suresh C Tyagi
- Department of Physiology, University of Louisville, Louisville, Kentucky
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19
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Eroglu E, Kocyigit I, Unal A, Korkar H, Karakukcu C, Orscelik O, Sipahioglu MH, Tokgoz B, Oymak O. Serum paraoxonase activity is associated with epicardial fat tissue in renal transplant recipients. Int Urol Nephrol 2015; 47:1409-14. [PMID: 26184836 DOI: 10.1007/s11255-015-1051-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS Cardiovascular disease is a major cause of mortality in renal transplant recipients. Paraoxonase-1 (PON-1) has been shown to protect against atherosclerosis by modifying lipoproteins. Epicardial fat tissue (EFT) has been proposed as a new cardiovascular risk factor. The aim of this study was to investigate the relationship between PON-1 activity and EFT in renal transplant recipients. METHODS Eighty renal transplant recipients were enrolled in this cross-sectional study. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. EFT was measured by echocardiography. RESULTS The mean age of the patients was 40.4 ± 12.3 years and mean post transplant follow-up duration was 57.2 ± 46 months. Mean PON-1 activity was 68.5 ± 30 U/L. PON-1 activity was positively correlated with age and body mass index and negatively correlated with parathyroid hormone, dialysis duration and EFT. The mean EFT thickness was 0.64 ± 0.17 cm. Multiple linear regression analysis was used to define independent determinants of EFT in renal transplant recipients. According to linear regression analysis, PON-1 levels and age were found to be independent predictors of EFT. CONCLUSION Reduced PON-1 activity was negatively associated with EFT and PON-1 activity independently predicts EFT in renal transplant recipients.
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Affiliation(s)
- Eray Eroglu
- Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey,
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20
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D'Marco L, Bellasi A, Raggi P. Cardiovascular biomarkers in chronic kidney disease: state of current research and clinical applicability. DISEASE MARKERS 2015; 2015:586569. [PMID: 25944976 PMCID: PMC4402164 DOI: 10.1155/2015/586569] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
The high incidence of cardiovascular events in chronic kidney disease (CKD) warrants an accurate evaluation of risk aimed at reducing the burden of disease and its consequences. The use of biomarkers to identify patients at high risk has been in use in the general population for several decades and has received mixed reactions in the medical community. Some practitioners have become staunch supporters and users while others doubt the utility of biomarkers and rarely measure them. In CKD patients numerous markers similar to those used in the general population and others more specific to the uremic population have emerged; however their utility for routine clinical application remains to be fully elucidated. The reproducibility and standardization of the serum assays are serious limitations to the broad implementation of these tests. The lack of focused research and validation in randomized trials rather than ad hoc measurement of multiple serum markers in observational studies is also cause for concern related to the clinical applicability of these markers. We review the current literature on biomarkers that may have a relevant role in field of nephrology.
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Affiliation(s)
- Luis D'Marco
- Unidad Avanzada de Investigación y Diagnostico Ecográfico y Renal, Clínica Puerto Ordaz, Puerto Ordaz, Venezuela
| | - Antonio Bellasi
- U.O.C. di Nefrologia e Dialisi, Ospedale Sant'Anna, Azienda Ospedaliera Sant'Anna, Como, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Radiology, Emory University, Atlanta, GA, USA
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21
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Potential cardiovascular risk protection of bilirubin in end-stage renal disease patients under hemodialysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:175286. [PMID: 25276769 PMCID: PMC4174976 DOI: 10.1155/2014/175286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
Abstract
We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 genotypes, respectively. Although no difference was found in UGT1A1 genotype distribution between the three tertiles of bilirubin, significant differences were found with increasing bilirubin levels, namely, a decrease in platelet, leukocyte, and lymphocyte counts, transferrin, oxidized low-density lipoprotein (ox-LDL), ox-LDL/low-density lipoprotein cholesterol ratio, apolipoprotein (Apo) A, Apo B, and interleukin-6 serum levels and a significant increased concentration of hemoglobin, hematocrit, erythrocyte count, iron, transferrin saturation, Apo A/Apo B ratio, adiponectin, and paraoxonase 1 serum levels. After adjustment for age these results remained significant. Our data suggest that higher bilirubin levels are associated with beneficial effects in HD patients, by improving lipid profile and reducing the inflammatory grade, which might contribute to increase in iron availability. These results suggest a potential cardiovascular risk protection of bilirubin in HD patients.
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Fülöp P, Seres I, Lőrincz H, Harangi M, Somodi S, Paragh G. Association of chemerin with oxidative stress, inflammation and classical adipokines in non-diabetic obese patients. J Cell Mol Med 2014; 18:1313-20. [PMID: 24702860 PMCID: PMC4124016 DOI: 10.1111/jcmm.12282] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/14/2014] [Indexed: 12/18/2022] Open
Abstract
The prevalence of obesity has been increasing worldwide. Chemerin is a recently discovered adipokine secreted by the enlarged adipose tissue with diverse biological effects that are not well detailed yet. This study aimed to elucidate the potential role of chemerin in oxidative stress and inflammation that are characteristics for excess weight and may eventually lead to insulin resistance and atherosclerotic complications. We also analysed the associations between chemerin and classical adipokines, namely leptin and adiponectin. Therefore, we investigated non-diabetic obese patients without manifest cardiovascular disease and compared their data to healthy lean individuals. Chemerin correlated positively with markers of oxidative stress and inflammation, while it showed a negative correlation with the measure of antioxidant status, characterized by the HDL-linked paraoxonase-1 enzyme. Chemerin also correlated positively with leptin and negatively with adiponectin respectively. In our study population, oxidized low-density lipoprotein and high-sensitivity C-reactive protein were found to be the strongest predictors of chemerin level. We conclude that chemerin may contribute to chronic inflammation and increased oxidative stress in obese individuals, even in the absence of manifest insulin resistance.
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Affiliation(s)
- Péter Fülöp
- Division of Metabolic Diseases, Department of Internal Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Kahvecioglu S, Ersoy A, Gullulu M, Dirican M. Effects of calcineurin inhibitors on paraoxonase and arylesterase activity after a kidney transplant. EXP CLIN TRANSPLANT 2014; 12:334-42. [PMID: 24447269 DOI: 10.6002/ect.2013.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cardiovascular disease is a common cause of morbidity and mortality in patients with chronic kidney failure, before and after a kidney transplant. Oxidation of lipoproteins that contain apolipoprotein B may contribute to the initiation of atherosclerosis. Paraoxonase may prevent cardiovascular disease. We compared the effects of different calcineurin inhibitors on risk factors for cardiovascular disease in kidney transplant recipients. MATERIALS AND METHODS In 16 kidney transplant recipients, treatment included tacrolimus in 8 patients and cyclosporine in 8 patients. Hemoglobin, glucose, renal function, lipid parameters, high-sensitivity C-reactive protein, homocysteine, malondialdehyde, paraoxonase activity, and arylesterase activity were measured before transplant and at 1, 6, and 12 months after the transplant. RESULTS The levels of homocysteine and malondialdehyde did not change significantly in patients who received either tacrolimus or cyclosporine. The high-sensitivity C-reactive protein was decreased (tacrolimus group, 1 mo) and increased (cyclosporine group, 6 and 12 mo) after the kidney transplant. Paraoxonase activity was increased (tacrolimus group, 1 mo). Arylesterase activity was increased (tacrolimus group, 1, 6, and 12 mo; cyclosporine group, 1 and 6 mo). The percentage of change in arylesterase activity was higher at 12 months in the tacrolimus than in the cyclosporine group. CONCLUSIONS Tacrolimus may be more effective than cyclosporine in improving risk factors for cardiovascular disease after kidney transplant.
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Affiliation(s)
- Serdar Kahvecioglu
- Department of Nephrology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
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Gugliucci A, Kinugasa E, Ogata H, Caccavello R, Kimura S. Activation of paraoxonase 1 after hemodialysis is associated with HDL remodeling and its increase in the HDL2 fraction and VLDL. Clin Chim Acta 2013; 430:9-14. [PMID: 24384301 DOI: 10.1016/j.cca.2013.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Paraoxonase 1 (PON1) activity is lower in renal failure patients. We hypothesize that part of the salutatory effect of hemodialysis on PON1 activity that we have previously found is due to HDL remodeling and shift of PON1 among HDL particles. METHODS A total of 42 patients (18 females and 24 males, 63 ± 12 yr) on long-term HD, with a mean dialysis course of 6.4 yr (range 1-19 yr), were recruited. PON1 arylesterase and lactonase activities, PON1 and apolipoprotein distribution in HDL subclasses were measured by gel gradient electrophoresis and western blotting. RESULTS The 3 different activities of PON1 we measured were significantly lower in patients as compared to control subjects; lactonase by 11%, triesterase by 19% and arylesterase by 20%, p<0.01. HDL increased slightly by 4.6%. LDL increased by 13% and VLDL decreased by 30%. These data are compatible with enhanced lipolysis of VLDL that is transformed into LDL. VLDL-PON1 activity increases significantly by 60%. PON1 activity increases by 16% in HDL2 whereas by this approach we could determine a 10% increase in the total area under the curve corresponding to total HDL. Changes in total lactonase activity were associated with changes in VLDL-PON1 and HDL2. In parallel with PON1 activation and shifts among particles, there are significant changes in apoE which increases notably in HDL2, paralleling the changes in PON1. No significant changes in apoAI or apoA-II the main structural HDL apolipoproteins were apparent after dialysis. CONCLUSIONS HD produces an activation of PON1 that can be predicted in part (30%) by efficiency of dialysis and in part (25%) by PON1 shifts to HDL2or VLDL (p<0.01). The removal of inhibitors and the change in the environment of PON1 in the micro-heterogeneity of HDL subclasses optimizes PON1 activity.
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Affiliation(s)
- Alejandro Gugliucci
- Glycation, Oxidation and Disease Laboratory, Department of Research, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA.
| | - Eriko Kinugasa
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama City, Japan
| | - Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama City, Japan
| | - Russell Caccavello
- Glycation, Oxidation and Disease Laboratory, Department of Research, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Satoshi Kimura
- Central Clinical Laboratory, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama City, Japan
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Locsey L, Seres I, Sztanek F, Harangi M, Padra J, Kovacs D, Fedor R, Asztalos L, Paragh G. Relationship Between Serum Paraoxonase and Homocysteine Thiolactonase Activity, Adipokines, and Asymmetric Dimethyl Arginine Concentrations in Renal Transplant Patients. Transplant Proc 2013; 45:3685-7. [DOI: 10.1016/j.transproceed.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Investigation of the common paraoxonase 1 variants with paraoxonase activity on bone fragility in Turkish patients. Mol Biol Rep 2013; 40:6519-24. [PMID: 24057271 DOI: 10.1007/s11033-013-2770-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
There is increasing evidence of a biochemical link between oxidative stress and bone metabolism. Oxidative stress has been shown to be involved in bone resorption as it causes loss of bone mineral density (BMD). Paraoxonase 1 (PON1), can prevent these effects of the oxidative stress on bone formation. It has been suggested that the PON1 gene as possibly implicated in reduced BMD in bone fragility cases. It has been hypothesized that PON1 gene polymorphisms may influence both the risk of osteoporosis and osteopenia occurrence and prognosis. The aim of our study is to evaluate the relationship between PON1 polymorphisms and bone fragility development. Seventy-four osteoporotic, 121 osteopenic and 79 nonosteoporotic postmenopausal women were recruited. For detection of the polymorphisms, polymerase chain reaction-restriction fragment length polymorphism techniques have been used. BMD was measured at the lumbar spine and hip by dual-energy X-ray absorptiometry. Distributions of PON1 (PON 192 and PON 55) polymorphisms in study groups were not significantly different. But, there was medium strength connection between in the osteopenic with control groups regarding PON1 55-PON1 192 haplotypes and we found a power strength connection between in the osteoporosis with control groups regarding PON1 55-PON1 192 haplotypes. Furthermore, subjects with PON1 192RR and PON1 55LL genotypes had lower PON activity values of osteoporotic subject compared to healthy control and this difference was statistically significant (p < 0.05). This result suggest that PON1 genotypes could be higher risk for osteoporosis, as determined by reduced BMD.
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Perła-Kaján J, Jakubowski H. Paraoxonase 1 and homocysteine metabolism. Amino Acids 2012; 43:1405-17. [PMID: 22643843 DOI: 10.1007/s00726-012-1321-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 05/04/2012] [Indexed: 01/23/2023]
Abstract
Paraoxonase 1 (PON1), a component of high-density lipoprotein (HDL), is a calcium-dependent multifunctional enzyme that connects metabolisms of lipoproteins and homocysteine (Hcy). Both PON1 and Hcy have been implicated in human diseases, including atherosclerosis and neurodegeneration. The involvement of Hcy in disease could be mediated through its interactions with PON1. Due to its ability to reduce oxidative stress, PON1 contributes to atheroprotective functions of HDL in mice and humans. Although PON1 has the ability to hydrolyze a variety of substrates, only one of them-Hcy-thiolactone-is known to occur naturally. In humans and mice, Hcy-thiolactonase activity of PON1 protects against N-homocysteinylation, which is detrimental to protein structure and function. PON1 also protects against neurotoxicity associated with hyperhomocysteinemia in mouse models. The links between PON1 and Hcy in relation to pathological states such as coronary artery disease, stroke, diabetic mellitus, kidney failure and Alzheimer's disease that emerge from recent studies are the topics of this review.
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Affiliation(s)
- Joanna Perła-Kaján
- Department of Biochemistry and Biotechnology, Poznań University of Life Sciences, Poznan, Poland.
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Sztanek F, Seres I, Harangi M, Locsey L, Koncsos P, Paragh G. Effect of Nutritional Status on Human Paraoxonase-1 Activity in Patients with Chronic Kidney Disease. ACTA ACUST UNITED AC 2012; 36:310-9. [DOI: 10.1159/000343383] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 11/19/2022]
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