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Bouazza A, Tahar A, AitAbderrhmane S, Saidani M, Koceir EA. Modulation of cardiometabolic risk and CardioRenal syndrome by oral vitamin D 3 supplementation in Black and White Southern Sahara residents with chronic kidney disease Stage 3: focus on racial and ethnic disparities. Ren Fail 2022; 44:1243-1262. [PMID: 35930297 PMCID: PMC9359195 DOI: 10.1080/0886022x.2022.2106244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Several studies have shown that cholecalciferol supplementation (25OHD-S) in chronic kidney disease (CKD) improves kidney injury by reducing fibrosis-related vascular calcification and declining apoptosis-linked nephron damage. METHODS The oral 25OHD-S was evaluated in 60,000 IU/month/36 weeks versus in 2000 IU/d/24 weeks in CKD Stage 3 with serum 25OHD level < 20 ng/mL. The study was undertaken on 156 black subjects and 150 white subjects Southern Sahara (SS). All biomarkers of cardiometabolic (CMet) and cardiorenal (CRenal) syndrome, Renin-angiotensin-aldosterone system (RAAS) profile, secondary hyperparathyroidism (SHPT), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin T (cTnT) and atherogenicity risk were assessed by biochemical methods. Estimate glomerular filtration rate (eGFR) by chronic CKD-EPI equation formula. Total serum vitamin D by liquid chromatography-tandem mass spectrometry (MS). RESULTS Vitamin D deficiency alters in the same manner CMet, CRenal, and others biomarkers in both groups SS; however, these disorders are more acute in blacks compared to whites SS. Oral 25OHD-S a highlighted improvement of eGFR drop, SHPT decrease, decline proteinuria, and cardiac failure risk (NT-proBNP and cTnT) attenuation. Concomitantly, 25OHD-S normalizes Renin, Aldosterone, and Angiotensin System (RAAS) activity. Nevertheless, homocysteine and Lp (a) do not modulate by 25OHD-S. CONCLUSIONS The oral vitamin D3 supplementation, according the dose, and the treatment duration does not like in black-skinned people versus to white-skinned inhabitants, while the 02 groups are native to the same Saharan environment. It emerge that a high intermittent dose through an extensive supplementation (60,000 IU/36 weeks) was more effective in black subjects. At opposite, a lower dose during a short period supplementation is sufficient (2000 IU/24 weeks) in white subjects.
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Affiliation(s)
- Asma Bouazza
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
| | - Amina Tahar
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
| | | | - Messaoud Saidani
- Clinical Nephrology Exploration Unit, Dialysis and Kidney Transplantation Unit, University Hospital Center of Beni Messous, Algiers, Algeria
| | - Elhadj-Ahmed Koceir
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
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Yunzhi C, Jiaxu C, Jie G, Yihui C, Wen L, Zhong Q. EFFECT OF ASTRAGALOSIDE ON VITAMIN D-RECEPTOR EXPRESSION AFTER ENDOTHELIN-1-INDUCED CARDIOMYOCYTE INJURY. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017. [PMID: 28638891 PMCID: PMC5471476 DOI: 10.21010/ajtcam.v14i4.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Astragaloside, which is one of the main components of Astragalus membranaceus, has been widely used in the treatment of congestive heart failure in China, and it can protect cardiomyocytes. Its mechanism of action remains unclear. Therefore, the present study was carried out to investigate the influence of astragaloside on rat cardiomyocytes stimulated with endothelin-1 (ET-1), and explored the underlying mechanism. MATERIALS AND METHODS ET-1 was used to stimulate primary rat cardiomyocytes and establish a cardiomyocyte hypertrophy model. Different astragaloside doses were administered in combination with ET-1. Cardiomyocyte hypertrophy and apoptosis were examined using transmission electron microscopy (TEM) and flow cytometry, respectively. The molecular mechanism was explored by analyzing the mRNA of the vitamin D receptor (VDR), cytochrome P450 family 27 subfamily B member 1(CYP27B), cytochrome P450 family 24 subfamily A member 1(CYP24A) and renin mRNA levels by quantificational real-time polymerase chain reaction(qRT-PCR). RESULTS Rat cardiomyocyte hypertrophy model was established successfully. Astragaloside administration significantly affected cell apoptosis and significantly inhibited ET-1-induced cardiomyocyte hypertrophy in a dose-dependent manner. Astragaloside treatment affected the expression of signaling molecules in the vitamin D axis. CONCLUSION Astragaloside inhibits ET-1-induced cardiomyocyte hypertrophy. This effect can be reversed by regulating the levels of the relevant factors in the vitamin D axis.
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Affiliation(s)
- Chen Yunzhi
- School of Preclinical Medicine, Beijing University of Chinese Medicine, No. 11, Beisanhuan Donglu, Chaoyang, Beijing, China 100029.,School of Preclinical Medicine, Guiyang University of Chinese Medicine, No.50, Shidonglu, Guiyang, Guizhou, China 55000
| | - Chen Jiaxu
- School of Preclinical Medicine, Beijing University of Chinese Medicine, No. 11, Beisanhuan Donglu, Chaoyang, Beijing, China 100029
| | - Gao Jie
- School of Preclinical Medicine, Guiyang University of Chinese Medicine, No.50, Shidonglu, Guiyang, Guizhou, China 55000
| | - Chai Yihui
- School of Preclinical Medicine, Guiyang University of Chinese Medicine, No.50, Shidonglu, Guiyang, Guizhou, China 55000
| | - Li Wen
- School of Preclinical Medicine, Guiyang University of Chinese Medicine, No.50, Shidonglu, Guiyang, Guizhou, China 55000
| | - Qin Zhong
- School of Preclinical Medicine, Guiyang University of Chinese Medicine, No.50, Shidonglu, Guiyang, Guizhou, China 55000
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Gallone G, Haerty W, Disanto G, Ramagopalan SV, Ponting CP, Berlanga-Taylor AJ. Identification of genetic variants affecting vitamin D receptor binding and associations with autoimmune disease. Hum Mol Genet 2017; 26:2164-2176. [PMID: 28335003 PMCID: PMC5886188 DOI: 10.1093/hmg/ddx092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 01/24/2023] Open
Abstract
Large numbers of statistically significant associations between sentinel SNPs and case-control status have been replicated by genome-wide association studies. Nevertheless, few underlying molecular mechanisms of complex disease are currently known. We investigated whether variation in binding of a transcription factor, the vitamin D receptor (VDR), whose activating ligand vitamin D has been proposed as a modifiable factor in multiple disorders, could explain any of these associations. VDR modifies gene expression by binding DNA as a heterodimer with the Retinoid X receptor (RXR). We identified 43,332 genetic variants significantly associated with altered VDR binding affinity (VDR-BVs) using a high-resolution (ChIP-exo) genome-wide analysis of 27 HapMap lymphoblastoid cell lines. VDR-BVs are enriched in consensus RXR::VDR binding motifs, yet most fell outside of these motifs, implying that genetic variation often affects the binding affinity only indirectly. Finally, we compared 341 VDR-BVs replicating by position in multiple individuals against background sets of variants lying within VDR-binding regions that had been matched in allele frequency and were independent with respect to linkage disequilibrium. In this stringent test, these replicated VDR-BVs were significantly (q < 0.1) and substantially (>2-fold) enriched in genomic intervals associated with autoimmune and other diseases, including inflammatory bowel disease, Crohn's disease and rheumatoid arthritis. The approach's validity is underscored by RXR::VDR motif sequence being predictive of binding strength and being evolutionarily constrained. Our findings are consistent with altered RXR::VDR binding contributing to immunity-related diseases. Replicated VDR-BVs associated with these disorders could represent causal disease risk alleles whose effect may be modifiable by vitamin D levels.
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Affiliation(s)
- Giuseppe Gallone
- MRC Functional Genomics Unit
- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3PT, UK
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Wilfried Haerty
- MRC Functional Genomics Unit
- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3PT, UK
| | - Giulio Disanto
- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3PT, UK
| | | | - Chris P. Ponting
- MRC Functional Genomics Unit
- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3PT, UK
- MRC Human Genetics Unit, The Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Antonio J. Berlanga-Taylor
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7BN, UK
- CGAT, MRC Functional Genomics Unit, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
- MRC-PHE Centre for Environment and Health, Department of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK
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Andersen LB, Przybyl L, Haase N, von Versen-Höynck F, Qadri F, Jørgensen JS, Sorensen GL, Fruekilde P, Poglitsch M, Szijarto I, Gollasch M, Peters J, Muller DN, Christesen HT, Dechend R. Vitamin D depletion aggravates hypertension and target-organ damage. J Am Heart Assoc 2015; 4:jah3789. [PMID: 25630909 PMCID: PMC4345870 DOI: 10.1161/jaha.114.001417] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background We tested the controversial hypothesis that vitamin D depletion aggravates hypertension and target‐organ damage by influencing renin. Methods and Results Four‐week‐old double‐transgenic rats (dTGR) with excess angiotensin (Ang) II production due to overexpression of the human renin (hREN) and angiotensinogen (hAGT) genes received vitamin D‐depleted (n=18) or standard chow (n=15) for 3 weeks. The depleted group had very low serum 25‐hydroxyvitamin D levels (mean±SEM; 3.8±0.29 versus 40.6±1.19 nmol/L) and had higher mean systolic BP at week 5 (158±3.5 versus 134.6±3.7 mm Hg, P<0.001), week 6 (176.6±3.3 versus 162.3±3.8 mm Hg, P<0.01), and week 7 (171.6±5.1 versus 155.9±4.3 mm Hg, P<0.05). Vitamin D depletion led to increased relative heart weights and increased serum creatinine concentrations. Furthermore, the mRNAs of natriuretic peptides, neutrophil gelatinase‐associated lipocalin, hREN, and rRen were increased by vitamin D depletion. Regulatory T cells in the spleen and in the circulation were not affected. Ang metabolites, including Ang II and the counter‐regulatory breakdown product Ang 1 to 7, were significantly up‐regulated in the vitamin D‐depleted groups, while ACE‐1 and ACE‐2 activities were not affected. Conclusions Short‐term severe vitamin D depletion aggravated hypertension and target‐organ damage in dTGR. Our data suggest that even short‐term severe vitamin D deficiency may directly promote hypertension and impacts on renin‐angiotensin system components that could contribute to target‐organ damage. The findings add to the evidence that vitamin D deficiency could also affect human hypertension.
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Affiliation(s)
- Louise Bjørkholt Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark (L.B.A., H.T.C.) Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (L.B.A., J.S., H.T.C.)
| | - Lukasz Przybyl
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.)
| | - Nadine Haase
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.)
| | | | - Fatimunnisa Qadri
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.)
| | - Jan Stener Jørgensen
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark (J.S.) Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (L.B.A., J.S., H.T.C.)
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark (G.L.S.)
| | - Palle Fruekilde
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark (P.F.)
| | | | - István Szijarto
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.) Max-Delbruck Center for Molecular Medicine, Berlin, Germany (I.S., M.G., D.N.M.)
| | - Maik Gollasch
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.) Max-Delbruck Center for Molecular Medicine, Berlin, Germany (I.S., M.G., D.N.M.)
| | - Joerg Peters
- Institute of Physiology, University Medicine Greifswald, Germany (J.P.)
| | - Dominik N Muller
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.) Max-Delbruck Center for Molecular Medicine, Berlin, Germany (I.S., M.G., D.N.M.)
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark (L.B.A., H.T.C.) Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (L.B.A., J.S., H.T.C.)
| | - Ralf Dechend
- Experimental and Clinical Research Center, a joint cooperation between the Max-Delbruck Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (L.P., N.H., F.Q., I.S., M.G., D.N.M., R.D.) HELIOS-Klinikum Berlin, Berlin, Germany (R.D.)
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Wesseling-Perry K, Salusky IB. Phosphate binders, vitamin D and calcimimetics in the management of chronic kidney disease-mineral bone disorders (CKD-MBD) in children. Pediatr Nephrol 2013; 28:617-25. [PMID: 23381010 PMCID: PMC3804000 DOI: 10.1007/s00467-012-2381-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 11/21/2012] [Accepted: 11/26/2012] [Indexed: 12/27/2022]
Abstract
In order to minimize complications on the skeleton and to prevent extraskeletal calcifications, the specific aims of the management of chronic kidney disease mineral and bone disorder (CKD-MBD) are to maintain blood levels of serum calcium and phosphorus as close to the normal range as possible, thereby maintaining serum parathyroid hormone (PTH) at levels appropriate for CKD stage, preventing hyperplasia of the parathyroid glands, avoiding the development of extra-skeletal calcifications, and preventing or reversing the accumulation of toxic substances such as aluminum and β2-microglobulin. In order to limit cardiovascular calcification, daily intake of elemental calcium, including from dietary sources and from phosphate binders, should not exceed twice the daily recommended intake for age and should not exceed 2.5 g/day. Calcium-free phosphate binders, such as sevelamer hydrochloride and sevelamer carbonate, are safe and effective alternatives to calcium-based binders, and their use widens the margin of safety for active vitamin D sterol therapy. Vitamin D deficiency is highly prevalent across the spectrum of CKD, and replacement therapy is recommended in vitamin D-deficient and insufficient individuals. Therapy with active vitamin D sterols is recommended after correction of the vitamin D deficiency state and should be titrated based on target PTH levels across the spectrum of CKD. Although the use of calcimimetic drugs has been proven to effectively control the biochemical features of secondary hyperparathyroidism, there is very limited experience with the use of such agents in pediatric patients and especially during the first years of life. Studies are needed to further define the role of such agents in the treatment of pediatric CKD-MBD.
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Glenn ST, Jones CA, Gross KW, Pan L. Control of renin [corrected] gene expression. Pflugers Arch 2012; 465:13-21. [PMID: 22576577 DOI: 10.1007/s00424-012-1110-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
Renin, as part of the renin-angiotensin system, plays a critical role in the regulation of blood pressure, electrolyte homeostasis, mammalian renal development, and progression of fibrotic/hypertrophic diseases. Renin gene transcription is subject to complex developmental and tissue-specific regulation. Initial studies using the mouse As4.1 cell line, which has many characteristics of the renin-expressing juxtaglomerular cells of the kidney, have identified a proximal promoter region (-197 to -50 bp) and an enhancer (-2,866 to -2,625 bp) upstream of the Ren-1(c) gene, which are critical for renin gene expression. The proximal promoter region contains several transcription factor binding sites including a binding site for the products of the developmental control genes Hox. The enhancer consists of at least 11 transcription factor binding sites and is responsive to various signal transduction pathways including cAMP, retinoic acid, endothelin-1, and cytokines, all of which are known to alter renin mRNA levels. Furthermore, in vivo models have validated several of these key components found within the proximal promoter region and the enhancer as well as other key sites necessary for renin gene transcription.
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Affiliation(s)
- Sean T Glenn
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263-0001, USA.
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Keddis MT, Garovic VD, Bailey KR, Wood CM, Raissian Y, Grande JP. Ischaemic nephropathy secondary to atherosclerotic renal artery stenosis: clinical and histopathological correlates. Nephrol Dial Transplant 2010; 25:3615-22. [PMID: 20501460 DOI: 10.1093/ndt/gfq269] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advanced renal artery stenosis (RAS) may cause progressive deterioration in renal function. We correlated the histopathological findings and clinical characteristics in selected patients with atherosclerotic RAS who underwent nephrectomy of their small kidneys for resistant renovascular hypertension. METHODS We studied 62 patients who underwent nephrectomy of a small kidney for uncontrolled hypertension between 1990 and 2000. RESULTS The mean patient age was 65.4 ± 9.6 years; 28 (45%) were men. Significant tubulointerstitial atrophy with relative glomerular sparing was the predominant pattern of injury in 44 (71%) patients. In 14 (23%) patients, diffuse global glomerulosclerosis was present. The severity of tubulointerstitial atrophy and the extent of glomerulosclerosis were both associated with smaller kidney size (P = 0.002). Three patterns of vascular involvement were present: atheroembolic, atherosclerotic and hypertensive vascular changes, which were documented in 39, 98 and 52% of subjects, respectively. The presence and severity of these vascular changes positively correlated with both atherosclerotic risk factors, such as hypertension, dyslipidaemia and renal insufficiency, and cardiovascular morbidity, including abdominal aortic aneurysm and myocardial infarction. Patients on statin therapy were noted to have less evidence of renal fibrosis as measured by transforming growth factor-beta staining (P = 0.003). CONCLUSION The severity of renal histopathological findings in patients who underwent nephrectomy for resistant hypertension correlated with an increased prevalence of cardiovascular disease, a greater degree of renal dysfunction and more severe dyslipidaemia. Statin therapy may affect development of intra-renal injury by slowing the progression of fibrosis.
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Affiliation(s)
- Mira T Keddis
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Is replacement therapy with nutritional and active forms of vitamin D required in chronic kidney disease mineral and bone disorder? Curr Opin Nephrol Hypertens 2009; 18:308-14. [DOI: 10.1097/mnh.0b013e32832c7654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wu-Wong JR. Potential for vitamin D receptor agonists in the treatment of cardiovascular disease. Br J Pharmacol 2009; 158:395-412. [PMID: 19371337 DOI: 10.1111/j.1476-5381.2009.00171.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vitamin D(3) is made in the skin and modified in the liver and kidney to form the active metabolite, 1,25-dihydroxyvitamin D(3) (calcitriol). Calcitriol binds to a nuclear receptor, the vitamin D receptor (VDR), and activates VDR to recruit cofactors to form a transcriptional complex that binds to vitamin D response elements in the promoter region of target genes. During the past three decades the field has focused mainly on the role of VDR in the regulation of parathyroid hormone, intestinal calcium/phosphate absorption and bone metabolism; several VDR agonists (VDRAs) have been developed for the treatment of osteoporosis, psoriasis and hyperparathyroidism secondary to chronic kidney disease (CKD). Emerging evidence suggests that VDR plays important roles in modulating cardiovascular, immunological, metabolic and other functions. For example, data from epidemiological, preclinical and clinical studies have shown that vitamin D and/or 25(OH)D deficiency is associated with increased risk for cardiovascular disease (CVD). However, VDRA therapy seems more effective than native vitamin D supplementation in modulating CVD risk factors. In CKD, where decreasing VDR activation persists over the course of the disease and a majority of the patients die of CVD, VDRA therapy was found to provide a survival benefit in both pre-dialysis and dialysis CKD patients. Although VDR plays an important role in regulating cardiovascular function and VDRAs may be potentially useful for treating CVD, at present no VDRA is approved for CVD, and also no serum markers, beside parathyroid hormone in CKD, exist to indicate the efficacy of VDRA in CVD.
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Szeto CC, Li PKT. The use of vitamin D analogues in chronic kidney diseases: possible mechanisms beyond bone and mineral metabolism. NDT Plus 2009; 2:205-12. [PMID: 25983993 PMCID: PMC4421197 DOI: 10.1093/ndtplus/sfp034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 03/03/2009] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) is a common and costly medical condition, and currently available therapeutic options remain unsatisfactory. Vitamin D analogues are widely used for the bone and mineral disorder associated with CKD. However, accumulating evidence suggests that vitamin D analogues may have actions other than their effects on bone and mineral metabolism. In this article, we review the following aspects on the use of vitamin D analogues for the treatment of CKD: (1) epidemiological studies showing that patients with late-stage CKD have better survival than untreated patients; (2) animal studies showing that vitamin D analogues may retard the progression of CKD; (3) human studies on the anti-proteinuric and possibly renal protecting effects of vitamin D analogues in CKD and (4) the potential mechanisms of its therapeutic benefit. Nonetheless, definitive proof of the clinical benefits by randomized control trial would be necessary before one could advocate the routine use of vitamin D analogues for the treatment of CKD patients.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, Hong Kong , China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, Hong Kong , China
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How PP, Mason DL, Lau AH. Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder. J Pharm Pract 2008. [DOI: 10.1177/0897190008315905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with chronic kidney disease (CKD) develop mineral and bone disorder (MBD), a common and important complication, as a result of impaired phosphorus excretion and reduced vitamin D activation. Altered mineral metabolism is now recognized as an independent cardiovascular risk factor in end-stage renal disease patients and contributes to the risk for accelerating vascular calcification. CKD patients are at high risk for cardiovascular disease and vascular calcification which account for the high morbidity and mortality in this patient population. Pharmacotherapeutic interventions are necessary to manage and treat the condition. Multiple classes of agents including phosphorus binders, vitamin D analogs, and calcimimetics are now available to treat CKD-MBD. Recent data have shown that treatment with sevelamer and vitamin D analogs are associated with a reduction in calcification and cardiovascular mortality and improved survival. This article provides an overview of the strategies and considerations for the management of CKD-MBD, as well as their implications on clinical outcomes.
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Affiliation(s)
- Priscilla P. How
- College of Pharmacy, Department of Pharmacy Practice, University of Illinois at Chicago, Illinois
| | - Darius L. Mason
- College of Pharmacy, Department of Pharmacy Practice, University of Illinois at Chicago, Illinois
| | - Alan H. Lau
- College of Pharmacy, Department of Pharmacy Practice, University of Illinois at Chicago, Illinois,
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Wu-Wong JR, Nakane M, Ma J, Ruan X, Kroeger PE. Elevated phosphorus modulates vitamin D receptor-mediated gene expression in human vascular smooth muscle cells. Am J Physiol Renal Physiol 2007; 293:F1592-604. [PMID: 17715259 DOI: 10.1152/ajprenal.00492.2006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Clinical observations show that an increase in serum inorganic phosphorus (Pi) is linked to higher cardiovascular (CV) mortality, while vitamin D receptor (VDR) agonist therapy is associated with survival benefit in stage 5 chronic kidney disease. Smooth muscle cells (SMCs) play an important role in CV pathophysiology, but the interaction between Pi and the VDR signaling pathway in SMCs is not known. Real-time RT-PCR studies revealed that elevated Pi (2.06 mM) modulated VDR-mediated regulation of a panel of genes including thrombomodulin and osteopontin in SMCs. DNA microarray results demonstrated that increasing Pi from 0.9 to 2.06 mM exerted a widespread modulating effect on VDR-mediated gene expression. A total of 325 target genes were affected by paricalcitol at 0.9 mM Pi, with 195 up- and 130 downregulated. The number of target genes affected by paricalcitol at 2.06 mM Pi decreased to 86, with 55 up- and 31 downregulated. VDR-mediated gene expression in As4.1 cells (a juxtaglomerular cell-like cell line derived from kidney tumors in SV40 T-antigen transgenic mice) and peroxisome proliferator-activated receptor (PPAR)gamma-mediated gene expression in SMCs were also altered by elevated Pi, suggesting that the observation is not unique to VDR in SMCs. Mechanism analysis showed that elevated Pi had no significant effect on VDR or PPARgamma protein level but altered the cytosolic vs. nuclear distribution of NF-kappaB or nuclear receptor corepressor 1 (NCoR1). Our results demonstrate for the first time that elevated Pi affects VDR-mediated gene expression in human coronary artery SMCs and the effect is not limited to VDR in SMCs.
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