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Cerqueira A, Quelhas-Santos J, Sampaio S, Ferreira I, Relvas M, Marques N, Dias CC, Pestana M. Endothelial Dysfunction Is Associated with Cerebrovascular Events in Pre-Dialysis CKD Patients: A Prospective Study. Life (Basel) 2021; 11:life11020128. [PMID: 33562195 PMCID: PMC7915587 DOI: 10.3390/life11020128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = −0.469, p < 0.0001), Charlson index (r = −0.399, p < 0.0001), systolic blood pressure (r = −0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (β = −0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.
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Affiliation(s)
- Ana Cerqueira
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
- Correspondence: ; Tel.: +351-22-5512100; Fax: +351-22-5512228
| | | | - Susana Sampaio
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
| | - Inês Ferreira
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
| | - Miguel Relvas
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
| | - Nídia Marques
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
| | - Cláudia Camila Dias
- Department of Community Medicine Health Information and Decision, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal;
- CINTESIS–Center for Health Technology and Services Research, 4200-250 Porto, Portugal
| | - Manuel Pestana
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
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Altunoren O, Kerkutluoglu M, Sarısık FN, Akkus G, Seyithanoglu M, Doganer A, Tutuncu Sezal D, Cagrı Aykan A, Eren N, Erken E, Gungor O. Can vasohibin-1, an endothelium-derived angiogenesis inhibitor, be a marker of endothelial dysfunction in hemodialysis patients? Semin Dial 2020; 33:418-427. [PMID: 32686227 DOI: 10.1111/sdi.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endothelial dysfunction (ED) is associated with high cardiovascular disease burden in hemodialysis (HD) patients. Vasohibin-1, an endothelium-derived angiogenesis inhibitor, is essential for endothelial cell survival, therefore it may be a promising marker of ED. We aimed to investigate whether vasohibin-1 levels are associated with ED markers in HD patients. METHODS Fifty HD patients and 30 healthy controls were included in the study. As markers of ED, endothelium-dependent flow-mediated dilatation (FMD), carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) were examined. Serum vasohibin-1 levels were measured with ELISA. RESULTS Serum vasohibin-1 levels were low (387.7 ± 115.7 vs 450.1 ± 140.1 P = .02), FMDs' were impaired (6.65 ± 2.50 vs 10.95 ± 2.86 P < .001), PWV (7.92 ± 1.964 vs 6.79 ± 0.96 P = .01) and CIMT (0.95 ± 0.20 vs 0.60 ± 0.11 P < .001) were increased in HD patients compared to healthy controls. In regression analysis, vasohibin-1 levels were not related with FMD, PWV, or CIMT. CONCLUSIONS Hemodialysis patients have low serum vasohibin-1 levels but serum levels of vasohibin-1 did not show any significant relationship with FMD, PWV, and CIMT in HD patients. Since vasohibin-1 acts via paracrine pathways, serum levels may be insufficient to explain the relationship between vasohibin and ED. Local vasohibin-1 activity on tissue level may be more important instead of circulating levels.
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Affiliation(s)
- Orcun Altunoren
- Nephrology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Murat Kerkutluoglu
- Cardiology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Feyza Nur Sarısık
- Internal Medicine Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Gulsum Akkus
- Internal Medicine Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Muhammed Seyithanoglu
- Biochemistry Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Adem Doganer
- Biostatistic Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Didem Tutuncu Sezal
- Internal Medicine Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ahmet Cagrı Aykan
- Cardiology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Necmi Eren
- Nephrology Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ertugrul Erken
- Nephrology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ozkan Gungor
- Nephrology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Wang L, Huang X, He W, Liu W, Yang J. Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease. BMC Nephrol 2019; 20:288. [PMID: 31362711 PMCID: PMC6668185 DOI: 10.1186/s12882-019-1484-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background The reactive hyperemia index (RHI), measured by peripheral arterial tonometry (PAT), is a novel measurement of endothelial function and has been proven to be valuable in cardiovascular risk stratification in several populations. The current study aims to explore its relation to renal function and its association with traditional cardiovascular risk factors in patients with chronic kidney disease (CKD). Methods Subjects with non-dialysis dependent CKD were recruited and 252 of them had a successful PAT test. In addition to general demographic and medical information, carotid-femoral pulse wave velocity (cfPWV), carotid-radial pulse wave velocity (crPWV) and augmentation index (AIx) were recorded. Results The mean age of the study population was 57.7 (±14.7) years and 155 (61.5%) were males. The average RHI was 1.92 (±14.7) with no difference noted between males and females. There was no statistically significant correlation between RHI and eGFR (r = − 0.107, p = 0.089) or urine protein-to-creatinine ratio (r = 0.036, p = 0.570). With adjustment for age and sex, RHI was associated with systolic blood pressure (BP) (β = 0.006, p = 0.001), diastolic BP (β = 0.008, p = 0.010), heart rate (β = − 0.007, p = 0.015) crPWV (β = 0.037, p = 0.022) and AIx (β = 0.006, p = 0.001), but not with cfPWV or any other conventional risk factors analyzed. Systolic BP remained the only predictor for RHI in the stepwise regression analysis. Conclusions RHI did not decline with reduced renal function in CKD patients and had a modest association with traditional cardiovascular risk factors. Further studies are warranted to determine if RHI could predict cardiovascular outcome in CKD patients.
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Affiliation(s)
- Lulu Wang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Xiaoqin Huang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Weichun He
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Wenjin Liu
- Department of Radiology, University of Washington, 850 Republican Street, Seattle, 98109, USA.
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China.
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Makimoto H, Shimizu K, Fujiu K, Lin T, Oshima T, Amiya E, Yamagata K, Kojima T, Daimon M, Nagatomo R, Waki K, Meyer C, Komuro I. Effect of Sympatholytic Therapy on Circadian Cardiac Autonomic Activity in Non-Diabetic Chronic Kidney Disease. Int Heart J 2018; 59:1352-1358. [PMID: 30369564 DOI: 10.1536/ihj.17-561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although beta-blockade itself is not a first choice for chronic kidney disease (CKD) patients, alpha-beta-blockers (ABB) do improve their prognoses. This study's aim was to evaluate the effect of beta-selective-blockers (BSB) and ABB on circadian cardiac autonomic activity in CKD patients.The study consisted of 496 non-diabetic individuals who underwent 24-hour Holter monitoring (149 CKD patients and 347 controls without CKD). Using heart rate variability analysis, we evaluated the proportion of NN50 and the high-frequency component (reflecting parasympathetic activity), and low- to high-frequency ratio (reflecting sympathovagal balance). These indices were evaluated by regression analysis incorporating gender, age, related comorbidities, and medications. BSB increased vagal activity only in the day-time and not the night-time in controls. In CKD patients, BSB was significantly related to higher vagal activity throughout the day and with lower sympathovagal balance at night. The night sympathovagal balance of CKD patients taking ABB was significantly higher than that of CKD patients taking BSB, which was the only significant difference between the effects of BSB and ABB.The sympatholytic therapy effect is different depending on CKD presence and whether patients are treated with BSB or ABB. In CKD patients without severe heart failure, BSB could be associated with higher parasympathetic activity and lower sympathovagal balance compared to ABB.
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Affiliation(s)
- Hisaki Makimoto
- Department of Cardiovascular Medicine, The University of Tokyo Hospital.,Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf
| | - Kohei Shimizu
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital.,Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | | | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Ritsuko Nagatomo
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Kayo Waki
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Christian Meyer
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
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Liu CY, Zhao ZH, Chen ZT, Che CH, Zou ZY, Wu XM, Chen SG, Li YX, Lin HB, Wei XF, You J, Huang HP. DL-3-n-butylphthalide protects endothelial cells against advanced glycation end product-induced injury by attenuating oxidative stress and inflammation responses. Exp Ther Med 2017; 14:2241-2248. [PMID: 28962149 DOI: 10.3892/etm.2017.4784] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
Endothelial dysfunction, regarded as a key step in the pathophysiological course of diabetic vascular complications, is initiated and deteriorated by advanced glycation end products (AGEs). DL-3-n-butylphthalide (DL-NBP) has been proven to have protective effects on neurons and vascular endothelial cells against ischemic and anoxic damage. The aim of the present study was to investigate whether NBP is able to attenuate AGE-induced endothelial dysfunction in vitro, and also elucidate the possible underlying mechanism. An injury model of human umbilical vein endothelial cells (HUVECs) induced by AGEs (200 µg/ml) was established. The results demonstrated that pretreatment with NBP (1-100 µM) significantly increased HUVEC viability and inhibited the apoptosis induced by AGEs. In addition, AGEs stimulated the expression levels of the receptor for AGEs protein and the downstream protein nuclear factor-κB in HUVECs, which were inhibited by pretreatment with NBP. Furthermore, it significantly reduced reactive oxygen species generation and the level of the inflammatory cytokines, intercellular cell adhesion molecule-1 and monocyte chemotactic protein-1, in HUVECs mediated by AGEs. The current findings indicated that NBP attenuated AGE-induced endothelial dysfunction by ameliorating inflammation and oxidative stress responses.
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Affiliation(s)
- Chang-Yun Liu
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Zhen-Hua Zhao
- Department of Neurology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Zhi-Ting Chen
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Chun-Hui Che
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Zhang-Yu Zou
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Xiao-Min Wu
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Sheng-Gen Chen
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Yuan-Xiao Li
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Han-Bin Lin
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Xiao-Fan Wei
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Jie You
- Department of Endocrinology, Union Hospital, Fujian Medical University, Fujian Endocrinology Institute, Fuzhou, Fujian 350001, P.R. China
| | - Hua-Pin Huang
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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Association between serum γ-glutamyltransferase and chronic kidney disease in urban Han Chinese: a prospective cohort study. Int Urol Nephrol 2016; 49:303-312. [DOI: 10.1007/s11255-016-1429-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
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Evaluation of assays for measurement of serum (anti)oxidants in hemodialysis patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:843157. [PMID: 24982909 PMCID: PMC4055181 DOI: 10.1155/2014/843157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/24/2014] [Accepted: 05/05/2014] [Indexed: 01/17/2023]
Abstract
Background. Various biomarkers and assays have been used for assessment of (anti)oxidant status in hemodialysis patients, including those intended for measurement of serum total (anti)oxidants, most often as a part of panel biomarkers. Methods. Serum (anti)oxidant status was measured in 32 chronically hemodialyzed patients and in 47 healthy persons, using two oxidations and three antioxidant assays. Results. The patients before the hemodialysis session have had higher values of total oxidants in comparison to the healthy persons, with a further increase during the hemodialysis. These findings were confirmed with both oxidation assays, but they differ in the percentage of increase and the statistical significance. All three antioxidant assays showed significantly higher values of the total serum antioxidants in the patients before the hemodialysis session in comparison to the healthy persons, and their significant decrease during the hemodialysis. However, the assays differ in the percentage of decrease, its statistical significance, and the correlations with uric acid. Conclusion. The variability of results of total (anti)oxidants which are obtained using different assays should be taken into account when interpreting data from clinical studies of oxidative stress, especially in complex pathologies such as chronic hemodialysis.
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Feng L, Zhu M, Zhang M, Jia X, Cheng X, Ding S, Zhu Q. Amelioration of compound 4,4'-diphenylmethane-bis(methyl)carbamate on high mobility group box1-mediated inflammation and oxidant stress responses in human umbilical vein endothelial cells via RAGE/ERK1/2/NF-κB pathway. Int Immunopharmacol 2012; 15:206-16. [PMID: 23219582 DOI: 10.1016/j.intimp.2012.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/22/2012] [Accepted: 11/23/2012] [Indexed: 01/25/2023]
Abstract
High mobility group box-1 (HMGB1), a secreted nuclear protein, acts as an inflammatory mediator and has been implicated in pathophysiological damage of diabetic vascular complications. A compound 4,4'-diphenylmethane-bis(methyl) carbamate (CM1) has a protective activity on advanced glycation end products (AGEs)-induced endothelial dysfunction in our previous study. The aim of this study was to investigate whether CM1 could attenuate HMGB1-induced endothelial dysfunction in human umbilical vein endothelial cells (HUVECs), and also elucidate the possible underlying mechanism. The pre-treatment of CM1 (10(-9)M) could inhibit significantly the migration of macrophages in co-incubation with HUVECs system. HMGB1 stimulated intercellular adhesion molecule-1 (ICAM-1), transforming growth factor-beta1 (TGF-β1) and receptor for advanced glycation end products (RAGE) protein expression in HUVECs, which were inhibited by pretreatment with CM1. Furthermore, it also reduced significantly reactive oxygen species (ROS) generation and inflammatory cytokine interleukin-6 (IL-6) level in co-incubation system. Immunofluorescence and Western blotting assays showed that CM1 could attenuate HMGB1-induced intracellular ERK1/2 and NF-kB activation in HUVECs. Our findings indicated that CM1 attenuated HMGB1-mediated endothelial activation by ameliorating inflammation and oxidant stress responses via RAGE/ERK1/2/NF-κB pathway.
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Affiliation(s)
- Liang Feng
- Key Laboratory of Delivery Systems of Chinese Materia Medica, Jiangsu Provincial Academy of Chinese Medicine, Jiangsu, Nanjing, 210028, China.
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Nerpin E, Ingelsson E, Risérus U, Helmersson-Karlqvist J, Sundström J, Jobs E, Larsson A, Lind L, Ärnlöv J. Association between glomerular filtration rate and endothelial function in an elderly community cohort. Atherosclerosis 2012; 224:242-6. [PMID: 22841608 DOI: 10.1016/j.atherosclerosis.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/05/2012] [Accepted: 07/01/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endothelial dysfunction is prevalent among individuals with chronic kidney disease. However, the association between glomerular filtration rate and endothelial function in the community is unclear and needs to be investigated in the general population. METHODS In the community-based Prospective Investigation of the Vasculature of Uppsala Seniors study (PIVUS, n = 952, mean age 70, women 49.3%), we investigated cross-sectional associations between estimated cystatin C-based glomerular filtration rate (eGFR), and 3 measures representing different aspects of endothelial function (endothelial-dependent vasodilation [EDV], endothelial independent vasodilatation [EIDV], and flow-mediated dilatation [FMD]). We also performed pre-specified sub-group analyses in participants with normal eGFR (>60 ml/min/1.73 m(2)). RESULTS In the whole cohort, 10 ml/min/1.73 m(2) higher eGFR was associated with 3% higher EDV (p = 0.001) and 2% higher EIDV (p = 0.007), adjusted for age and sex. The associations were attenuated and no longer statistically significant after adjusting for established cardiovascular risk factors. In participants with eGFR >60 ml/min/1.73 m(2), 10 ml higher eGFR was associated with 2% higher EDV (p = 0.04) after adjusting for sex and age. eGFR was not associated to FMD in any model or sub-sample. CONCLUSION This community-based study suggests that eGFR is associated with endothelial function also in persons with normal kidney function, but that this association is largely explained by confounding by established cardiovascular risk factors. Thus, our data do not support the notion of a direct causal interplay between renal and vascular function prior to the development of CKD.
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Affiliation(s)
- Elisabet Nerpin
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
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