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Kirkman DL, Chavez DA. Exercise for chronic kidney disease: effects on vascular and cardiopulmonary function. Am J Physiol Heart Circ Physiol 2024; 326:H138-H147. [PMID: 37975707 DOI: 10.1152/ajpheart.00400.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
Patients with chronic kidney disease (CKD) have an exacerbated prevalence of cardiovascular disease (CVD). Vascular dysfunction, characterized by impaired endothelial function and arterial stiffness, and markedly low cardiorespiratory fitness levels are hallmark manifestations of the disease that contribute to the CVD burden. Despite advancements in blood pressure and lipid lowering pharmacological therapies, CVD remains markedly prevalent across the spectrum of CKD. This highlights a stagnation in effective clinical strategies to improve cardiovascular health and reinforces the critical need for adjuvant lifestyle strategies such as physical activity and exercise training to be incorporated into routine clinical care. This narrative review provides an overview of the known effects of exercise on vascular and cardiopulmonary function across the spectrum of CKD. The physiological mechanisms of vascular dysfunction that serve as exercise-specific therapeutic targets are highlighted and future perspectives are discussed.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Domenico A Chavez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
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2
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Cheng YH, Yao CA, Yang CC, Hsu SP, Chien CT. Sodium thiosulfate through preserving mitochondrial dynamics ameliorates oxidative stress induced renal apoptosis and ferroptosis in 5/6 nephrectomized rats with chronic kidney diseases. PLoS One 2023; 18:e0277652. [PMID: 36795670 PMCID: PMC9934356 DOI: 10.1371/journal.pone.0277652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/01/2022] [Indexed: 02/17/2023] Open
Abstract
Chronic kidney disease (CKD) progression may be evoked through dysregulated mitochondrial dynamics enhanced oxidative stress and inflammation contributing to high cardiovascular morbidity and mortality. Previous study has demonstrated sodium thiosulfate (STS, Na2S2O3) could effectively attenuate renal oxidative injury in the animal model of renovascular hypertension. We explored whether the potentially therapeutic effect of STS is available on the attenuating CKD injury in thirty-six male Wistar rats with 5/6 nephrectomy. We determined the STS effect on reactive oxygen species (ROS) amount in vitro and in vivo by an ultrasensitive chemiluminescence-amplification method, ED-1 mediated inflammation, Masson's trichrome stained fibrosis, mitochondrial dynamics (fission and fusion) and two types of programmed cell death, apoptosis and ferroptosis by western blot and immunohistochemistry. Our in vitro data showed STS displayed the strongest scavenging ROS activity at the dosage of 0.1 g. We applied STS at 0.1 g/kg intraperitoneally 5 times/week for 4 weeks to these CKD rats. CKD significantly enhanced the degree in arterial blood pressure, urinary protein, BUN, creatinine, blood and kidney ROS amount, leukocytes infiltration, renal 4-HNE expression, fibrosis, dynamin-related protein 1 (Drp1) mediated mitochondrial fission, Bax/c-caspase 9/c-caspase 3/poly (ADP-ribose) polymerase (PARP) mediated apoptosis, iron overload/ferroptosis and the decreased xCT/GPX4 expression and OPA-1 mediated mitochondrial fusion. STS treatment significantly ameliorated oxidative stress, leukocyte infiltration, fibrosis, apoptosis and ferroptosis and improved mitochondrial dynamics and renal dysfunction in CKD rats. Our results suggest that STS as drug repurposing strategy could attenuate CKD injury through the action of anti-mitochondrial fission, anti-inflammation, anti-fibrosis, anti-apoptotic, and anti-ferroptotic mechanisms.
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Affiliation(s)
- Yu-Hsuan Cheng
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chih-Ching Yang
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
- Office of Public Relation of Ministry of Health and Welfare, Taipei, Taiwan, ROC
- Center for General Education, Mackay College of Medicine, Nursing and Management, New Taipei City, Taiwan, ROC
| | - Shih-Ping Hsu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Industrial Management, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Chiang-Ting Chien
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
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3
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Wang H, Xie D, Wu L, Zhao L. Association of Exercise With Vascular Function in Patients With CKD: A Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:904299. [PMID: 35872793 PMCID: PMC9299368 DOI: 10.3389/fmed.2022.904299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aim Vascular function is associated with an increased risk of cardiovascular events in patients with chronic kidney disease (CKD). Whether exercise improves vascular function in such patients remains controversial. This study aimed to conduct a meta-analysis on the effect of exercise training on the vascular function of patients with CKD. Methods Embase, the Cochrane Central Register of Controlled Trials, and Medline were searched from inception until November 15, 2021. The terms exercise, CKD, dialysis, kidney transplant, and randomized controlled trial (RCT) were searched alone or in combination. RCTs were included when studies compared exercise with active control, usual care, or no intervention, and the studies reported vascular function on patients with CKD. Results This meta-analysis included 18 RCTs with 817 patients. Exercise training was significantly associated with decreased pulse wave velocity weighted mean difference (WMD), −0.56; 95% confidence interval (CI), −1.02 to −0.09, P = 0.02 and augmentation index (WMD, −3.26; 95% CI, −5.46 to −1.05, P = 0.004). It was also significantly associated with improved peak VO2 (WMD, 2.64; 95% CI, 1.94–3.35, P < 0.00001), general health (WMD, 7.03; 95% CI, 0.65–13.42, P = 0.03), and vitality (WMD, 9.1; 95% CI, 2.50–15.69, P = 0.007). Conclusions The meta-analysis suggested that exercise training improved vascular function in patients with CKD. An exercise program should be considered as one of the management strategies for vascular dysfunction in patients with CKD. Further studies are needed to demonstrate that exercise training improves cardiovascular diseases in patients with CKD.
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Affiliation(s)
- Huan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dengpiao Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Dengpiao Xie
| | - Lisheng Wu
- Southern Medical University, Guangzhou, China
| | - Liangbin Zhao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Liangbin Zhao
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Moecke DMP, Martins GHC, Garlet TC, Bonorino KC, Luciani MG, Bion M, Dos Santos B, da Silva Gevaerd M, Filho JA, Dos Santos ARS, Vieira DSC, Dafre AL, de Camargo Hizume Kunzler D. Aerobic Exercise Attenuates Kidney Injury, Improves Physical Performance, and Increases Antioxidant Defenses in Lungs of Adenine-Induced Chronic Kidney Disease Mice. Inflammation 2022; 45:1895-1910. [PMID: 35727396 DOI: 10.1007/s10753-022-01643-y] [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: 02/19/2021] [Revised: 12/30/2021] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
The association between chronic kidney disease (CKD) and pulmonary pathophysiological changes is well stablished. Nevertheless, the effects of aerobic exercise (AE) on lungs of CKD need further clarification. Thus, Swiss mice were divided in control, AE, CKD, and CKD + AE groups. CKD was induced by 0.2% adenine intake during 8 weeks (4 weeks of CKD induction and 4 weeks of AE). AE consisted in running on treadmill, at moderate intensity, 30 min/day, 5 days/week, during 4 weeks. Twenty-four hours after the last training day, functional capacity test was performed, and 48 h after the test, mice were euthanized. CKD mice showed a significant increase in urine output, serum urea, and creatinine concentrations, and decreased body weight and urine density, besides oxidative damage (p = 0.044), edema area (p < 0.001), leukocyte infiltration (p = 0.040), and collagen area in lung tissue (p = 0.004). AE resulted in an increase of distance traveled (p = 0.049) and maximum speed (p = 0.046), increased activity of catalase (p = 0.031) and glutathione peroxidase (p = 0.048) in lungs, increased levels of nitric oxide (NOx) in serum (p = 0.001) and bronchoalveolar lavage fluid (p = 0.047), and decreased kidney histological injury (p = 0.018) of CKD mice. However, AE also increased oxidative damage (p = 0.003) and did not change collagen content or perivascular edema in lungs (p > 0.05) of CKD mice. Therefore, AE attenuated kidney injury and improved antioxidants defenses in lungs. Despite no significant changes in pulmonary damage, AE significantly improved physical performance in CKD mice.
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Affiliation(s)
- Débora Melissa Petry Moecke
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Gisele Henrique Cardoso Martins
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Thaine Cristina Garlet
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Kelly Cattelan Bonorino
- Laboratory of Neurobiology of Pain and Inflammation (LANDI), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marilia Gabriela Luciani
- Center for Agricultural Sciences (CAV), Universidade Estadual de Santa Catarina (UDESC), Lages, Santa Catarina, Brazil
| | - Monique Bion
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Barbara Dos Santos
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Monique da Silva Gevaerd
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Jamil Assreuy Filho
- Nitric Oxide Pharmacology Laboratory, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Adair Roberto Soares Dos Santos
- Laboratory of Neurobiology of Pain and Inflammation (LANDI), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Daniella Serafin Couto Vieira
- Polydoro Ernani de São Thiago University Hospital, Universidade Federal de Santa Catarina (HU/UFSC), Pathological Anatomy Service, Florianópolis, Santa Catarina, Brazil
| | - Alcir Luiz Dafre
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Deborah de Camargo Hizume Kunzler
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil.
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5
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Sprick JD, Mammino K, Jeong J, DaCosta DR, Hu Y, Morison DG, Nocera JR, Park J. Aerobic exercise training improves endothelial function and attenuates blood pressure reactivity during maximal exercise in chronic kidney disease. J Appl Physiol (1985) 2022; 132:785-793. [PMID: 35142559 PMCID: PMC8917938 DOI: 10.1152/japplphysiol.00808.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have exaggerated increases in blood pressure during exercise that are associated with endothelial dysfunction. We hypothesized that aerobic exercise training would improve endothelial function and attenuate blood pressure reactivity during exercise in CKD. Sedentary individuals with CKD stages III-IV underwent 12 wk of aerobic cycling exercise (n = 26) or nonaerobic exercise (n = 22, control). Both interventions were performed 3 days/wk and matched for duration. Endothelial function was measured via peripheral arterial tonometry and quantified as reactive hyperemia index (RHI). Peak oxygen uptake (V̇o2peak) was assessed via maximal treadmill exercise testing with concomitant blood pressure monitoring. All measurements were performed at baseline and after the 12-wk intervention. A linear mixed model was used to compare the rate of increase in blood pressure during the test. RHI improved with exercise (Pre = 1.78 ± 0.10 vs. Post = 2.01 ± 0.13, P = 0.03) with no change following stretching (Pre = 1.73 ± 0.08 vs. Post = 1.67 ± 0.10, P = 0.69). Peak systolic blood pressure during the maximal treadmill exercise test was lower after exercise training (Pre = 186 ± 5 mmHg, Post = 174 ± 4 mmHg, P = 0.003) with no change after stretching (Pre = 190 ± 6 mmHg, Post = 190 ± 4 mmHg, P = 0.12). The rate of increase in systolic blood pressure during the V̇o2peak test tended to decrease after training for both groups (-2 mmHg/stage) with no differences between groups (P = 0.97). There was no change in V̇o2peak after either intervention. In conclusion, aerobic exercise training improves endothelial function and attenuates peak blood pressure reactivity during exercise in CKD.NEW & NOTEWORTHY Patients with chronic kidney disease (CKD) exhibit increased blood pressure reactivity during exercise that is associated with endothelial dysfunction. Twelve weeks of structured, aerobic, exercise training improves endothelial function and attenuates peak blood pressure responses during exercise in CKD stages III-IV.
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Affiliation(s)
- Justin D. Sprick
- 1Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
| | - Kevin Mammino
- 2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
| | - Jinhee Jeong
- 1Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
| | - Dana R. DaCosta
- 1Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
| | - Yingtian Hu
- 4Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Doree G. Morison
- 1Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,2Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Joe R. Nocera
- 2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia,5Departments of Neurology and Rehabilitative Medicine, Emory University Department of Medicine, Atlanta, Georgia
| | - Jeanie Park
- 1Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,2Department of Veterans Affairs Health Care System, Decatur, Georgia,3Department of Veterans Affairs Health Care System, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
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Kotake H, Yamada S, Ogura Y, Watanabe S, Inoue K, Ichikawa D, Sugaya T, Ohata K, Natsuki Y, Hoshino S, Watanabe M, Kimura K, Shibagaki Y, Kamijo-Ikemori A. Endurance exercise training-attenuated diabetic kidney disease with muscle weakness in spontaneously diabetic Torii fatty rats. Kidney Blood Press Res 2021; 47:203-218. [PMID: 34923497 DOI: 10.1159/000521464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to evaluate protective effects of endurance exercise training against diabetic kidney disease (DKD) with muscle weakness by using male spontaneously diabetic Torii (SDT) fatty rats as type 2 diabetic animal models with obesity, hypertension, and hyperlipidemia. Methods Eight-week-old SDT fatty rats (n = 12) and Sprague-Dawley (SD) rats (n = 10) were randomly divided into exercise (Ex; SDT-Ex: n = 6, SD-Ex: n = 5) and sedentary groups (SDT-Cont: n = 6, SD-Cont: n = 5), respectively. Each group underwent regular treadmill exercise four times a week from ages 8 to 16 weeks. Results The exercise attenuated hypertension and hyperlipidemia and prevented increases in renal parameter levels without affecting blood glucose levels. In the SDT fatty rats, it prevented induction of renal morphological abnormalities in the interstitium of the superficial and intermediate layers of the cortex. Downregulated expression of endothelial nitric oxide synthase in the glomerulus of the SDT fatty rats was significantly upregulated by the exercise. The exercise upregulated the renal expressions of both medium-chain acyl-CoA dehydrogenase and peroxisome proliferator-activated receptor γ coactivator-1α related to fatty acid metabolism. It increased muscle strength and both muscle weight and cross-sectional area of type IIb muscle fibers in the extensor digitorum longus muscle in the SDT fatty rats. Conclusion Endurance exercise training in type 2 diabetes ameliorates DKD by improving endothelial abnormality and enhancing fatty acid metabolism in addition to attenuated hypertension, hyperlipidemia, and muscle weakness independently of blood glucose levels.
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Affiliation(s)
- Hitoshi Kotake
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Yamada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuji Ogura
- Department of Physiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shiika Watanabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuho Inoue
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeshi Sugaya
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiichi Ohata
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasunori Natsuki
- Institute for Ultrastructural Morphology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Seiko Hoshino
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Minoru Watanabe
- Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | | | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Atsuko Kamijo-Ikemori
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
- Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
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7
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Grazioli E, Romani A, Marrone G, Di Lauro M, Cerulli C, Urciuoli S, Murri A, Guerriero C, Tranchita E, Tesauro M, Parisi A, Di Daniele N, Noce A. Impact of Physical Activity and Natural Bioactive Compounds on Endothelial Dysfunction in Chronic Kidney Disease. Life (Basel) 2021; 11:life11080841. [PMID: 34440585 PMCID: PMC8402113 DOI: 10.3390/life11080841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) represents a world-wide public health problem. Inflammation, endothelial dysfunction (ED) and vascular calcifications are clinical features of CKD patients that increase cardiovascular (CV) mortality. CKD-related CV disease pathogenic mechanisms are not only associated with traditional factors such as arterial hypertension and dyslipidemia, but also with ED, oxidative stress and low-grade inflammation. The typical comorbidities of CKD contribute to reduce the performance and the levels of the physical activity in nephropathic patients compared to healthy subjects. Currently, the effective role of physical activity on ED is still debated, but the available few literature data suggest its positive contribution. Another possible adjuvant treatment of ED in CKD patients is represented by natural bioactive compounds (NBCs). Among these, minor polar compounds of extra virgin olive oil (hydroxytyrosol, tyrosol and oleocanthal), polyphenols, and vitamin D seem to exert a beneficial role on ED in CKD patients. The objective of the review is to evaluate the effectiveness of physical exercise protocols and/or NBCs on ED in CKD patients.
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Affiliation(s)
- Elisa Grazioli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Annalisa Romani
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), DiSIA, University of Florence, Via Ugo Schiff 6, 50019 Sesto Fiorentino, Florence, Italy; (A.R.); (S.U.)
| | - Giulia Marrone
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Manuela Di Lauro
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Claudia Cerulli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Silvia Urciuoli
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), DiSIA, University of Florence, Via Ugo Schiff 6, 50019 Sesto Fiorentino, Florence, Italy; (A.R.); (S.U.)
| | - Arianna Murri
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Cristina Guerriero
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Eliana Tranchita
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Manfredi Tesauro
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
- Correspondence: (M.T.); (A.N.); Tel.: +39-06-2090-2982 (M.T.); +39-06-2090-2194 (A.N.)
| | - Attilio Parisi
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Nicola Di Daniele
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Annalisa Noce
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
- Correspondence: (M.T.); (A.N.); Tel.: +39-06-2090-2982 (M.T.); +39-06-2090-2194 (A.N.)
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8
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Avin KG, Allen MR, Chen NX, Srinivasan S, O'Neill KD, Troutman AD, Mast G, Swallow EA, Brown MB, Wallace JM, Zimmers TA, Warden SJ, Moe SM. Voluntary Wheel Running Has Beneficial Effects in a Rat Model of CKD-Mineral Bone Disorder (CKD-MBD). J Am Soc Nephrol 2019; 30:1898-1909. [PMID: 31501355 DOI: 10.1681/asn.2019040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/16/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Reduced bone and muscle health in individuals with CKD contributes to their higher rates of morbidity and mortality. METHODS We tested the hypothesis that voluntary wheel running would improve musculoskeletal health in a CKD rat model. Rats with spontaneous progressive cystic kidney disease (Cy/+ IU) and normal littermates (NL) were given access to a voluntary running wheel or standard cage conditions for 10 weeks starting at 25 weeks of age when the rats with kidney disease had reached stage 2-3 of CKD. We then measured the effects of wheel running on serum biochemistry, tissue weight, voluntary grip strength, maximal aerobic capacity (VO2max), body composition and bone micro-CT and mechanics. RESULTS Wheel running improved serum biochemistry with decreased creatinine, phosphorous, and parathyroid hormone in the rats with CKD. It improved muscle strength, increased time-to-fatigue (for VO2max), reduced cortical porosity and improved bone microarchitecture. The CKD rats with voluntary wheel access also had reduced kidney cystic weight and reduced left ventricular mass index. CONCLUSIONS Voluntary wheel running resulted in multiple beneficial systemic effects in rats with CKD and improved their physical function. Studies examining exercise interventions in patients with CKD are warranted.
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Affiliation(s)
- Keith G Avin
- Division of Nephrology and .,Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Matthew R Allen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Neal X Chen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Shruthi Srinivasan
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Kalisha D O'Neill
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Ashley D Troutman
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Garrison Mast
- Departments of Medicine, Anatomy and Cell Biology, and
| | | | - Mary Beth Brown
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Joseph M Wallace
- Division of Nephrology and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Teresa A Zimmers
- Medicine and General Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Sharon M Moe
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
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9
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l-Arginine supplementation blunts resistance exercise improvement in rats with chronic kidney disease. Life Sci 2019; 232:116604. [PMID: 31260684 DOI: 10.1016/j.lfs.2019.116604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease (CKD) patients present L-arginine (L-arg) deficiency and L-arg supplementation has been used as a treatment. In addition, sarcopenia is another common problem in CKD population, resistance training (RT) is one of the conservative strategies developed to prevent CKD progression, and however there are no evidences of a combination of these two strategies to treat CKD outcomes. The aim of this study was to evaluate the effects of oral L-arg supplementation combined with RT in an experimental model of CKD. Twenty-five Munich-Wistar male rats, 8-week-old were divided in 5 groups: Sham (sedentary control), Nx (CKD sedentary), Nx L-arg (CKD sedentary supplemented with 2% of L-arg), Nx RT (CKD exercised) Nx RT + L-arg (CKD exercised and supplemented with 2% of L-arg). CKD model was obtained by a subtotal 5/6 nephrectomy. RT was performed on a ladder climbing, three weekly sessions on non-consecutive days, with an intensity of 70% maximum carrying capacity. They were submitted to RT and/or L-arg supplementation for 10 weeks. There was a significant improvement in muscle strength, renal function, anti-inflammatory cytokines, arginase metabolism and renal fibrosis after RT. However, the combination of RT and L-arg impaired all the improvements promoted by RT alone. The L-arg supplementation alone did not impair renal fibrosis and renal function. In conclusion, RT improved inflammatory balance, muscle strength, renal function and consequently decreased renal fibrosis. Nevertheless, the association with L-arg supplementation prevented all these effects promoted by RT.
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10
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Kirkman DL, Ramick MG, Muth BJ, Stock JM, Pohlig RT, Townsend RR, Edwards DG. Effects of aerobic exercise on vascular function in nondialysis chronic kidney disease: a randomized controlled trial. Am J Physiol Renal Physiol 2019; 316:F898-F905. [PMID: 30810061 PMCID: PMC6580257 DOI: 10.1152/ajprenal.00539.2018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/26/2022] Open
Abstract
Endothelial dysfunction and arterial stiffness are nontraditional risk factors of chronic kidney disease (CKD)-related cardiovascular disease (CVD) that could be targeted with exercise. This study investigated the effect of moderate to vigorous aerobic exercise on vascular function in nondialysis CKD. In this randomized, controlled trial, 36 nondialysis patients with CKD (means ± SE, age: 58 ± 2 yr, estimated glomerular filtration rate: 44 ± 2 ml·min-1·1.73 m-2) were allocated to an exercise training (EXT) or control (CON) arm. The EXT group performed 3 × 45 min of supervised exercise per week at 60-85% heart rate reserve for 12 wk, whereas the CON group received routine care. Outcomes were assessed at 0 and 12 wk. The primary outcome, microvascular function, was assessed via cutaneous vasodilation during local heating measured by laser-Doppler flowmetry coupled with microdialysis. Participants were instrumented with two microdialysis fibers for the delivery of 1) Ringer solution and 2) the superoxide scavenger tempol. Conduit artery function was assessed via brachial artery flow-mediated dilation. Aortic pressure waveforms and pulse wave velocity were acquired with tonometry and oscillometry. Microvascular function improved after EXT (week 0 vs.week 12, EXT: 87 ± 2% vs. 91 ± 2% and CON: 86 ± 2% vs. 84 ± 3%, P = 0.03). At baseline, pharmacological delivery of tempol improved microvascular function (Ringer solution vs. tempol: 86 ± 1% vs. 90 ± 1%, P = 0.02) but was no longer effective after EXT (91 ± 2% vs. 87 ± 1%, P = 0.2), suggesting that an improved redox balance plays a role in EXT-related improvements. Brachial artery flow-mediated dilation was maintained after EXT (EXT: 2.6 ± 0.4% vs. 3.8 ± 0.8% and CON: 3.5 ± 0.6% vs. 2.3 ± 0.4%, P = 0.02). Central arterial hemodynamics and arterial stiffness were unchanged after EXT. Aerobic exercise improved microvascular function and maintained conduit artery function and should be considered as an adjunct therapy to reduce CVD risk in CKD.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University , Richmond, Virginia
| | - Meghan G Ramick
- Department of Kinesiology, West Chester University , West Chester, Pennsylvania
| | - Bryce J Muth
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware , Newark, Delaware
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennyslvania
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
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11
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Guers JJ, Kasecky-Lardner L, Farquhar WB, Edwards DG, Lennon SL. Voluntary wheel running prevents salt-induced endothelial dysfunction: role of oxidative stress. J Appl Physiol (1985) 2018; 126:502-510. [PMID: 30571282 DOI: 10.1152/japplphysiol.00421.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Diets high in salt can lead to endothelial dysfunction, a nontraditional risk factor for cardiovascular disease (CVD). Exercise is known to reduce CVD risk; however, it remains unknown whether chronic physical activity can attenuate salt-induced endothelial dysfunction independent of blood pressure (BP) and whether these changes are due to an upregulation in endogenous antioxidants. Eight-week-old Sprague-Dawley rats were fed either a normal (NS; 0.49%)- or a high (HS; 4.0%)-salt diet and further divided into voluntary wheel running (NS-VWR, HS-VWR) and sedentary (NS, HS) groups for 6 wk. BP was measured weekly and remained unchanged within groups ( P = 0.373). Endothelium-dependent relaxation (EDR) was impaired in the femoral artery of HS compared with NS (38.6 ± 4.0% vs. 65.0 ± 3.6%; P = 0.013) animals, whereas it was not different between NS and HS-VWR (73.4 ± 6.4%; P = 0.273) animals. Incubation with the antioxidants TEMPOL ( P = 0.024) and apocynin ( P = 0.013) improved EDR in HS animals, indicating a role for reactive oxygen species (ROS). Wheel running upregulated the antioxidant superoxide dismutase-2 (SOD-2) ( P = 0.011) under HS conditions and lowered NOX4 and Gp91-phox, two subunits of NADPH oxidase. Wheel running elevated phosphorylated endothelial nitric oxide synthase (eNOS) ( P = 0.014) in HS-fed rats, demonstrating a role for physical activity and eNOS activity under HS conditions. Finally, there was a reduction in EDR ( P = 0.038) when femoral arteries from NS-VWR animals were incubated with TEMPOL or apocynin, suggesting there may be a critical level of ROS needed to maintain endothelial function. In summary, physical activity protected HS-fed rats from reductions in endothelial function, likely through increased SOD-2 levels and reduced oxidative stress. NEW & NOTEWORTHY Our data suggest that voluntary wheel running can prevent impairments in endothelium-dependent relaxation in the femoral artery of rats fed a high-salt diet. This appears to be independent of blood pressure and mediated through a decrease in expression of NADPH oxidases as a result of physical activity. These data suggest that increased chronic physical activity can protect the vasculature from a diet high in salt, likely through a reduction in oxidative stress.
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Affiliation(s)
- John J Guers
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | | | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware.,Department of Biological Sciences, University of Delaware , Newark, Delaware
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware.,Department of Biological Sciences, University of Delaware , Newark, Delaware
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
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12
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Organ JM, Allen MR, Myers-White A, Elkhatib W, O'Neill KD, Chen NX, Moe SM, Avin KG. Effects of treadmill running in a rat model of chronic kidney disease. Biochem Biophys Rep 2018; 16:19-23. [PMID: 30229133 PMCID: PMC6140622 DOI: 10.1016/j.bbrep.2018.09.001] [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: 07/26/2018] [Accepted: 09/04/2018] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) progression results in musculoskeletal dysfunction that is associated with a higher likelihood of hospitalization and is predictive of hospitalizations and mortality. Despite this, there is a lack of effective interventions to treat the musculoskeletal dysfunction. We studied treadmill running as an intervention to improve musculoskeletal health in a translational rat model that has slowly progressive CKD. CKD rats were subjected to treadmill exercise or no treadmill exercise for 10 weeks (n = 8 each group). Animals ran for 60 min, 5 times per week starting at a speed of 8 m/min and ending at 18 m/min (1 m/min increase/week). Treadmill training had no effect on muscle strength (assessed as maximally stimulated torque), half-relaxation time (time from peak torque to 50%) or muscle cross-sectional area. Overall, there were no biochemical improvements related to CKD progression. Skeletal muscle catabolism was higher than non-exercised animals without a concomitant change in muscle synthesis markers or regeneration transcription factors. These results suggest that aerobic exercise, achieved via treadmill running was not protective in CKD animals and actually produced potentially harmful effects (increased catabolism). Given the high prevalence and dramatic musculoskeletal mobility impairment in patients with CKD, there is a clear need to understand how to effectively prescribe exercise in order to benefit the musculoskeletal system.
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Affiliation(s)
- J M Organ
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - M R Allen
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, United States.,Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - A Myers-White
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - W Elkhatib
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - K D O'Neill
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - N X Chen
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - S M Moe
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - K G Avin
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States.,Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, IN, United States
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13
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Li T, Gua C, Wu B, Chen Y. Increased circulating trimethylamine N-oxide contributes to endothelial dysfunction in a rat model of chronic kidney disease. Biochem Biophys Res Commun 2017; 495:2071-2077. [PMID: 29247650 DOI: 10.1016/j.bbrc.2017.12.069] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 12/23/2022]
Abstract
Chronic kidney disease (CKD) is strongly associated with increased cardiovascular risk. Impaired endothelial function, a key initiating step in the pathogenesis of cardiovascular disease, has been reported in patients with CKD, but the mechanisms responsible for endothelial dysfunction in CKD remain elusive. Emerging evidence reveals that trimethylamine-N-oxide (TMAO), a gut microbiota-generated metabolite, is involved in the pathogenesis of many cardiovascular diseases. Circulating TMAO is elevated in CKD. Here we tested the hypothesis that elevated TMAO plays a contributory role in the pathogenesis of endothelial dysfunction in CKD. Rats underwent 5/6 nephrectomy to induce CKD or sham operation, and were treated with 1.0% 3,3-Dimethyl-1-butanol (DMB, an inhibitor of trimethylamine formation) or vehicle. Eight weeks after nephrectomy and DMB treatment, circulating TMAO levels were markedly elevated in CKD-vehicle rats compared with sham-vehicle rats, but were reduced in CKD-DMB rats. Acetylcholine-induced endothelium-dependent vasodilation was impaired in CKD-vehicle rats compared with sham-vehicle rats as indicated by reduced maximal relaxation (Emax) and decreased area under the curve (AUC). Emax and AUC were both normalized in CKD-DMB rats. No difference in sodium nitroprusside-induced endothelial-independent vasodilation was observed across groups. Molecular studies revealed that endothelial nitric-oxide synthase activity was decreased, while superoxide production and proinflammatory cytokine expression were increased in the aorta of CKD-vehicle rats compared with sham-vehicle rats. Of note, the abnormalities in above molecular parameters were completely restored in CKD-DMB rats. These results suggest that CKD elevates circulating TMAO levels, which may reduce eNOS-derived NO production by increasing vascular oxidative stress and inflammation, contributing to CKD-associated endothelial dysfunction and cardiovascular disease.
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Affiliation(s)
- Tiejun Li
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China.
| | - Chaojun Gua
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China
| | - Baogang Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China
| | - Yanli Chen
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China
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14
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Li T, Chen Y, Gua C, Li X. Elevated Circulating Trimethylamine N-Oxide Levels Contribute to Endothelial Dysfunction in Aged Rats through Vascular Inflammation and Oxidative Stress. Front Physiol 2017; 8:350. [PMID: 28611682 PMCID: PMC5447752 DOI: 10.3389/fphys.2017.00350] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/12/2017] [Indexed: 12/25/2022] Open
Abstract
Vascular endothelial dysfunction, a characteristic of the aging process, is an important risk factor for cardiovascular disease in aging. Although, vascular inflammation and oxidative stress are major contributors to endothelial dysfunction in aging, the underlying mechanisms during the aging process are not fully understood. Accumulating evidence reveals that gut microbiota-dependent metabolite trimethylamine-N-oxide (TMAO) is implicated in the pathogenesis of many cardiovascular diseases. We tested the hypothesis that aging increases circulating TMAO levels, which induce vascular inflammation and oxidative stress, resulting in age-associated endothelial dysfunction. Old (22-mo-old) and young (4-mo-old) Fischer-344 rats were treated without (control) or with 1.0% 3,3-Dimethyl-1-butanol (DMB, an inhibitor of trimethylamine formation) in drinking water for 8 weeks. Compared with young control group, old control group had markedly higher plasma TMAO levels, which were reduced by DMB treatment. Endothelium-dependent relaxation of aorta in response to acetylcholine was impaired in old control group compared with young control group as indicated by decreased maximal relaxation (Emax) and reduced area under the curve (AUC). Emax and AUC were both normalized in old rats treated with DMB. No difference in endothelial-independent relaxation in response to sodium nitroprusside was observed among groups. Molecular studies revealed that old control group exhibits increased expression of proinflammatory cytokines and superoxide production, and decreased expression of endothelial nitric-oxide synthase (eNOS) in the aorta, all of which were restored by DMB treatment. These results suggest that aging increases circulating TMAO levels, which may impair eNOS-derived NO bioavailability by increasing vascular inflammation and oxidative stress, contributing to aging-associated endothelial dysfunction.
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Affiliation(s)
- Tiejun Li
- Department of Cardiology, Shengjing Hospital of China Medical UniversityShenyang, China
| | - Yanli Chen
- Department of Cardiology, Shengjing Hospital of China Medical UniversityShenyang, China
| | - Chaojun Gua
- Department of Cardiology, Shengjing Hospital of China Medical UniversityShenyang, China
| | - Xiaodong Li
- Department of Cardiology, Shengjing Hospital of China Medical UniversityShenyang, China
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15
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Downey RM, Liao P, Millson EC, Quyyumi AA, Sher S, Park J. Endothelial dysfunction correlates with exaggerated exercise pressor response during whole body maximal exercise in chronic kidney disease. Am J Physiol Renal Physiol 2017; 312:F917-F924. [PMID: 28274927 DOI: 10.1152/ajprenal.00603.2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) patients have exercise intolerance associated with increased cardiovascular mortality. Previous studies demonstrate that blood pressure (BP) and sympathetic nerve responses to handgrip exercise are exaggerated in CKD. These patients also have decreased nitric oxide (NO) bioavailability and endothelial dysfunction, which could potentially lead to an impaired ability to vasodilate during exercise. We hypothesized that CKD patients have exaggerated BP responses during maximal whole body exercise and that endothelial dysfunction correlates with greater exercise pressor responses in these patients. Brachial artery flow-mediated dilation (FMD) was assessed before maximal treadmill exercise in 56 participants: 38 CKD (56.7 ± 1.2 yr old, 38 men) and 21 controls (52.8 ± 1.8 yr old, 20 men). During maximal treadmill exercise, the slope-of-rise in systolic BP (+10.32 vs. +7.75 mmHg/stage, P < 0.001), mean arterial pressure (+3.50 vs. +2.63 mmHg/stage, P = 0.004), and heart rate (+11.87 vs. +10.69 beats·min-1·stage-1, P = 0.031) was significantly greater in CKD compared with controls. Baseline FMD was significantly lower in CKD (2.76 ± 0.42% vs. 5.84 ± 0.97%, P = 0.008). Lower FMD values were significantly associated with a higher slope-of-rise in systolic BP (+11.05 vs. 8.71 mmHg/stage, P = 0.003) during exercise in CKD, as well as poorer exercise capacity measured as peak oxygen uptake (V̇o2peak; 19.47 ± 1.47 vs. 24.57 ± 1.51 ml·min-1·kg-1, P < 0.001). These findings demonstrate that low FMD in CKD correlates with augmented BP responses during exercise and lower V̇o2peak, suggesting that endothelial dysfunction may contribute to exaggerated exercise pressor responses and poor exercise capacity in CKD patients.
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Affiliation(s)
- Ryan M Downey
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Department of Veterans Affairs Medical Center, Decatur, Georgia
| | - Peizhou Liao
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Erin C Millson
- Clinical Research Network, Atlanta Clinical and Translational Science Institute, Emory University School of Medicine, Atlanta, Georgia; and
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Salman Sher
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; .,Research Service Line, Department of Veterans Affairs Medical Center, Decatur, Georgia
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16
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Guers JJ, Prisby RD, Edwards DG, Lennon-Edwards S. Intermittent parathyroid hormone administration attenuates endothelial dysfunction in old rats. J Appl Physiol (1985) 2016; 122:76-81. [PMID: 27815368 DOI: 10.1152/japplphysiol.00348.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 11/22/2022] Open
Abstract
Aging is an independent risk factor for cardiovascular disease and is characterized by a decline in endothelial function. Parathyroid hormone (PTH) administration has been shown to increase endothelial nitric oxide synthase (eNOS) expression. The purpose of this investigation was to determine the effect of intermittent PTH administration on aortic endothelial function in old rodents. We hypothesized that intermittent PTH administration would improve endothelial function in older rodents. Old (24-mo-old) and young (4-mo-old) Fischer-344 rats were given 10 injections of PTH 1-34 (43 μg·kg-1·day-1) or phosphate-buffered saline (100 μl/day) over 15 days. Endothelium-dependent relaxation of aortic rings in response to acetylcholine (10-9 to 10-5 M) was significantly impaired in old control (OC) compared with young control (YC) as indicated by a reduced area under the curve (AUC, 100 ± 6.28 vs. 54.08 ± 8.3%; P < 0.05) and impaired maximal relaxation (Emax, 70.1 ± 4.48 vs. 92.9 ± 4.38%; P < 0.05). Emax was improved in old animals treated with PTH (OPTH) (OC, 70.1 ± 4.48 vs. OPTH, 85 ± 7.48%; P < 0.05) as well as AUC (OC, 54.08 ± 8.3 vs. OPTH, 82.5 ± 5.7%; P < 0.05) while logEC50 was not different. Endothelial-independent relaxation in response to sodium nitroprusside was not different among groups. Aortic eNOS protein expression was significantly decreased in OC compared with YC (P < 0.05). PTH treatment restored eNOS expression in OPTH animals (P < 0.05). These data suggest that PTH may play a role in attenuating age-related impairments in aortic endothelial function. NEW & NOTEWORTHY We have demonstrated that intermittent parathyroid hormone administration can rescue age-related vascular dysfunction by improving endothelial-dependent dilation in the aorta of older rodents. This demonstrates a novel potential benefit of parathyroid hormone administration in aging.
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Affiliation(s)
- John J Guers
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - Rhonda D Prisby
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - David G Edwards
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - Shannon Lennon-Edwards
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
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17
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Martens CR, Kirkman DL, Edwards DG. The Vascular Endothelium in Chronic Kidney Disease: A Novel Target for Aerobic Exercise. Exerc Sport Sci Rev 2016; 44:12-9. [PMID: 26509484 DOI: 10.1249/jes.0000000000000065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endothelial dysfunction occurs in chronic kidney disease (CKD) and increases the risk for cardiovascular disease. The mechanisms of endothelial dysfunction seem to evolve throughout kidney disease progression, culminating in reduced L-arginine transport and impaired nitric oxide bioavailability in advanced disease. This review examines the hypothesis that aerobic exercise may reverse endothelial dysfunction by improving endothelial cell L-arginine uptake in CKD.
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Affiliation(s)
- Christopher R Martens
- 1Department of Integrative Physiology, University of Colorado, Boulder, CO; and 2Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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18
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Rodríguez-Núñez I, Romero F, Saavedra MJ. [Exercise-induced shear stress: Physiological basis and clinical impact]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:244-54. [PMID: 27118039 DOI: 10.1016/j.acmx.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/10/2016] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
The physiological regulation of vascular function is essential for cardiovascular health and depends on adequate control of molecular mechanisms triggered by endothelial cells in response to mechanical and chemical stimuli induced by blood flow. Endothelial dysfunction is one of the major risk factors for cardiovascular disease, where an imbalance between synthesis of vasodilator and vasoconstrictor molecules is one of its main mechanisms. In this context, the shear stress is one of the most important mechanical stimuli to improve vascular function, due to endothelial mechanotransduction, triggered by stimulation of various endothelial mechanosensors, induce signaling pathways culminating in increased bioavailability of vasodilators molecules such as nitric oxide, that finally trigger the angiogenic mechanisms. These mechanisms allow providing the physiological basis for the effects of exercise on vascular health. In this review it is discussed the molecular mechanisms involved in the vascular response induced by shear stress and its impact in reversing vascular injury associated with the most prevalent cardiovascular disease in our population.
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Affiliation(s)
- Iván Rodríguez-Núñez
- Laboratorio de Biología del Ejercicio, Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile; Carrera de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Concepción, Chile; Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de la Frontera. Laboratorio de Neurociencia y Biología de péptidos CEBIOR-CEGIN BIOREN, Depto. Ciencias Preclínicas, Facultad Medicina, UFRO, Temuco, Chile; Programa de Magíster en Kinesiología Cardiorrespiratoria, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile.
| | - Fernando Romero
- Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de la Frontera. Laboratorio de Neurociencia y Biología de péptidos CEBIOR-CEGIN BIOREN, Depto. Ciencias Preclínicas, Facultad Medicina, UFRO, Temuco, Chile
| | - María Javiera Saavedra
- Programa de Magíster en Kinesiología Cardiorrespiratoria, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
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