Does Renal Function Influence Plasma Levels of Advanced Glycation and Oxidation Protein Products in Patients with Chronic Rheumatic Diseases Complicated by Secondary Amyloidosis?

The Relationship between Advanced Oxidation Protein Products, Vascular Calcifications and Arterial Stiffness in Predialysis Chronic Kidney Disease Patients

Background and Objectives: Cardiovascular morbidity and mortality are increased in patients with chronic kidney disease (CKD). It is likely that the accumulation of uremic toxins resulting in increased oxidative stress (OS) is a major contributing factor, but no clear link has been identified. The purpose of this research is to establish if advanced oxidation protein product (AOPP) levels in the serum of predialysis patients are a contributing factor to vascular calcification and increased arterial stiffness. Materials and Methods: After obtaining the informed consent, 46 predialysis patients (CKD stages G3-G5) were included in the study. In order to identify vascular calcifications, hand and pelvic radiographs were performed. Valvular calcifications were identified using cardiac ultrasound. AOPP were measured using a commercially available ELISA kit. The relationships between serum AOPP values and biochemical parameters relevant in the evaluation of CKD patients were analyzed. In addition to identifying the differences in AOPP levels between patients with/without vascular or valvular calcifications, the research focused on describing the relationship between OS and arterial stiffness assessed by oscillometric pulse-wave velocity (PWV) measurement. Results: No significant relationship between serum AOPP and vascular or valvular calcifications was highlighted, but significant correlations of AOPP with C-reactive protein (p = 0.025), HDL-cholesterol levels (p = 0.04), HbA1c (p = 0.05) and PWV values (p = 0.02) were identified. Conclusions: The usefulness of (OS) measurement in clinical practice remains debatable; however, the relationship between AOPP and arterial stiffness could be valuable in improving cardiovascular risk assessment of patients with CKD.

The Physiopathology of Cardiorenal Syndrome: A Review of the Potential Contributions of Inflammation

Inter-organ crosstalk plays an essential role in the physiological homeostasis of the heart and other organs, and requires a complex interaction between a host of cellular, molecular, and neural factors. Derangements in these interactions can initiate multi-organ dysfunction. This is the case, for instance, in the heart or kidneys where a pathological alteration in one organ can unfavorably affect function in another distant organ; attention is currently being paid to understanding the physiopathological consequences of kidney dysfunction on cardiac performance that lead to cardiorenal syndrome. Different cardiorenal connectors (renin-angiotensin or sympathetic nervous system activation, inflammation, uremia, etc.) and non-traditional risk factors potentially contribute to multi-organ failure. Of these, inflammation may be crucial as inflammatory cells contribute to over-production of eicosanoids and lipid second messengers that activate intracellular signaling pathways involved in pathogenesis. Indeed, inflammation biomarkers are often elevated in patients with cardiac or renal dysfunction. Epigenetics, a dynamic process that regulates gene expression and function, is also recognized as an important player in single-organ disease. Principal epigenetic modifications occur at the level of DNA (i.e., methylation) and histone proteins; aberrant DNA methylation is associated with pathogenesis of organ dysfunction through a number of mechanisms (inflammation, nitric oxide bioavailability, endothelin, etc.). Herein, we focus on the potential contribution of inflammation in pathogenesis of cardiorenal syndrome.

Salivary markers of oxidative stress are related to age and oral health in adult non-smokers

BACKGROUND

Salivary concentrations of thiobarbituric acid-reacting substances (TBARS) are associated with the periodontal status assessed as papillary bleeding index (PBI). Whether this association is age independent is currently unclear. Salivary concentrations of advanced oxidation protein products (AOPPs) and advanced glycation end products (AGEs) have not been assessed in relation to age or oral health yet. The aim of our study was to analyse salivary markers of oxidative stress in dental patients in relation to age, gender and oral health.

METHODS

Consecutive adult non-smoking dental patients were enrolled (n = 204; aged 19-83 years). PBI and the caries index (CI) were assessed. Markers of oxidative stress, such as TBARS, AOPPs and AGEs, and the total antioxidant capacity (TAC) were measured in saliva samples taken before clinical examination.

RESULTS

Linear regression showed that salivary TBARS, AGEs and TAC significantly increase with age (r squared = 5.3%, 2.1% and 5%, respectively). PBI is an independent predictor of salivary TBARS (r squared = 5.5%), and the CI negatively affected AOPPs (r = 3.2%) and positively affected TBARS (r = 2.5%). Gender did not affect any of the analysed parameters.

CONCLUSIONS

Age as a significant contributor to the variance should be taken into account in studies focusing on salivary markers of oxidative stress. The relationship between PBI and salivary TBARS confirms results from previous studies. In addition, our results show that the association is age independent. Negative association between the CI and AOPPs might be related to recent findings that AOPP might be actually a marker of non-enzymatic antioxidant status.

Diagnostic potential of plasma carboxymethyllysine and carboxyethyllysine in multiple sclerosis

BACKGROUND

This study compared the level of advanced glycation end products (AGEs), N-(Carboxymethyl)lysine (CML) and N-(Carboxyethyl)lysine (CEL), in patients with multiple sclerosis (MS) and healthy controls (HCs), correlating these markers with clinical indicators of MS disease severity.

METHODS

CML and CEL plasma levels were analyzed in 99 MS patients and 43 HCs by tandem mass spectrometry (LC/MS/MS). Patients were stratified based on drug modifying therapies (DMTs) including interferon beta, glatiramer acetate and natalizumab.

RESULTS

The level of plasma CEL, but not CML, was significantly higher in DMT-naïve MS patients when compared to HCs (P < 0.001). Among MS patients, 91% had higher than mean plasma CEL observed in HCs. DMTs reduced CML and CEL plasma levels by approximately 13% and 40% respectively. CML and CEL plasma levels correlated with the rate of MS clinical relapse.

CONCLUSION

Our results suggest that AGEs in general and CEL in particular could be useful biomarkers in MS clinical practice. Longitudinal studies are warranted to determine any causal relationship between changes in plasma level of AGEs and MS disease pathology. These studies will pave the way for use of AGE inhibitors and AGE-breaking agents as new therapeutic modalities in MS.

Plasma pentosidine: a potential biomarker in the management of multiple sclerosis

Background: The chronic inflammation associated with multiple sclerosis (MS) may lead to the upregulation of pentosidine.

Objectives: This cross-sectional study compares plasma pentosidine levels among healthy controls (HCs) and patients with MS at different disease stages. The study also determines pentosidine's usefulness as a biomarker of MS disease activity and/or severity via its correlation with a number of indicators of MS disease.

Methods: Pentosidine levels were analyzed in 98 MS patients and 43 HCs using reverse-phase high-pressure liquid chromatography with fluorescence detection.

Results: Plasma pentosidine levels were significantly higher in MS patients when compared with HCs ( p = 0.02). Patients on disease-modifying therapies (DMTs) had lower plasma pentosidine levels when compared with DMT-naïve patients ( p =  0.01). Pentosidine plasma levels correlated with indicators of MS disease severity, including Extended Disability Status Scale ( p = 0.03), MS Severity Scale ( p = 0.01), and MS Functional Composite ( p = 0.03). No correlation between pentosidine levels and age, rate of clinical relapse, and disease duration was observed.

Conclusions: Our results suggest that pentosidine could be a novel, inflammatory biomarker in MS clinical practice. Longitudinal studies are warranted to determine any causal relationship between changes in plasma pentosidine levels and MS disease pathology. These studies may pave the way for use of advanced glycation end product (AGE) inhibitors and AGE-breaking agents as new therapeutic modalities in MS.

Inflammation and cardiovascular events in individuals with and without chronic kidney disease

Inflammation and chronic kidney disease predict cardiovascular events. Here we evaluated markers of inflammation including fibrinogen, albumin and white blood cell count in individuals with and without stages 3-4 chronic kidney disease to assess inflammation as a risk factor for adverse events, the synergy between inflammation and chronic kidney disease, and the prognostic ability of these inflammatory markers relative to that of C-reactive protein. Using Atherosclerosis Risk in Communities and Cardiovascular Health Study data, inflammation was defined by worst quartile of at least 2 of these 3 markers. In Cox regression models, inflammation was assessed as a risk factor for a composite of cardiac events, stroke and mortality as well as components of this composite. Among 20 413 patients, inflammation was identified in 3594 and chronic kidney disease in 1649. In multivariable analyses, both inflammation and chronic kidney disease predicted all outcomes, but their interaction was non-significant. In 5597 patients with C-reactive protein levels, inflammation and elevated C-reactive protein had similar hazard ratios. When focusing only on individuals with the worst quartile of white cell count and albumin, results remained consistent.