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Mavrogeorgis E, Valkenburg S, Siwy J, Latosinska A, Glorieux G, Mischak H, Jankowski J. Integration of Urinary Peptidome and Fecal Microbiome to Explore Patient Clustering in Chronic Kidney Disease. Proteomes 2024; 12:11. [PMID: 38651370 PMCID: PMC11036268 DOI: 10.3390/proteomes12020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Millions of people worldwide currently suffer from chronic kidney disease (CKD), requiring kidney replacement therapy at the end stage. Endeavors to better understand CKD pathophysiology from an omics perspective have revealed major molecular players in several sample sources. Focusing on non-invasive sources, gut microbial communities appear to be disturbed in CKD, while numerous human urinary peptides are also dysregulated. Nevertheless, studies often focus on isolated omics techniques, thus potentially missing the complementary pathophysiological information that multidisciplinary approaches could provide. To this end, human urinary peptidome was analyzed and integrated with clinical and fecal microbiome (16S sequencing) data collected from 110 Non-CKD or CKD individuals (Early, Moderate, or Advanced CKD stage) that were not undergoing dialysis. Participants were visualized in a three-dimensional space using different combinations of clinical and molecular data. The most impactful clinical variables to discriminate patient groups in the reduced dataspace were, among others, serum urea, haemoglobin, total blood protein, urinary albumin, urinary erythrocytes, blood pressure, cholesterol measures, body mass index, Bristol stool score, and smoking; relevant variables were also microbial taxa, including Roseburia, Butyricicoccus, Flavonifractor, Burkholderiales, Holdemania, Synergistaceae, Enterorhabdus, and Senegalimassilia; urinary peptidome fragments were predominantly derived from proteins of collagen origin; among the non-collagen parental proteins were FXYD2, MGP, FGA, APOA1, and CD99. The urinary peptidome appeared to capture substantial variation in the CKD context. Integrating clinical and molecular data contributed to an improved cohort separation compared to clinical data alone, indicating, once again, the added value of this combined information in clinical practice.
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Affiliation(s)
- Emmanouil Mavrogeorgis
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Sophie Valkenburg
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (S.V.); (G.G.)
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Agnieszka Latosinska
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Griet Glorieux
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (S.V.); (G.G.)
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, 52074 Aachen, Germany
- Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, 6229 Maastricht, The Netherlands
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Zwaenepoel B, De Backer T, Glorieux G, Verbeke F. Predictive value of protein-bound uremic toxins for heart failure in patients with chronic kidney disease. ESC Heart Fail 2024; 11:466-474. [PMID: 38041505 PMCID: PMC10804180 DOI: 10.1002/ehf2.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 12/03/2023] Open
Abstract
AIMS This retrospective cohort study aimed to be the first to evaluate the association between plasma protein-bound uremic toxins (PBUTs) concentrations, echocardiographic parameters of heart failure (HF), and incident HF events in patients with chronic kidney disease (CKD) not on dialysis. METHODS AND RESULTS Retrospective, single-centre, cohort study at the Ghent University Hospital, Belgium. Adults with CKD stages G1-G5, not on dialysis, could be included. Exclusion criteria were ongoing pregnancy, age <18 years, active acute infection, active malignancy, history of transplantation, or a cardiovascular event within 3 months prior to inclusion. Free and total concentrations of five PBUTs were quantified at baseline: indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG), indole-3 acetic acid (IAA), and hippuric acid (HA). Patients were grouped into three echocardiographic categories: normal left ventricular ejection fraction (LVEF) and normal left ventricular end-diastolic pressure (LVEDP), normal LVEF and increased LVEDP, and reduced LVEF, based on available echocardiographic data in a time interval of ±6 months around the plasma sample collection. A total of 523 patients were included between January 2011 and January 2014. Echocardiographic data within the predefined timeframe were available for 210 patients (40% of patients). Levels of pCG and pCS were significantly higher in patients with reduced (<50%) versus normal LVEF (P < 0.05). After a median follow-up 5.5 years, 43 (8.4%) patients reached the composite endpoint of hospitalization or mortality due to HF. Free fractions of IxS, pCS, and pCG showed the strongest association with clinical outcome: free IxS: HR 1.71 (95% CI 1.11-2.63; P = 0.015), free pCS: HR 1.82 (95% CI 1.11-3.01; P = 0.019), and free pCG: HR 1.67 (95% CI 1.08-2.58; P = 0.020), and these results were independent of age, gender, body mass index, diabetes, and systolic blood pressure. In models that were also adjusted for serum creatinine, the free fractions of these PBUTs remained significant. CONCLUSIONS Elevated free concentrations of IxS, pCG, and pCS were independently associated with an increased risk of HF events in non-dialysed CKD patients. Further research is necessary to confirm these findings and investigate the potential impact of PBUT-lowering interventions on HF events in this patient group.
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Affiliation(s)
- Bert Zwaenepoel
- Department of CardiologyGhent University Hospital, Ghent UniversityGhentBelgium
| | - Tine De Backer
- Department of CardiologyGhent University Hospital, Ghent UniversityGhentBelgium
| | - Griet Glorieux
- Department of NephrologyGhent University Hospital, Ghent UniversityGhentBelgium
| | - Francis Verbeke
- Department of NephrologyGhent University Hospital, Ghent UniversityGhentBelgium
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Jaimes Campos MA, Andújar I, Keller F, Mayer G, Rossing P, Staessen JA, Delles C, Beige J, Glorieux G, Clark AL, Mullen W, Schanstra JP, Vlahou A, Rossing K, Peter K, Ortiz A, Campbell A, Persson F, Latosinska A, Mischak H, Siwy J, Jankowski J. Prognosis and Personalized In Silico Prediction of Treatment Efficacy in Cardiovascular and Chronic Kidney Disease: A Proof-of-Concept Study. Pharmaceuticals (Basel) 2023; 16:1298. [PMID: 37765106 PMCID: PMC10537115 DOI: 10.3390/ph16091298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Kidney and cardiovascular diseases are responsible for a large fraction of population morbidity and mortality. Early, targeted, personalized intervention represents the ideal approach to cope with this challenge. Proteomic/peptidomic changes are largely responsible for the onset and progression of these diseases and should hold information about the optimal means of treatment and prevention. (2) Methods: We investigated the prediction of renal or cardiovascular events using previously defined urinary peptidomic classifiers CKD273, HF2, and CAD160 in a cohort of 5585 subjects, in a retrospective study. (3) Results: We have demonstrated a highly significant prediction of events, with an HR of 2.59, 1.71, and 4.12 for HF, CAD, and CKD, respectively. We applied in silico treatment, implementing on each patient's urinary profile changes to the classifiers corresponding to exactly defined peptide abundance changes, following commonly used interventions (MRA, SGLT2i, DPP4i, ARB, GLP1RA, olive oil, and exercise), as defined in previous studies. Applying the proteomic classifiers after the in silico treatment indicated the individual benefits of specific interventions on a personalized level. (4) Conclusions: The in silico evaluation may provide information on the future impact of specific drugs and interventions on endpoints, opening the door to a precision-based medicine approach. An investigation into the extent of the benefit of this approach in a prospective clinical trial is warranted.
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Affiliation(s)
- Mayra Alejandra Jaimes Campos
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (M.A.J.C.); (A.L.); (H.M.); (J.S.)
- Institute for Molecular Cardiovascular Research, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Iván Andújar
- Proteomic Laboratory, Center for Genetic Engineering and Biotechnology, Havana 10600, Cuba
| | - Felix Keller
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria; (F.K.); (G.M.)
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria; (F.K.); (G.M.)
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (P.R.); (F.P.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Jan A. Staessen
- Non-Profit Research Institute Alliance for the Promotion of Preventive Medicine, 2800 Mechlin, Belgium;
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.D.); (W.M.)
| | - Joachim Beige
- Division of Nephrology and KfH Renal Unit, Hospital St Georg, 04129 Leipzig, Germany;
- Medical Clinic 2, Martin-Luther-University Halle/Wittenberg, 06112 Halle, Germany
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Andrew L. Clark
- Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham HU16 5JQ, UK;
| | - William Mullen
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.D.); (W.M.)
| | - Joost P. Schanstra
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, 31432 Toulouse, France;
- Renal Fibrosis, Université Toulouse III Paul-Sabatier, Route de Narbonne, 31062 Toulouse, France
| | - Antonia Vlahou
- Centre of Systems Biology, Biomedical Research Foundation of the Academy of Athens (BRFAA), 115 27 Athens, Greece;
| | - Kasper Rossing
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia;
- Department of Physiology, Anatomy, Microbiology, La Trobe University, Melbourne, VIC 3083, Australia
- Department of Medicine and Immunology, Monash University, Melbourne, VIC 3800, Australia
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC 3010, Australia
| | - Alberto Ortiz
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz UAM, 28040 Madrid, Spain;
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Frederik Persson
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (P.R.); (F.P.)
| | - Agnieszka Latosinska
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (M.A.J.C.); (A.L.); (H.M.); (J.S.)
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (M.A.J.C.); (A.L.); (H.M.); (J.S.)
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.D.); (W.M.)
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (M.A.J.C.); (A.L.); (H.M.); (J.S.)
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, 6211 Maastricht, The Netherlands
- Aachen-Maastricht Institute for Cardiorenal Disease (AMICARE), University Hospital RWTH Aachen, 52074 Aachen, Germany
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Tourountzis T, Lioulios G, Van Laecke S, Ginikopoulou E, Nikolaidou V, Moysidou E, Stai S, Christodoulou M, Fylaktou A, Glorieux G, Stangou M. Immunosenescence and Immune Exhaustion Are Associated with Levels of Protein-Bound Uremic Toxins in Patients on Hemodialysis. Biomedicines 2023; 11:2504. [PMID: 37760945 PMCID: PMC10525954 DOI: 10.3390/biomedicines11092504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The accumulation of protein-bound uremic toxins (PBUTs) in chronic kidney disease may affect patients' immune status. The aim of the study was to evaluate their potential impacts on lymphocyte alterations in patients on hemodialysis (HD). METHODS The plasma levels of PBUTs were assessed in 54 patients on HD and 31 healthy individuals, using ultra-performance liquid chromatography. The results correlated with the senescent and exhausted status of lymphocytes, based on certain surface molecules, analyzed by flow cytometry. RESULTS The plasma levels of PBUTs were significantly increased in the patients on HD compared with the healthy controls. The patients with residual kidney function had reduced hippuric acid (HA) levels, total (p = 0.03) and free (p = 0.04), and free IxS levels (p = 0.02). The total and free HA levels correlated negatively with less differentiated subpopulations, CD4+CD45RA+CD31+ (p = 0.037 and p = 0.027), CD8+CD28+CD57- (p = 0.01, p = 0.01), and naïve B cells (CD19+IgD+CD27-) (p = 0.04, p = 0.03). Both the total and the free pCS levels correlated positively with exhausted CD4 cells, p = 0.02 and p = 0.01, respectively. A multivariate analysis showed that IxS and age were the main independent parameters implicated in the reduction intotal CD4 and B lymphocytes and their naïve and early differentiated subsets. CONCLUSIONS Increased PBUTs levels are associated with immune disturbances of patients on HD, HA, and IxS in the immunosenescent and pCS in the immunoexhaustion alterations.
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Affiliation(s)
| | - Georgios Lioulios
- Department of Nephrology, General Hospital “Hippokratio”, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (E.M.); (S.S.); (M.C.); (M.S.)
| | - Steven Van Laecke
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Gent, Belgium; (S.V.L.); (G.G.)
| | | | - Vasiliki Nikolaidou
- Department of Immunology, National Peripheral Histocompatibility Center, General Hospital “Hippokratio”, 54642 Thessaloniki, Greece; (V.N.); (A.F.)
| | - Eleni Moysidou
- Department of Nephrology, General Hospital “Hippokratio”, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (E.M.); (S.S.); (M.C.); (M.S.)
| | - Stamatia Stai
- Department of Nephrology, General Hospital “Hippokratio”, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (E.M.); (S.S.); (M.C.); (M.S.)
| | - Michalis Christodoulou
- Department of Nephrology, General Hospital “Hippokratio”, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (E.M.); (S.S.); (M.C.); (M.S.)
| | - Asimina Fylaktou
- Department of Immunology, National Peripheral Histocompatibility Center, General Hospital “Hippokratio”, 54642 Thessaloniki, Greece; (V.N.); (A.F.)
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Gent, Belgium; (S.V.L.); (G.G.)
| | - Maria Stangou
- Department of Nephrology, General Hospital “Hippokratio”, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (E.M.); (S.S.); (M.C.); (M.S.)
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5
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Amaya-Garrido A, Brunet M, Buffin-Meyer B, Piedrafita A, Grzesiak L, Agbegbo E, Del Bello A, Ferrandiz I, Ardeleanu S, Bermudez-Lopez M, Fedou C, Camus M, Burlet-Schiltz O, Massines J, Buléon M, Feuillet G, Alves M, Neau E, Casemayou A, Breuil B, Saulnier-Blache JS, Denis C, Voelkl J, Glorieux G, Hobson S, Arefin S, Rahman A, Kublickiene K, Stenvinkel P, Bascands JL, Faguer S, Valdivielso JM, Schanstra JP, Klein J. Calprotectin is a contributor to and potential therapeutic target for vascular calcification in chronic kidney disease. Sci Transl Med 2023; 15:eabn5939. [PMID: 37672568 DOI: 10.1126/scitranslmed.abn5939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
Vascular calcification is an important risk factor for cardiovascular (CV) mortality in patients with chronic kidney disease (CKD). It is also a complex process involving osteochondrogenic differentiation of vascular smooth muscle cells (VSMCs) and abnormal deposition of minerals in the vascular wall. In an observational, multicenter European study, including 112 patients with CKD from Spain and 171 patients on dialysis from France, we used serum proteome analysis and further validation by ELISA to identify calprotectin, a circulating damage-associated molecular pattern protein, as being independently associated with CV outcome and mortality. This was confirmed in an additional cohort of 170 patients with CKD from Sweden, where increased serum calprotectin concentrations correlated with increased vascular calcification. In primary human VSMCs and mouse aortic rings, calprotectin exacerbated calcification. Treatment with paquinimod, a calprotectin inhibitor, as well as pharmacological inhibition of the receptor for advanced glycation end products and Toll-like receptor 4 inhibited the procalcifying effect of calprotectin. Paquinimod also ameliorated calcification induced by the sera of uremic patients in primary human VSMCs. Treatment with paquinimod prevented vascular calcification in mice with chronic renal failure induced by subtotal nephrectomy and in aged apolipoprotein E-deficient mice as well. These observations identified calprotectin as a key contributor of vascular calcification, and increased circulating calprotectin was strongly and independently associated with calcification, CV outcome, and mortality in patients with CKD. Inhibition of calprotectin might therefore be a promising strategy to prevent vascular calcification in patients with CKD.
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Affiliation(s)
- Ana Amaya-Garrido
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Manon Brunet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Alexis Piedrafita
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Lucile Grzesiak
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Ezechiel Agbegbo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Inés Ferrandiz
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Serban Ardeleanu
- AURAR Saint Louis Dialysis Center, 97421 Saint Louis, La Réunion, France
| | - Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, 25198 Lleida, Spain
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Mylène Camus
- Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, 31400 Toulouse, France
| | - Odile Burlet-Schiltz
- Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, 31400 Toulouse, France
| | - Jean Massines
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Marie Buléon
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Melinda Alves
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jean-Sébastien Saulnier-Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Colette Denis
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jakob Voelkl
- Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, 4040 Linz, Austria
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Gent, Belgium
| | - Sam Hobson
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Awahan Rahman
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Jean-Loup Bascands
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, 97491 Sainte Clotilde, La Réunion, France
| | - Stanislas Faguer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - José M Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, 25198 Lleida, Spain
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
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6
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Abstract
Homeostasis is a prerequisite for health. When homeostasis becomes disrupted, dysfunction occurs. This is especially the case for the gut microbiota, which under normal conditions lives in symbiosis with the host. As there are as many microbial cells in and on our body as human cells, it is unlikely they would not contribute to health or disease. The gut bacterial metabolism generates numerous beneficial metabolites but also uremic toxins and their precursors, which are transported into the circulation. Barrier function in the intestine, the heart, and the kidneys regulates metabolite transport and concentration and plays a role in inter-organ and inter-organism communication via small molecules. This communication is analyzed from the perspective of the remote sensing and signaling theory, which emphasizes the role of a large network of multispecific, oligospecific, and monospecific transporters and enzymes in regulating small-molecule homeostasis. The theory provides a systems biology framework for understanding organ cross talk and microbe-host communication involving metabolites, signaling molecules, nutrients, antioxidants, and uremic toxins. This remote small-molecule communication is critical for maintenance of homeostasis along the gut-heart-kidney axis and for responding to homeostatic perturbations. Chronic kidney disease is characterized by gut dysbiosis and accumulation of toxic metabolites. This slowly impacts the body, affecting the cardiovascular system and contributing to the progression of kidney dysfunction, which in its turn influences the gut microbiota. Preserving gut homeostasis and barrier functions or restoring gut dysbiosis and dysfunction could be a minimally invasive way to improve patient outcomes and quality of life in many diseases, including cardiovascular and kidney disease.
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Affiliation(s)
- Griet Glorieux
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Gent, Belgium (G.G., R.V., F.V.)
| | - Sanjay K Nigam
- Department of Pediatrics (S.K.N.), University of California San Diego, La Jolla, CA
- Division of Nephrology, Department of Medicine (S.K.N.), University of California San Diego, La Jolla, CA
| | - Raymond Vanholder
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Gent, Belgium (G.G., R.V., F.V.)
| | - Francis Verbeke
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Gent, Belgium (G.G., R.V., F.V.)
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7
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Lohia S, Latosinska A, Zoidakis J, Makridakis M, Mischak H, Glorieux G, Vlahou A, Jankowski V. Glycosylation Analysis of Urinary Peptidome Highlights IGF2 Glycopeptides in Association with CKD. Int J Mol Sci 2023; 24:ijms24065402. [PMID: 36982475 PMCID: PMC10048973 DOI: 10.3390/ijms24065402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Chronic kidney disease (CKD) is prevalent in 10% of world’s adult population. The role of protein glycosylation in causal mechanisms of CKD progression is largely unknown. The aim of this study was to identify urinary O-linked glycopeptides in association to CKD for better characterization of CKD molecular manifestations. Urine samples from eight CKD and two healthy subjects were analyzed by CE-MS/MS and glycopeptides were identified by a specific software followed by manual inspection of the spectra. Distribution of the identified glycopeptides and their correlation with Age, eGFR and Albuminuria were evaluated in 3810 existing datasets. In total, 17 O-linked glycopeptides from 7 different proteins were identified, derived primarily from Insulin-like growth factor-II (IGF2). Glycosylation occurred at the surface exposed IGF2 Threonine 96 position. Three glycopeptides (DVStPPTVLPDNFPRYPVGKF, DVStPPTVLPDNFPRYPVG and DVStPPTVLPDNFPRYP) exhibited positive correlation with Age. The IGF2 glycopeptide (tPPTVLPDNFPRYP) showed a strong negative association with eGFR. These results suggest that with aging and deteriorating kidney function, alterations in IGF2 proteoforms take place, which may reflect changes in mature IGF2 protein. Further experiments corroborated this hypothesis as IGF2 increased plasma levels were observed in CKD patients. Protease predictions, considering also available transcriptomics data, suggest activation of cathepsin S with CKD, meriting further investigation.
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Affiliation(s)
- Sonnal Lohia
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
- Institute for Molecular Cardiovascular Research, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | | | - Jerome Zoidakis
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Manousos Makridakis
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | | | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Division, Ghent University Hospital, 9000 Gent, Belgium
| | - Antonia Vlahou
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Vera Jankowski
- Institute for Molecular Cardiovascular Research, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-(0241)-80-80580
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8
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Massy ZA, Lambert O, Metzger M, Sedki M, Chaubet A, Breuil B, Jaafar A, Tack I, Nguyen-Khoa T, Alves M, Siwy J, Mischak H, Verbeke F, Glorieux G, Herpe YE, Schanstra JP, Stengel B, Klein J. Machine Learning-Based Urine Peptidome Analysis to Predict and Understand Mechanisms of Progression to Kidney Failure. Kidney Int Rep 2023; 8:544-555. [PMID: 36938091 PMCID: PMC10014385 DOI: 10.1016/j.ekir.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The identification of patients with chronic kidney disease (CKD) at risk of progressing to kidney failure (KF) is important for clinical decision-making. In this study we assesed whether urinary peptidome (UP) analysis may help classify patients with CKD and improve KF risk prediction. Methods The UP was analyzed using capillary electrophoresis coupled to mass spectrometry in a case-cohort sample of 1000 patients with CKD stage G3 to G5 from the French CKD-Renal Epidemiology and Information Network (REIN) cohort. We used unsupervised and supervised machine learning to classify patients into homogenous UP clusters and to predict 3-year KF risk with UP, respectively. The predictive performance of UP was compared with the KF risk equation (KFRE), and evaluated in an external cohort of 326 patients. Results More than 1000 peptides classified patients into 3 clusters with different CKD severities and etiologies at baseline. Peptides with the highest discriminative power for clustering were fragments of proteins involved in inflammation and fibrosis, highlighting those derived from α-1-antitrypsin, a major acute phase protein with anti-inflammatory and antiapoptotic properties, as the most significant. We then identified a set of 90 urinary peptides that predicted KF with a c-index of 0.83 (95% confidence interval [CI]: 0.81-0.85) in the case-cohort and 0.89 (0.83-0.94) in the external cohort, which were close to that estimated with the KFRE (0.85 [0.83-0.87]). Combination of UP with KFRE variables did not further improve prediction. Conclusion This study shows the potential of UP analysis to uncover new pathophysiological CKD progression pathways and to predict KF risk with a performance equal to that of the KFRE.
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Affiliation(s)
- Ziad A. Massy
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Mohammed Sedki
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Methodology Pole, Villejuif, France
| | - Adeline Chaubet
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Acil Jaafar
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Ivan Tack
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Thao Nguyen-Khoa
- Laboratory of Biochemistry, HU Necker-Enfants Malades, AP-HP Centre Université de Paris, Paris, France
- INSERM U1151, Institut Necker-Enfants Malades, Université de Paris Cité, Paris, France
| | - Melinda Alves
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany
| | | | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Biological Resource Center of the Amiens University Hospital, 1 rondpoint du Pr Christian Cabrol, Amiens Cedex, France
| | - Joost P. Schanstra
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
- Correspondence: Julie Klein, Institute of Metabolic and Cardiovascular disease, 1 avenue Jean-Poulhès, 31432 Toulouse Cedex 4, France.
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9
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Paats J, Adoberg A, Arund J, Dhondt A, Fernström A, Fridolin I, Glorieux G, Gonzalez-Parra E, Holmar J, Leis L, Luman M, Perez-Gomez VM, Pilt K, Sanchez-Ospina D, Segelmark M, Uhlin F, Ortiz A. Time-averaged concentration estimation of uremic toxins with different removal kinetics: a novel approach based on intradialytic spent dialysate measurements. Clin Kidney J 2022; 16:735-744. [PMID: 37007697 PMCID: PMC10061434 DOI: 10.1093/ckj/sfac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Kt/Vurea is the most used marker to estimate dialysis adequacy; however, it does not reflect the removal of many other uremic toxins, and a new approach is needed. We have assessed the feasibility of estimating intradialytic serum time-averaged concentration (TAC) of various uremic toxins from their spent dialysate concentrations that can be estimated non-invasively online with optical methods.
Methods
Serum and spent dialysate levels and total removed solute (TRS) of urea, uric acid (UA), indoxyl sulfate (IS) and β2-microglobulin (β2M) were evaluated with laboratory methods during 312 hemodialysis sessions in 78 patients with 4 different dialysis treatment settings. TAC was calculated from serum concentrations and evaluated from TRS and logarithmic mean concentrations of spent dialysate (Mln D).
Results
Mean intradialytic serum TAC values of urea, UA, β2M and IS were 10.4±3.8 mmol/L, 191.6±48.1 µmol/L, 13.3±4.3 mg/L and 82.9±43.3 µmol/L, respectively. These serum TAC values were similar and highly correlated to those estimated from TRS: 10.5±3.6 mmol/L (R2 = 0.92), 191.5±42.8 µmol/L (R2 = 0.79), 13.0±3.2 mg/L (R2 = 0.59), and 82.7±40.0 µmol/L (R2 = 0.85) and from Mln D 10.7±3.7 mmol/L (R2 = 0.92), 191.6±43.8 µmol/L (R2 = 0.80), 12.9±3.2 mg/L (R2 = 0.63), and 82.2±38.6 µmol/L (R2 = 0.84), respectively.
Conclusions
Intradialytic serum TAC of different uremic toxins can be estimated non-invasively from their concentration in spent dialysate. This sets the stage for TAC estimation from online optical monitoring of spent dialysate concentrations of diverse solutes and for further optimization of estimation models for each uremic toxin.
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Affiliation(s)
- Joosep Paats
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
| | - Annika Adoberg
- Centre of Nephrology, North Estonia Medical Centre , Tallinn , Estonia
| | - Jürgen Arund
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
| | - Annemieke Dhondt
- Nephrology Division, Ghent University Hospital , Ghent , Belgium
| | - Anders Fernström
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Ivo Fridolin
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
| | - Griet Glorieux
- Nephrology Division, Ghent University Hospital , Ghent , Belgium
| | - Emilio Gonzalez-Parra
- Fundación Jiménez Díaz University Hospital Health Research Institute , Madrid , Spain
| | - Jana Holmar
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
| | - Liisi Leis
- Centre of Nephrology, North Estonia Medical Centre , Tallinn , Estonia
| | - Merike Luman
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
- Centre of Nephrology, North Estonia Medical Centre , Tallinn , Estonia
| | | | - Kristjan Pilt
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
| | - Didier Sanchez-Ospina
- Fundación Jiménez Díaz University Hospital Health Research Institute , Madrid , Spain
| | - Mårten Segelmark
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Fredrik Uhlin
- Department of Health Technologies, Tallinn University of Technology , Tallinn , Estonia
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Alberto Ortiz
- Fundación Jiménez Díaz University Hospital Health Research Institute , Madrid , Spain
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10
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Wilmot H, Glorieux G, Hubin X, Gengler N. A genomic breed assignment test for traceability of meat of Dual-Purpose Blue. Livest Sci 2022. [DOI: 10.1016/j.livsci.2022.104996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Verbeke F, Vanholder R, Van Biesen W, Glorieux G. Contribution of Hypoalbuminemia and Anemia to the Prognostic Value of Plasma p-Cresyl Sulfate and p-Cresyl Glucuronide for Cardiovascular Outcome in Chronic Kidney Disease. J Pers Med 2022; 12:jpm12081239. [PMID: 36013188 PMCID: PMC9410048 DOI: 10.3390/jpm12081239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Free plasma concentrations of protein-bound uremic toxins (PBUTs) may be influenced by serum albumin and hemoglobin. The potential association of serum albumin and hemoglobin with free levels of p-cresyl sulfate (pCS) and p-cresyl glucuronide (pCG) and their predictive value for cardiovascular morbidity and mortality were explored. A total of 523 non-dialysis chronic kidney disease (CKD) stages G1–G5 patients were prospectively followed for the occurrence of fatal or non-fatal cardiovascular events over a 5.5-year period. A negative correlation was found between albumin and between hemoglobin, and both total and free pCS and pCG. In multiple linear regression, PBUTs were negatively associated with eGFR (estimated glomerular filtration rate) and hemoglobin but not albumin. In multivariate Cox regression analysis, albumin was a predictor of outcome, independent of pCS and pCG, without interactions between albumin and pCS or pCG. The relation of low hemoglobin with adverse outcome was lost when albumin was entered into the model. Lower concentrations of pCS and pCG are associated with higher serum albumin and hemoglobin. This may indicate that there are two pathways in the blood that potentially contribute to attenuating the vasculotoxic effects of these PBUTs. The association of PBUTs with cardiovascular risk is not explained by albumin levels, which remains a strong and independent predictor for adverse outcome.
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12
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Vandecruys M, De Smet S, Cornelissen V, Raes J, De Geest S, Naesens M, Leunis S, De Beir J, Vanden Wyngaert K, Nagler E, Glorieux G, Van Biesen W, Calders P, Monbaliu D, Van Craenenbroeck A. MO590: A Home-Based Exercise and Physical Activity Intervention After Kidney Transplantation: Impact of Exercise Intensity. The Phoenix-Kidney Study Protocol. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac075.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Advances in the field of kidney transplantation have led to improved postoperative survival rates, but age-standardized mortality nonetheless remains 2- to 7-fold higher in kidney transplant recipients—with cardiovascular disease representing the leading cause of death in recipients with a functioning graft. Poor physical fitness, not completely recovering after transplantation, adds to the heightened cardiovascular risk of hypertension, diabetes, dyslipidemia and obesity. So does the post-transplant continuation of gut microbial dysbiosis, which recently emerged as a modulator of muscular, metabolic and cardiovascular health. Exercise-based rehabilitation and physical activity interventions may prove pivotal in the care of kidney transplant recipients to address aforementioned outcomes.
METHOD
At 3 months post-transplant, a probability sample of 147 adult kidney transplant recipients from two independent Belgian transplant centers will be randomly allocated to either 6 months of home-based moderate-intensity training (MIT, n = 49), concurrent moderate- and high-intensity training (MHIT, n = 49) or usual care (CON, n = 49) (Figure1). High-intensity training sessions in MHIT are based on the Scandinavian model (four blocks of 4 min at high intensity interspersed by 3 min of active recovery), performed twice a week, and of equivalent energy expenditure as moderate-intensity training (Figure2). MIT and MHIT will perform similar muscle strengthening exercises, twice a week. The training intervention will be followed by an individualized activity intervention aiming for long-term physical activity maintenance in MIT and MHIT; using motivational interviewing techniques, co-creation of an action plan adapted to the patients’ preferences, goal-setting, gradually decreasing follow-up prompts over time and self-monitoring of physical activity behavior. Study participants will be followed-up till 2 years after transplantation. We hypothesize that the study intervention will improve our primary outcome cardiorespiratory fitness, assessed as peak oxygen uptake, at 9 months post-transplant. Secondary outcomes include muscle fitness, motor fitness, body composition, cardiovascular health, gut microbiome characteristics, health-related quality of life, safety, cost-effectiveness and implementation outcomes (Figure1). The role of training intensity and the role of baseline gut microbiome characteristics as predictor of individuals’ training response will be explored.
RESULTS
Results from this two-phased RCT will provide novel insights in the safety, implementation potential, cost-effectiveness and effectiveness of a home-based exercise program and physical activity intervention in de novo kidney transplant recipients to improve physical fitness, cardiovascular health, gut microbiome characteristics and health-related quality of life.
CONCLUSION
PHOENIX-kidney represents the first adequately powered multicenter RCT evaluating basic, clinical and health-economic outcome parameters in response to an exercise training and physical activity intervention in kidney transplant recipients.
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Affiliation(s)
- Marieke Vandecruys
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Belgium
| | - Stefan De Smet
- KU Leuven, Department of Microbiology, Immunology and Transplantation; Department of Rehabilitation Sciences, Belgium
| | | | - Jeroen Raes
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Belgium
| | - Sabina De Geest
- KU Leuven, University of Basel, Department of Public Health and Primary Care, KU Leuven, Belgium; Department Public Health, University of Basel, Switzerland, Belgium
| | - Maarten Naesens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Belgium
| | - Sofie Leunis
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Belgium
| | - Jasmine De Beir
- Ghent University, Department of Rehabilitation Sciences, Belgium
| | | | - Evi Nagler
- Ghent University, Department of Internal Medicine and Pediatrics, Belgium
| | - Griet Glorieux
- Ghent University, Department of Internal Medicine and Pediatrics, Belgium
| | - Wim Van Biesen
- Ghent University, Department of Internal Medicine and Pediatrics, Belgium
| | - Patrick Calders
- Ghent University, Department of Rehabilitation Sciences, Belgium
| | - Diethard Monbaliu
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Belgium
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13
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Steenbeke M, Speeckaert R, Desmedt S, Glorieux G, Delanghe JR, Speeckaert MM. The Role of Advanced Glycation End Products and Its Soluble Receptor in Kidney Diseases. Int J Mol Sci 2022; 23:ijms23073439. [PMID: 35408796 PMCID: PMC8998875 DOI: 10.3390/ijms23073439] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic kidney disease (CKD) are more prone to oxidative stress and chronic inflammation, which may lead to an increase in the synthesis of advanced glycation end products (AGEs). Because AGEs are mostly removed by healthy kidneys, AGE accumulation is a result of both increased production and decreased kidney clearance. On the other hand, AGEs may potentially hasten decreasing kidney function in CKD patients, and are independently related to all-cause mortality. They are one of the non-traditional risk factors that play a significant role in the underlying processes that lead to excessive cardiovascular disease in CKD patients. When AGEs interact with their cell-bound receptor (RAGE), cell dysfunction is initiated by activating nuclear factor kappa-B (NF-κB), increasing the production and release of inflammatory cytokines. Alterations in the AGE-RAGE system have been related to the development of several chronic kidney diseases. Soluble RAGE (sRAGE) is a decoy receptor that suppresses membrane-bound RAGE activation and AGE-RAGE-related toxicity. sRAGE, and more specifically, the AGE/sRAGE ratio, may be promising tools for predicting the prognosis of kidney diseases. In the present review, we discuss the potential role of AGEs and sRAGE as biomarkers in different kidney pathologies.
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Affiliation(s)
- Mieke Steenbeke
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (S.D.); (G.G.)
| | - Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Stéphanie Desmedt
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (S.D.); (G.G.)
| | - Griet Glorieux
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (S.D.); (G.G.)
| | - Joris R. Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Marijn M. Speeckaert
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (S.D.); (G.G.)
- Research Foundation Flanders, 1000 Brussels, Belgium
- Correspondence:
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14
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Ebrahim Z, Proost S, Tito RY, Raes J, Glorieux G, Moosa MR, Blaauw R. The Effect of ß-Glucan Prebiotic on Kidney Function, Uremic Toxins and Gut Microbiome in Stage 3 to 5 Chronic Kidney Disease (CKD) Predialysis Participants: A Randomized Controlled Trial. Nutrients 2022; 14:nu14040805. [PMID: 35215453 PMCID: PMC8880761 DOI: 10.3390/nu14040805] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 12/21/2022] Open
Abstract
There is growing evidence that gut dysbiosis contributes to the progression of chronic kidney disease (CKD) owing to several mechanisms, including microbiota-derived uremic toxins, diet and immune-mediated factors. The aim of this study was to investigate the effect of a ß-glucan prebiotic on kidney function, uremic toxins and the gut microbiome in stage 3 to 5 CKD participants. Fifty-nine participants were randomized to either the ß-glucan prebiotic intervention group (n = 30) or the control group (n = 29). The primary outcomes were to assess kidney function (urea, creatinine and glomerular filtration rate), plasma levels of total and free levels of uremic toxins (p-cresyl sulfate (pCS), indoxyl-sulfate (IxS), p-cresyl glucuronide (pCG) and indoxyl 3-acetic acid (IAA) and gut microbiota using 16S rRNA sequencing at baseline, week 8 and week 14. The intervention group (age 40.6 ± 11.4 y) and the control group (age 41.3 ± 12.0 y) did not differ in age or any other socio-demographic variables at baseline. There were no significant changes in kidney function over 14 weeks. There was a significant reduction in uremic toxin levels at different time points, in free IxS at 8 weeks (p = 0.003) and 14 weeks (p < 0.001), free pCS (p = 0.006) at 14 weeks and total and free pCG (p < 0.001, p < 0.001, respectively) and at 14 weeks. There were no differences in relative abundances of genera between groups. Enterotyping revealed that the population consisted of only two of the four enterotypes: Bacteroides 2 and Prevotella. The redundancy analysis showed a few factors significantly affected the gut microbiome: these included triglyceride levels (p < 0.001), body mass index (p = 0.002), high- density lipoprotein (p < 0.001) and the prebiotic intervention (p = 0.002). The ß-glucan prebiotic significantly altered uremic toxin levels of intestinal origin and favorably affected the gut microbiome.
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Affiliation(s)
- Zarina Ebrahim
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 8000, South Africa;
- Correspondence: (Z.E.); (S.P.)
| | - Sebastian Proost
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (R.Y.T.); (J.R.)
- Center for Microbiology, VIB, 3000 Leuven, Belgium
- Correspondence: (Z.E.); (S.P.)
| | - Raul Yhossef Tito
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (R.Y.T.); (J.R.)
- Center for Microbiology, VIB, 3000 Leuven, Belgium
| | - Jeroen Raes
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (R.Y.T.); (J.R.)
- Center for Microbiology, VIB, 3000 Leuven, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium;
| | | | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 8000, South Africa;
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15
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Ebrahim Z, Glorieux G, Moosa MR, Blaauw R. Effect of simplified dietary advice on nutritional status and uremic toxins in chronic kidney disease participants. South African Journal of Clinical Nutrition 2022. [DOI: 10.1080/16070658.2021.2018788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zarina Ebrahim
- Division of Human Nutrition, Stellenbosch University, Cape Town, South Africa
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - M Rafique Moosa
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Renée Blaauw
- Division of Human Nutrition, Stellenbosch University, Cape Town, South Africa
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16
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Steenbeke M, Valkenburg S, Gryp T, Van Biesen W, Delanghe JR, Speeckaert MM, Glorieux G. Gut Microbiota and Their Derived Metabolites, a Search for Potential Targets to Limit Accumulation of Protein-Bound Uremic Toxins in Chronic Kidney Disease. Toxins (Basel) 2021; 13:toxins13110809. [PMID: 34822593 PMCID: PMC8625482 DOI: 10.3390/toxins13110809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022] Open
Abstract
Chronic kidney disease (CKD) is characterized by gut dysbiosis with a decrease in short-chain fatty acid (SCFA)-producing bacteria. Levels of protein-bound uremic toxins (PBUTs) and post-translational modifications (PTMs) of albumin increase with CKD, both risk factors for cardiovascular morbidity and mortality. The relationship between fecal metabolites and plasma concentrations of PBUTs in different stages of CKD (n = 103) was explored. Estimated GFR tends to correlate with fecal butyric acid (BA) concentrations (rs = 0.212; p = 0.032), which, in its turn, correlates with the abundance of SCFA-producing bacteria. Specific SCFAs correlate with concentrations of PBUT precursors in feces. Fecal levels of p-cresol correlate with its derived plasma UTs (p-cresyl sulfate: rs = 0.342, p < 0.001; p-cresyl glucuronide: rs = 0.268, p = 0.006), whereas an association was found between fecal and plasma levels of indole acetic acid (rs = 0.306; p = 0.002). Finally, the albumin symmetry factor correlates positively with eGFR (rs = 0.274; p = 0.005). The decreased abundance of SCFA-producing gut bacteria in parallel with the fecal concentration of BA and indole could compromise the intestinal barrier function in CKD. It is currently not known if this contributes to increased plasma levels of PBUTs, potentially playing a role in the PTMs of albumin. Further evaluation of SCFA-producing bacteria and SCFAs as potential targets to restore both gut dysbiosis and uremia is needed.
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Affiliation(s)
- Mieke Steenbeke
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sophie Valkenburg
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
| | - Tessa Gryp
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
- Laboratory Bacteriology Research, Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
| | - Joris R Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Marijn M Speeckaert
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Unit, Ghent University Hospital, 9000 Ghent, Belgium
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17
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Gryp T, Faust K, Van Biesen W, Huys GRB, Verbeke F, Speeckaert M, Raes J, Vaneechoutte M, Joossens M, Glorieux G. Gut Microbiome Profiling Uncovers a Lower Abundance of Butyricicoccus in Advanced Stages of Chronic Kidney Disease. J Pers Med 2021; 11:jpm11111118. [PMID: 34834470 PMCID: PMC8621827 DOI: 10.3390/jpm11111118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) is characterized by the accumulation of uremic toxins which exert deleterious effects on various organ systems. Several of these uremic toxins originate from the bacterial metabolization of aromatic amino acids in the colon. This study assessed whether the gut microbial composition varies among patients in different stages of CKD. Uremic metabolites were quantified by UPLC/fluorescence detection and microbial profiling by 16S rRNA amplicon sequencing. Gut microbial profiles of CKD patients were compared among stages 1–2, stage 3 and stages 4–5. Although a substantial inter-individual difference in abundance of the top 15 genera was observed, no significant difference was observed between groups. Bristol stool scale (BSS) correlated negatively with p-cresyl sulfate and hippuric acid levels, irrespective of the intake of laxatives. Butyricicoccus, a genus with butyrate-generating properties, was decreased in abundance in advanced stages of CKD compared to the earlier stages (p = 0.043). In conclusion, in this cross-sectional study no gradual differences in the gut microbial profile over the different stages of CKD were observed. However, the decrease in the abundance of Butyricicoccus genus with loss of kidney function stresses the need for more in-depth functional exploration of the gut microbiome in CKD patients not on dialysis.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (T.G.); (W.V.B.); (F.V.); (M.S.)
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (K.F.); (G.R.B.H.); (J.R.); (M.J.)
- Laboratory Bacteriology Research, Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Karoline Faust
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (K.F.); (G.R.B.H.); (J.R.); (M.J.)
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (T.G.); (W.V.B.); (F.V.); (M.S.)
| | - Geert R. B. Huys
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (K.F.); (G.R.B.H.); (J.R.); (M.J.)
- Center for Microbiology, VIB, 3001 Leuven, Belgium;
| | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (T.G.); (W.V.B.); (F.V.); (M.S.)
| | - Marijn Speeckaert
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (T.G.); (W.V.B.); (F.V.); (M.S.)
| | - Jeroen Raes
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (K.F.); (G.R.B.H.); (J.R.); (M.J.)
- Center for Microbiology, VIB, 3001 Leuven, Belgium;
| | | | - Marie Joossens
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium; (K.F.); (G.R.B.H.); (J.R.); (M.J.)
- Laboratory of Microbiology, Department of Biochemistry and Microbiology, Ghent University, 9000 Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (T.G.); (W.V.B.); (F.V.); (M.S.)
- Correspondence: ; Tel.: +32-93-324-511
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18
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Fourdinier O, Glorieux G, Brigant B, Diouf M, Pletinck A, Vanholder R, Choukroun G, Verbeke F, Massy ZA, Metzinger-Le Meuth V, Metzinger L, Group-EUTox OBOTEUTW. Syndecan-1 and Free Indoxyl Sulfate Levels Are Associated with miR-126 in Chronic Kidney Disease. Int J Mol Sci 2021; 22:ijms221910549. [PMID: 34638892 PMCID: PMC8508835 DOI: 10.3390/ijms221910549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Chronic kidney disease (CKD) is a major cause of death worldwide and is associated with a high risk for cardiovascular and all-cause mortality. In CKD, endothelial dysfunction occurs and uremic toxins accumulate in the blood. miR-126 is a regulator of endothelial dysfunction and its blood level is decreased in CKD patients. In order to obtain a better understanding of the physiopathology of the disease, we correlated the levels of miR-126 with several markers of endothelial dysfunction, as well as the representative uremic toxins, in a large cohort of CKD patients at all stages of the disease. Using a univariate analysis, we found a correlation between eGFR and most markers of endothelial dysfunction markers evaluated in this study. An association of miR-126 with all the evaluated uremic toxins was also found, while uremic toxins were not associated with the internal control, specifically cel-miR-39. The correlation between the expression of endothelial dysfunction biomarker Syndecan-1, free indoxyl sulfate, and total p-cresyl glucuronide on one side, and miR-126 on the other side was confirmed using multivariate analysis. As CKD is associated with reduced endothelial glycocalyx (eGC), our results justify further evaluation of the role of correlated parameters in the pathophysiology of CKD.
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Affiliation(s)
- Ophélie Fourdinier
- Nephrology Dialysis and Transplantation Department, Amiens University Hospital, 80054 Amiens, France; (O.F.); (G.C.)
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (G.G.); (A.P.); (R.V.); (F.V.)
| | - Benjamin Brigant
- UPJV HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (B.B.); (V.M.-L.M.)
| | - Momar Diouf
- Biostatistics Unit, Clinical Research and Innovation Department, Amiens-Picardie University Hospital, 80054 Amiens, France;
| | - Anneleen Pletinck
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (G.G.); (A.P.); (R.V.); (F.V.)
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (G.G.); (A.P.); (R.V.); (F.V.)
| | - Gabriel Choukroun
- Nephrology Dialysis and Transplantation Department, Amiens University Hospital, 80054 Amiens, France; (O.F.); (G.C.)
| | - Francis Verbeke
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (G.G.); (A.P.); (R.V.); (F.V.)
| | - Ziad A. Massy
- Ambroise Paré Hospital, Division of Nephrology, APHP, Paris Ile de France Ouest (UVSQ) University, et INSERM 1018 Eq. 5, CESP, Boulogne Billancourt et Villejuif, 92100 Paris, France;
| | - Valérie Metzinger-Le Meuth
- UPJV HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (B.B.); (V.M.-L.M.)
- INSERM UMRS 1148, Laboratory for Vascular Translational Science (LVTS), UFR SMBH, Université Sorbonne Paris Nord, CEDEX, 93017 Bobigny, France
| | - Laurent Metzinger
- UPJV HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (B.B.); (V.M.-L.M.)
- Correspondence: ; Tel.: +33-322-82-5356
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Speeckaert MM, Seegmiller J, Glorieux G, Lameire N, Van Biesen W, Vanholder R, Delanghe JR. Measured Glomerular Filtration Rate: The Query for a Workable Golden Standard Technique. J Pers Med 2021; 11:949. [PMID: 34683089 PMCID: PMC8541429 DOI: 10.3390/jpm11100949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/12/2023] Open
Abstract
Inulin clearance has, for a long time, been considered as the reference method to determine measured glomerular filtration rates (mGFRs). However, given the known limitations of the standard marker, serum creatinine, and of inulin itself, and the frequent need for accurate GFR estimations, several other non-radioactive (iohexol and iothalamate) and radioactive (51Cr-EDTA, 99mTc-DTPA, 125I iothalamate) exogenous mGFR filtration markers are nowadays considered the most accurate options to evaluate GFR. The availability of 51Cr-EDTA is limited, and all methods using radioactive tracers necessitate specific safety precautions. Serum- or plasma-based certified reference materials for iohexol and iothalamate and evidence-based protocols to accurately and robustly measure GFR (plasma vs. urinary clearance, single-sample vs. multiple-sample strategy, effect of sampling time delay) are lacking. This leads to substantial variation in reported mGFR results across studies and questions the scientific reliability of the alternative mGFR methods as the gold standard to evaluate kidney function. On top of the scientific discussion, regulatory issues are further narrowing the clinical use of mGFR methods. Therefore, this review is a call for standardization of mGFR in terms of three aspects: the marker, the analytical method to assess concentrations of that marker, and the procedure to determine GFR in practice. Moreover, there is also a need for an endogenous filtration marker or a panel of filtration markers from a single blood draw that would allow estimation of GFR as accurately as mGFR, and without the need for application of anthropometric, clinical, and demographic characteristics.
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Affiliation(s)
- Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (N.L.); (W.V.B.); (R.V.)
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Jesse Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (N.L.); (W.V.B.); (R.V.)
| | - Norbert Lameire
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (N.L.); (W.V.B.); (R.V.)
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (N.L.); (W.V.B.); (R.V.)
| | - Raymond Vanholder
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (N.L.); (W.V.B.); (R.V.)
| | - Joris R. Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium;
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Abstract
When chronic kidney disease develops, the capacity of the kidneys to clear metabolic waste products from the body is gradually lost. This process results in the retention of a large array of compounds affecting biochemical and biological functions (uremic toxins), of which several can cause cardiovascular damage. This article reviews the main cardiotoxic mechanisms related to uremic toxin retention (endothelial dysfunction, vascular smooth muscle cell alterations, inflammation, mineral bone disorder, insulin resistance, and thrombogenicity) and the main responsible retention compounds. Therapeutic options are reviewed, such as influencing solute generation by intestinal microbiota.
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Affiliation(s)
- Sophie Valkenburg
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, Gent 9000, Belgium
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, Gent 9000, Belgium
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, Gent 9000, Belgium.
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21
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El Amouri A, Snauwaert E, Foulon A, Vande Moortel C, Van Dyck M, Van Hoeck K, Godefroid N, Glorieux G, Van Biesen W, Vande Walle J, Raes A, Eloot S. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatr Nephrol 2021; 36:1589-1595. [PMID: 33387017 DOI: 10.1007/s00467-020-04840-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations. METHODS In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA). RESULTS In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function. CONCLUSIONS Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.
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Affiliation(s)
- Amina El Amouri
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Evelien Snauwaert
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Aurélie Foulon
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Charlotte Vande Moortel
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maria Van Dyck
- Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (campus Gasthuisberg), Herestraat 49, 3000, Leuven, Belgium
| | - Koen Van Hoeck
- Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Antwerp, Wilrijkstraat 10, Belgium
| | - Nathalie Godefroid
- Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sunny Eloot
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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22
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Steenbeke M, Valkenburg S, Van Biesen W, Delanghe J, Speeckaert M, Glorieux G. MO460ASSOCIATION BETWEEN CARBAMYLATED ALBUMIN, GUT MICROBIOTA AND THEIR DERIVED METABOLITES IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab090.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Chronic kidney disease (CKD) is characterized by gut dysbiosis. We recently demonstrated a decrease of short-chain fatty acid (SCFA) producing bacterial species with the progression of CKD. Besides, levels of protein-bound uremic toxins (PBUTs) and post-translational modifications of protein are increased in CKD, both are risk factors for accelerated cardiovascular morbidity and mortality. The link between the gut-kidney axis and protein carbamylation is unclear. The aim of the study was to explore the relation between carbamylated albumin, estimated by the albumin symmetry factor, and plasma levels of PBUTs, fecal levels of SCFAs (ongoing), and the abundance of related gut microbiota in different stages of CKD (1-5).
Method
The study cohort includes 103 non-dialyzed CKD patients (stages 1-5). Serum proteins were detected by capillary electrophoresis and UV absorbance at 214 nm with the symmetry factor as a marker of albumin carbamylation [the lower the symmetry factor, the more carbamylated albumin].
The quantification of PBUTs and SCFAs in plasma and fecal samples, respectively, using validated UPLC methods.
Results
The Pearson correlation coefficient (r) shows a positive correlation between the albumin symmetry factor and the estimated glomerular filtration rate (eGFR) (r=0.3025; p=0.0019).
The albumin symmetry factor correlates positively with the abundance of Butyricicoccus spp. (r= 0.3211; p=0.0009), Faecalibacterium prausnitzii (r=0.2765; p=0.0047) and Roseburia spp. (r=0.2527; p=0.0100) and negatively with the PBUTs, p-cresyl sulfate (pCS) (r=-0.2819; p=0.0039), p-cresyl glucuronide (pCG) (r=-0.2819; p=0.0039) and indoxyl sulfate (IxS) (r=-0.2650; p=0.0068).
Conclusion
The decreased abundance of SCFA producing gut bacteria with the progression of CKD can evoke unfavorable conditions in the gut. This can contribute to increased plasma levels of PBUTs potentially (indirectly) playing a role in albumin carbamylation. It will be further explored whether fecal levels of SCFAs are affected in parallel and could be potential targets to restore gut dysbiosis and uremia.
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Affiliation(s)
- Mieke Steenbeke
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Nephrology Unit, Gent, Belgium
| | - Sophie Valkenburg
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Nephrology Unit, Gent, Belgium
| | - Wim Van Biesen
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Nephrology Unit, Gent, Belgium
| | - Joris Delanghe
- Ghent University, Department of Diagnostic Sciences, Gent, Belgium
| | - Marijn Speeckaert
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Nephrology Unit, Gent, Belgium
- Research Foundation Flanders (FWO), Brussel, Belgium
| | - Griet Glorieux
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Nephrology Unit, Gent, Belgium
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23
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El Amouri A, Snauwaert E, Foulon A, Vande Moortel C, Van Dyck M, Van Hoeck K, Godefroid N, Glorieux G, Van Biesen W, Vande Walle J, Raes A, Eloot S. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins (Basel) 2021; 13:toxins13030225. [PMID: 33808581 PMCID: PMC8003569 DOI: 10.3390/toxins13030225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.
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Affiliation(s)
- Amina El Amouri
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
- Correspondence:
| | - Evelien Snauwaert
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Aurélie Foulon
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Charlotte Vande Moortel
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Maria Van Dyck
- Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (Campus Gasthuisberg), Herestraat 49, 3000 Leuven, Belgium;
| | - Koen Van Hoeck
- Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium;
| | - Nathalie Godefroid
- Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Sunny Eloot
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
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Vlahou A, Hallinan D, Apweiler R, Argiles A, Beige J, Benigni A, Bischoff R, Black PC, Boehm F, Céraline J, Chrousos GP, Delles C, Evenepoel P, Fridolin I, Glorieux G, van Gool AJ, Heidegger I, Ioannidis JPA, Jankowski J, Jankowski V, Jeronimo C, Kamat AM, Masereeuw R, Mayer G, Mischak H, Ortiz A, Remuzzi G, Rossing P, Schanstra JP, Schmitz-Dräger BJ, Spasovski G, Staessen JA, Stamatialis D, Stenvinkel P, Wanner C, Williams SB, Zannad F, Zoccali C, Vanholder R. Data Sharing Under the General Data Protection Regulation: Time to Harmonize Law and Research Ethics? Hypertension 2021; 77:1029-1035. [PMID: 33583200 PMCID: PMC7968961 DOI: 10.1161/hypertensionaha.120.16340] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. The General Data Protection Regulation (GDPR) became binding law in the European Union Member States in 2018, as a step toward harmonizing personal data protection legislation in the European Union. The Regulation governs almost all types of personal data processing, hence, also, those pertaining to biomedical research. The purpose of this article is to highlight the main practical issues related to data and biological sample sharing that biomedical researchers face regularly, and to specify how these are addressed in the context of GDPR, after consulting with ethics/legal experts. We identify areas in which clarifications of the GDPR are needed, particularly those related to consent requirements by study participants. Amendments should target the following: (1) restricting exceptions based on national laws and increasing harmonization, (2) confirming the concept of broad consent, and (3) defining a roadmap for secondary use of data. These changes will be achieved by acknowledged learned societies in the field taking the lead in preparing a document giving guidance for the optimal interpretation of the GDPR, which will be finalized following a period of commenting by a broad multistakeholder audience. In parallel, promoting engagement and education of the public in the relevant issues (such as different consent types or residual risk for re-identification), on both local/national and international levels, is considered critical for advancement. We hope that this article will open this broad discussion involving all major stakeholders, toward optimizing the GDPR and allowing a harmonized transnational research approach.
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Affiliation(s)
- Antonia Vlahou
- From the Systems Biology Center, Biomedical Research Foundation, Academy of Athens, Greece (A.V.)
| | - Dara Hallinan
- FIZ Karlsruhe - Leibniz-Institut für Informationsinfrastruktur, Eggenstein-Leopoldshafen, Germany (D.H., F.B.)
| | - Rolf Apweiler
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom (R.A.)
| | - Angel Argiles
- SAS RD-Néphrologie and Bio-Communication Cardio-Métabolique (BC2M) EA7288 and University Hospital Lapeyronie, University of Montpellier, France (A.A.)
| | - Joachim Beige
- KfH-Nierenzentrum und Klinikum St. Georg, Nephrologie, Leipzig, Germany (J.B.)
| | - Ariela Benigni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (A.B., G.R.)
| | - Rainer Bischoff
- Department of Analytical Biochemistry, University of Groningen, The Netherlands (R.B.)
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Canada (P.C.B.)
| | - Franziska Boehm
- FIZ Karlsruhe - Leibniz-Institut für Informationsinfrastruktur, Eggenstein-Leopoldshafen, Germany (D.H., F.B.)
| | - Jocelyn Céraline
- Institute of Genetics and Molecular and Cellular Biology, Institut de cancérologie Strasbourg Europe, Université de Strasbourg, France (J.C.)
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Greece; (G.P.C.)
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.D.)
| | - Pieter Evenepoel
- Laboratory of Nephrology, Department of Immunology and Microbiology, Leuven, Belgium (P.E.)
| | - Ivo Fridolin
- Department of Health Technologies, Tallinn University of Technology, Estonia (I.F.)
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Belgium (G.G., R.V.)
| | - Alain J van Gool
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.J.v.G.)
| | - Isabel Heidegger
- Department of Urology, Medizinische Universität Innsbruck, Austria (I.H.)
| | - John P A Ioannidis
- Departments of Medicine and of Epidemiology and Population Health and Meta-Research Innovation Center at Stanford (METRICS), Stanford University (J.P.A.I.)
| | - Joachim Jankowski
- Institute of Cardiovascular Research, RWTH Aachen University, Germany (J.J., V.J.)
| | - Vera Jankowski
- Institute of Cardiovascular Research, RWTH Aachen University, Germany (J.J., V.J.)
| | - Carmen Jeronimo
- Cancer Biology and Epigenetics Group, Portuguese Oncology Institute of Porto and Abel Salazar Institute of Biomedical Sciences, University of Porto, Portugal (C.J.)
| | - Ashish M Kamat
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Centre, Houston (A.K.)
| | - Rosalinde Masereeuw
- Div. Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, NL (R.M.)
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medizinische Universität Innsbruck, Austria (G.M.)
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics AG, Hannover, Germany (H.M.)
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS - Fundación Jiménez Díaz-UAM, Madrid, Spain (A.O.)
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (A.B., G.R.)
| | - Peter Rossing
- Steno Diabetes Center, University of Copenhagen, Denmark (P.R.)
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse and Université Toulouse III Paul-Sabatier, France (J.P.S.)
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nuremberg, and Department of Urology, Friedrich-Alexander University of Erlangen, Germany (B.J.S-D)
| | - Goce Spasovski
- Department of Nephrology, University Clinical Center Skopje, North Macedonia (G.S.)
| | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium, Biomedical Science Group, University of Leuven (J.A.S.)
| | - Dimitrios Stamatialis
- Bioartificial organs, Department of Biomaterials Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands (D.S.)
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska University Hospital, Stockholm, Sweden (P.S.)
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany (C.W.)
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston (S.B.W.)
| | - Faiez Zannad
- Centre d'Investigation Clinique Inserm and Université de Lorraine, CHU Nancy, France (F.Z.)
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Italy (C.Z.)
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Glorieux G, Vanholder R, Van Biesen W, Pletinck A, Schepers E, Neirynck N, Speeckaert M, De Bacquer D, Verbeke F. Free p-cresyl sulfate shows the highest association with cardiovascular outcome in chronic kidney disease. Nephrol Dial Transplant 2021; 36:998-1005. [DOI: 10.1093/ndt/gfab004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Several protein-bound uraemic toxins (PBUTs) have been associated with cardiovascular (CV) and all-cause mortality in chronic kidney disease (CKD) but the degree to which this is the case per individual PBUT and the pathophysiological mechanism have only partially been unraveled.
Methods
We compared the prognostic value of both total and free concentrations of five PBUTs [p-cresyl sulfate (pCS), p-cresyl glucuronide, indoxyl sulfate, indole acetic acid and hippuric acid] in a cohort of 523 patients with non-dialysis CKD Stages G1–G5. Patients were followed prospectively for the occurrence of a fatal or non-fatal CV event as the primary endpoint and a number of other major complications as secondary endpoints. In addition, association with and the prognostic value of nine markers of endothelial activation/damage was compared.
Results
After a median follow-up of 5.5 years, 149 patients developed the primary endpoint. In multivariate Cox regression models adjusted for age, sex, systolic blood pressure, diabetes mellitus and estimated glomerular filtration rate, and corrected for multiple testing, only free pCS was associated with the primary endpoint {hazard ratio [HR]1.39 [95% confidence interval (CI) 1.14–1.71]; P = 0.0014}. Free pCS also correlated with a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (r = −0.114, P < 0.05), angiopoietin-2 (ANGPT2) (r = 0.194, P < 0.001), matrix metallopeptidase 7 (MMP-7; (r = 0.238, P < 0.001) and syndecan 1 (r = 0.235, P < 0.001). Of these markers of endothelial activation/damage, ANGPT2 [HR 1.46 (95% CI 1.25–1.70); P < 0.0001] and MMP-7 [HR 1.31 (95% CI 1.08–1.59); P = 0.0056] were also predictive of the primary outcome.
Conclusions
Among PBUTs, free pCS shows the highest association with CV outcome in non-dialysed patients with CKD. Two markers of endothelial activation/damage that were significantly correlated with free pCS, ANGPT2 and MMP-7 were also associated with CV outcome. The hypothesis that free pCS exerts its CV toxic effects by an adverse effect on endothelial function deserves further exploration.
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Affiliation(s)
- Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Anneleen Pletinck
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Eva Schepers
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Neirynck
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Marijn Speeckaert
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
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Barba C, Soulage CO, Caggiano G, Glorieux G, Fouque D, Koppe L. Effects of Fecal Microbiota Transplantation on Composition in Mice with CKD. Toxins (Basel) 2020; 12:toxins12120741. [PMID: 33255454 PMCID: PMC7761367 DOI: 10.3390/toxins12120741] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/07/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a renal disorder characterized by the accumulation of uremic toxins with limited strategies to reduce their concentrations. A large amount of data supports the pivotal role of intestinal microbiota in CKD complications and as a major source of uremic toxins production. Here, we explored whether fecal microbiota transplantation (FMT) could be attenuated in metabolic complication and uremic toxin accumulation in mice with CKD. Methods: Kidney failure was chemically induced by a diet containing 0.25% (w/w) of adenine for four weeks. Mice were randomized into three groups: control, CKD and CKD + FMT groups. After four weeks, CKD mice underwent fecal microbiota transplantation (FMT) from healthy mice or phosphate buffered saline as control. The gut microbiota structure, uremic toxins plasmatic concentrations, and metabolic profiles were explored three weeks after transplantation. Results: Associated with the increase of alpha diversity, we observed a noticeable improvement of gut microbiota disturbance, after FMT treatment. FMT further decreased p-cresyl sulfate accumulation and improved glucose tolerance. There was no change in kidney function. Conclusions: These data indicate that FMT limited the accumulation of uremic toxins issued from intestinal cresol pathway by a beneficial effect on gut microbiota diversity. Further studies are needed to investigate the FMT efficiency, the timing and feces amount for the transplantation before, to become a therapeutic option in CKD patients.
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Affiliation(s)
- Christophe Barba
- CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (C.B.); (C.O.S.); (D.F.)
- Department of Nephrology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310 Pierre Bénite, France
| | - Christophe O. Soulage
- CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (C.B.); (C.O.S.); (D.F.)
| | - Gianvito Caggiano
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Gent, Belgium;
| | - Denis Fouque
- CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (C.B.); (C.O.S.); (D.F.)
- Department of Nephrology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310 Pierre Bénite, France
| | - Laetitia Koppe
- CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (C.B.); (C.O.S.); (D.F.)
- Department of Nephrology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310 Pierre Bénite, France
- Correspondence:
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Gryp T, Vanholder R, Glorieux G. The authors reply. Kidney Int 2020; 98:784. [PMID: 32828239 DOI: 10.1016/j.kint.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine and Pediatrics, Nephrology Division, Ghent University Hospital, Ghent, Belgium
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Division, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Division, Ghent University Hospital, Ghent, Belgium.
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De Vos C, Lemarcq L, Dhondt A, Glorieux G, Van Biesen W, Eloot S. The impact of intradialytic cycling on the removal of protein-bound uraemic toxins: A randomised cross-over study. Int J Artif Organs 2020; 44:156-164. [PMID: 32820982 DOI: 10.1177/0391398820949880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The evidence on impact of intradialytic exercise on the removal of urea, is conflictive. Impact of exercise on kinetics of serum levels of protein-bound uraemic toxins, known to exert toxicity and to have kinetics dissimilar of those of urea, has so far not been explored. Furthermore, if any effect, the most optimal intensity, time point and/or required duration of intradialytic exercise to maximise removal remain obscure. We therefore studied the impact of different intradialytic cycling schedules on the removal of protein-bound uraemic toxins during haemodialysis (HD).This randomised cross-over study included seven stable patients who were dialysed with an FX800 dialyser during three consecutive midweek HD sessions of 240 min: (A) without cycling; (B) cycling for 60 min between 60th and 120th minutes of dialysis; and (C) cycling for 60 min between 150th and 210th minutes, with the same cycling load as in session B. Blood and dialysate flows were respectively 300 and 500 mL/min. Blood was sampled from the blood inlet at different time points, and dialysate was partially collected (300 mL/h). Small water soluble solutes and protein-bound toxins were quantified and intradialytic reduction ratios (RR) and overall removal were calculated per solute.Total solute removal and reduction ratios were not different between the three test sessions, except for the reduction ratios RR60-120 and RR150-210 for potassium.In conclusion, we add evidence to the existing literature that, regardless of the timing within the dialysis session, intradialytic exercise has no impact on small solute clearance, and demonstrated also a lack of impact for protein-bound solutes.
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Barba C, Soulage C, Glorieux G, PICARD C, Fouque D, Koppe L. P0922A LOW AROMATIC AMINO-ACID DIET IMPROVES RENAL FUNCTION AND PREVENTS KIDNEY FIBROSIS IN MICE WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Despite decades of use of low protein diets (LPD) in the management of chronic kidney disease (CKD), the mechanisms through which it delays the progression to end-stage renal disease (ESRD) remain controversial. A reduced production of uremic toxins could contribute to the benefits of the LPD. Aromatic amino-acids are precursors of major uremic toxins such as p-cresyl sulfate (PCS), indoxyl sulfate (IS), indole-3-acetic acid or phenol. We investigated the hypothesis that a low aromatic amino acid diet (LAA, namely low intake of tyrosine, tryptophan and phenylalanine) while being normoproteic, could be as effective as a LPD, through the specific diminution of uremic toxins production.
Method
Renal failure was chemically induced in mice with a diet containing 0.25% (w/w) of adenine. Thereafter, they received 3 different diets for 6 weeks: normoproteic diet (NPD: 14.7% proteins, aromatics 0.019%), LPD (5% proteins, aromatics 0.007%) and LAA (14% proteins, aromatics 0.007%).
Results
LAA and LPD had no significant effect on body weight. Plasma creatinine was significantly lower in LPD and LAA groups compared to NPD group (72 ± 4 and 73 ± 4 µmol/L vs 127 ± 6 µmol/L, p<0.0001), as well as proteinuria (1.3 ± 0.3 and 1.2 ± 0.1 mg/24h vs 3.8 ± 0.9 mg/24h, p<0.05). Kidney fibrosis was more severe in NPD group vs LPD and LAA groups (17 ± 1% vs 10 ± 1 % and 13 ± 2 %, p<0.0001 and p=0.01). Kidney inflammation was also reduced with LPD and LAA. Free PCS and IS were lower in LPD and LAA groups compared to NPD group.
Conclusion
These results suggest that LAA confers similar benefits as compared with those of LPD to delay the progression of CKD through reduction of uremic toxins production, with lower risk of malnutrition.
Renal function and urinary protein excretion in control and CKD mice Serum creatinine (A), blood urea nitrogen (B) and urinary proteins (C) in control and CKD mice fed with normoproteic diet (NPD), low protein diet (LPD) or low aromatic amino-acid diet (LAA). Data are expressed as mean ± SEM for n = 5-11 animals in each group.
*p < 0.05, **p < 0.01, ***p < 0.001 vs CKD-NPD; (two-way ANOVA and Dunnett post hoc test).
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Affiliation(s)
- Christophe Barba
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Department of Nephrology, Pierre-Bénite, France
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, VILLEURBANNE, France
| | - Christophe Soulage
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, VILLEURBANNE, France
| | - Griet Glorieux
- Ghent University Hospital, Nephrology Section, Department of Internal Medicine, Ghent, Belgium
| | - Cecile PICARD
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Department of Pathology, Bron, France
| | - Denis Fouque
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Department of Nephrology, Pierre-Bénite, France
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, VILLEURBANNE, France
| | - Laetitia Koppe
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Department of Nephrology, Pierre-Bénite, France
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, VILLEURBANNE, France
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Gryp T, Vaneechoutte M, Joossens M, Van Biesen W, Glorieux G. P0703IDENTIFICATION AND QUANTIFICATION OF UREMIC TOXIN PRECURSORS-GENERATING GUT BACTERIA IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
In chronic kidney disease (CKD), impaired kidney function results in the accumulation of uremic toxins, which exert deleterious biological effects, contributing to cardiovascular morbidity and mortality. Protein-bound uremic toxins (PBUTs), such as p-cresyl sulfate, indoxyl sulfate and indole-3-acetic acid (IAA), originate from phenolic and indolic compounds, which are end products of the gut bacterial metabolization of aromatic amino acids (AAA). This study investigated the microbial composition in different stages of CKD by isolating, identifying and quantifying PBUT precursor-generating bacteria from fecal samples.
Method
Using fecal samples from patients in CKD stage 1 (n=6) and stage 5 (n=6), bacteria were cultured in a yeast casitone fatty acid glucose broth medium supplemented with AAA under aerobic (2d at 37°C) and anaerobic conditions (7d at 37°C), and confirmed as PBUT precursor-generating bacteria based on their generation capacity of phenolic and indolic compounds, measured with (U)HPLC.
Next, fecal DNA from 14 controls, 111 non-dialyzed and 27 dialyzed CKD patients was used to quantify the total bacterial number but also of 11 of the identified PBUT precursor-generating bacteria with qPCR. Using a Kruskal-Wallis test, bacterial loads were compared between the different CKD stages and control. Correlations between disease stages (control and CKD 1-5) and the abundance of bacterial species were assessed with the Spearman’s rank test.
Results
In total, 150 different bacterial species were isolated from the CKD fecal samples, of which 101 were identified and 92 classified as PBUT precursor-generating bacteria. In general, p-cresol and phenol were mainly generated under anaerobic conditions, while indole and IAA were generated under both aerobic and anaerobic conditions. Phenolic compounds and IAA were predominantly generated by bacterial species belonging to the Bacteroidaceae, Clostridiaceae, Enterococcaceae and Tannerellaceae, while indolic compounds were mainly generated by Bifidobacteriaceae and Enterobacteriaceae.
Quantitative analysis of 11 confirmed PBUT precursor-generating bacteria revealed a higher abundance of Streptococcus spp. and Enterobacteriaceae in fecal samples from HD patients compared to controls and early CKD stages, and for Roseburia spp. compared to CKD 5. Moreover, in HD, the abundance of Clostridioides difficile and Lactobacillus spp. was increased compared to CKD 1-5, and of Escherichia coli compared to control (all p>0.05). The abundance of Bacteroides spp., Faecalibacterium prausnitzii, Akkermansia muciniphila and Bifidobacterium spp. as well as the total number of bacteria was comparable among the different CKD stages and controls. Finally, decrease in kidney function (ranging from control to CKD 5) positively correlated with the abundance of Enterobacteriaceae (rs=0.210), and E. coli (rs=0.286), while an inverse correlation was found with Streptococcus spp. (rs=-0.255), Butyricoccus spp. (rs=-0.326), F. prausnitzii (rs=-0.250), Roseburia spp. (rs=-0.342) and Bifidobacterium spp. (rs=-0.303) (all p>0.05).
Conclusion
The identified PBUT precursor-generating bacteria are potential targets to reduce the plasma PBUT levels in CKD. In addition, in this CKD cohort, based on qPCR, an altered gut microbial composition with the progression of CKD could be established/confirmed.
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Affiliation(s)
- Tessa Gryp
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Ghent, Belgium
- Ghent University, Department of Diagnostic Sciences, Ghent, Belgium
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Leuven, Belgium
| | | | - Marie Joossens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Leuven, Belgium
| | - Wim Van Biesen
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Ghent, Belgium
| | - Griet Glorieux
- Ghent University Hospital, Department of Internal Medicine and Pediatrics, Ghent, Belgium
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Van Biesen W, Van Craenenbroeck A, Abramowicz D, Els H, Nic V, Glorieux G, Couttenye MM, Eloot S. TO011HEALTH UTILITY BUT NOT UREMIC TOXINS ARE ASSOCIATED WITH ONE YEAR MORTALITY IN HD PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa141.to011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Patient centred care is progressively gaining importance. Standardized outcomes should take into account patient relevant outcomes, such as mortality and quality of life. It is unknown whether the health utility index EQ5D, an objective assessment of quality of life, is associated with mortality in haemodialysis patients. Serum concentrations of different uremic toxins have been associated with survival. We intended to explore whether EQ5D rather than concentrations of representative uraemic toxins (UT) was associated with mortality.
Method
Prospective longitudinal multicentric cohort study of all haemodialysis patients at 5 representative dialysis centres in Flanders. Total and free concentrations of representative uraemic toxins indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG), indole acetic acid (IAA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), hippuric acid (HA) and uric acid (UA) were determined at baseline. Mini Nutritional Assessment (MNA) and EQ5D were assessed by dedicated nurses. Mortality was assessed from administrative or medical records. A Cox regression model was built, both fixed and as conditional forward including clinical parameters, MNA, EQ5D and serum concentrations of the different uraemic toxins.
Results
216 prevalent patients (62%male, age 67.2 ± 15.7) all on high flux haemodialysis were included. Over the observation period, 59 patients (27%) died. Health utility as assessed by EQ5D was 0.69±0.28; perceived health by visual analogue scale (VAS) (0-100) was 59.6±18.6. Adjusting for age, gender and MNA score, free but not total concentrations of IxS, pCS and IAA and EQ5D score were associated with overall survival in the forced entry model. However, neither in the fixed entry, the forward or backward model were serum concentrations of uraemic toxins retained, and only age, gender, BMI, EQ5D and VAS were consistently associated with survival.
Conclusion
Measures of health utility, such as EQ5D, and quality of life, such as a simple VAS score, are more predictive of survival in patients on regular haemodialysis than serum concentrations of a panel of relevant uraemic toxins. Health utility and QoL are thus not only directly relevant to patients, but also indirectly through an association with improved survival.
The concept of dialysis adequacy has been challenged over the last decade, mainly because it was focusing on small solute clearance. Different authors reported that concentrations of middle molecular and protein bound solutes were more representative. In our study, free but not total solute concentrations were associated with survival. However, adjusting additionally for health utility and/or health perception and/or assessment of nutritional status abolishes this association. Studies assessing interventions to enhance solute removal should not only include solute concentrations as outcome, but also consider EQ5D, VAS and nutritional status as important outcomes to enhance patient centeredness of their findings.
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Affiliation(s)
| | | | | | - Holvoet Els
- Ghent University Hospital, Renal Division, Gent, Belgium
| | - Veys Nic
- Ghent University Hospital, Renal Division, Gent, Belgium
| | - Griet Glorieux
- Ghent University Hospital, Renal Division, Gent, Belgium
| | | | - Sunny Eloot
- Ghent University Hospital, Renal Division, Gent, Belgium
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Glorieux G, Gryp T, Perna A. Gut-Derived Metabolites and Their Role in Immune Dysfunction in Chronic Kidney Disease. Toxins (Basel) 2020; 12:toxins12040245. [PMID: 32290429 PMCID: PMC7232434 DOI: 10.3390/toxins12040245] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Several of the uremic toxins, which are difficult to remove by dialysis, originate from the gut bacterial metabolism. This opens opportunities for novel targets trying to decrease circulating levels of these toxins and their pathophysiological effects. The current review focuses on immunomodulatory effects of these toxins both at their side of origin and in the circulation. In the gut end products of the bacterial metabolism such as p-cresol, trimethylamine and H2S affect the intestinal barrier structure and function while in the circulation the related uremic toxins stimulate cells of the immune system. Both conditions contribute to the pro-inflammatory status of patients with chronic kidney disease (CKD). Generation and/or absorption of these toxin precursors could be targeted to decrease plasma levels of their respective uremic toxins and to reduce micro-inflammation in CKD.
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Affiliation(s)
- Griet Glorieux
- Nephrology Division, Ghent University Hospital and Ghent University, 9000 Ghent, Belgium;
- Correspondence: ; Tel.: +32-9-3324511
| | - Tessa Gryp
- Nephrology Division, Ghent University Hospital and Ghent University, 9000 Ghent, Belgium;
| | - Alessandra Perna
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
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Gryp T, Huys GR, Joossens M, Van Biesen W, Glorieux G, Vaneechoutte M. Isolation and Quantification of Uremic Toxin Precursor-Generating Gut Bacteria in Chronic Kidney Disease Patients. Int J Mol Sci 2020; 21:E1986. [PMID: 32183306 PMCID: PMC7139965 DOI: 10.3390/ijms21061986] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
In chronic kidney disease (CKD), impaired kidney function results in accumulation of uremic toxins, which exert deleterious biological effects and contribute to inflammation and cardiovascular morbidity and mortality. Protein-bound uremic toxins (PBUTs), such as p-cresyl sulfate, indoxyl sulfate and indole-3-acetic acid, originate from phenolic and indolic compounds, which are end products of gut bacterial metabolization of aromatic amino acids (AAA). This study investigates gut microbial composition at different CKD stages by isolating, identifying and quantifying PBUT precursor-generating bacteria. Fecal DNA extracts from 14 controls and 138 CKD patients were used to quantify total bacterial number and 11 bacterial taxa with qPCR. Moreover, isolated bacteria from CKD 1 and CKD 5 fecal samples were cultured in broth medium supplemented with AAA under aerobic and anaerobic conditions, and classified as PBUT precursor-generators based on their generation capacity of phenolic and indolic compounds, measured with U(H)PLC. In total, 148 different fecal bacterial species were isolated, of which 92 were PBUT precursor-generators. These bacterial species can be a potential target for reducing PBUT plasma levels in CKD. qPCR indicated lower abundance of short chain fatty acid-generating bacteria, Bifidobacterium spp. and Streptococcus spp., and higher Enterobacteriaceae and E. coli with impaired kidney function, confirming an altered gut microbial composition in CKD.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (W.V.B.); (G.G.)
- Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, 9000 Ghent, Belgium;
- Department of Microbiology, Immunology and Transplantation, Molecular Microbiology—Microbiome Research Lab, KU Leuven, 3000 Leuven, Belgium (M.J.)
| | - Geert R.B. Huys
- Department of Microbiology, Immunology and Transplantation, Molecular Microbiology—Microbiome Research Lab, KU Leuven, 3000 Leuven, Belgium (M.J.)
| | - Marie Joossens
- Department of Microbiology, Immunology and Transplantation, Molecular Microbiology—Microbiome Research Lab, KU Leuven, 3000 Leuven, Belgium (M.J.)
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (W.V.B.); (G.G.)
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (W.V.B.); (G.G.)
| | - Mario Vaneechoutte
- Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, 9000 Ghent, Belgium;
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Gryp T, Glorieux G, Joossens M, Vaneechoutte M. Comparison of five assays for DNA extraction from bacterial cells in human faecal samples. J Appl Microbiol 2020; 129:378-388. [PMID: 32034968 PMCID: PMC7384110 DOI: 10.1111/jam.14608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/30/2022]
Abstract
Aim To determine the most effective DNA extraction method for bacteria in faecal samples. Materials and Results This study assessed five commercial methods, that is, NucliSens easyMag, QIAamp DNA Stool Mini kit, PureLink Microbiome DNA purification kit, QIAamp PowerFecal DNA kit and RNeasy PowerMicrobiome kit, of which the latter has been optimized for DNA extraction. The DNA quantity and quality were determined using Nanodrop, Qubit and qPCR. The PowerMicrobiome kit recovered the highest DNA concentration, whereby this kit also recovered the highest gene copy number of Gram positives, Gram negatives and total bacteria. Furthermore, the PowerMicrobiome kit in combination with mechanical pre‐treatment (bead beating) and with combined enzymatic and mechanical pre‐treatment (proteinase K+mutanolysin+bead beating) was more effective than without pre‐treatment. Conclusion From the five DNA extraction methods that were compared, the PowerMicrobiome kit, preceded by bead beating, which is standard included, was found to be the most effective DNA extraction method for bacteria in faecal samples. Significance and Impact of the Study The quantity and quality of DNA extracted from human faecal samples is a first important step to optimize molecular methods. Here we have shown that the PowerMicrobiome kit is an effective DNA extraction method for bacterial cells in faecal samples for downstream qPCR purpose.
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Affiliation(s)
- T Gryp
- Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium.,Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent, Belgium.,Department of Microbiology, Immunology and Transplantation, Molecular Microbiology - Microbiome Research Lab, KU Leuven, Leuven, Belgium
| | - G Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent, Belgium
| | - M Joossens
- Department of Microbiology, Immunology and Transplantation, Molecular Microbiology - Microbiome Research Lab, KU Leuven, Leuven, Belgium
| | - M Vaneechoutte
- Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium
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Gryp T, De Paepe K, Vanholder R, Kerckhof FM, Van Biesen W, Van de Wiele T, Verbeke F, Speeckaert M, Joossens M, Couttenye MM, Vaneechoutte M, Glorieux G. Gut microbiota generation of protein-bound uremic toxins and related metabolites is not altered at different stages of chronic kidney disease. Kidney Int 2020; 97:1230-1242. [PMID: 32317112 DOI: 10.1016/j.kint.2020.01.028] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 01/06/2023]
Abstract
Chronic kidney disease (CKD) is characterized by accumulation of protein-bound uremic toxins such as p-cresyl sulfate, p-cresyl glucuronide, indoxyl sulfate and indole-3-acetic acid, which originate in the gut. Intestinal bacteria metabolize aromatic amino acids into p-cresol and indole, (further conjugated in the colon mucosa and liver) and indole-3-acetic acid. Here we measured fecal, plasma and urine metabolite concentrations; the contribution of gut bacterial generation to plasma protein-bound uremic toxins accumulation; and influx into the gut of circulating protein-bound uremic toxins at different stages of CKD. Feces, blood and urine were collected from 14 control individuals and 141 patients with CKD. Solutes were quantified by ultra-high performance liquid chromatography. To assess the rate of bacterial generation of p-cresol, indole and indole-3-acetic acid, fecal samples were cultured ex vivo. With CKD progression, an increase in protein-bound uremic toxins levels was observed in plasma, whereas the levels of these toxins and their precursors remained the same in feces and urine. Anaerobic culture of fecal samples showed no difference in ex vivo p-cresol, indole and indole-3-acetic acid generation. Therefore, differences in plasma protein-bound uremic toxins levels between different CKD stages cannot be explained by differences in bacterial generation rates in the gut, suggesting retention due to impaired kidney function as the main contributor to their increased plasma levels. Thus, as fractional clearance decreased with the progression of CKD, tubular clearance appeared to be more affected than the glomerular filtration rate, and there was no net increase in protein-bound uremic toxins influx into the gut lumen with increased plasma levels.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium; Department of Microbiology, Immunology and Transplantation, Molecular Microbiology-Microbiome Research Lab, KU Leuven, Leuven, Belgium.
| | - Kim De Paepe
- Department of Biotechnology, Center for Microbial Ecology and Technology, Ghent University, Ghent, Belgium
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Frederiek-Maarten Kerckhof
- Department of Biotechnology, Center for Microbial Ecology and Technology, Ghent University, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Tom Van de Wiele
- Department of Biotechnology, Center for Microbial Ecology and Technology, Ghent University, Ghent, Belgium
| | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Marijn Speeckaert
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Marie Joossens
- Department of Microbiology, Immunology and Transplantation, Molecular Microbiology-Microbiome Research Lab, KU Leuven, Leuven, Belgium
| | | | - Mario Vaneechoutte
- Department of Diagnostic Sciences, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
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De Bruyne S, Himpe J, Delanghe SE, Glorieux G, Van Biesen W, De Buyzere ML, Speeckaert MM, Delanghe JR. Carbamoylated Nail Proteins as Assessed by Near-Infrared Analysis are Associated with Load of Uremic Toxins and Mortality in Hemodialysis Patients. Toxins (Basel) 2020; 12:toxins12020083. [PMID: 31991867 PMCID: PMC7076796 DOI: 10.3390/toxins12020083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022] Open
Abstract
Carbamoylation is an important risk factor for accelerated atherogenesis and mortality in patients undergoing hemodialysis (HD). We intended to explore whether carbamoylation as assessed by near-infrared (NIR) analysis of nail proteins is associated with (a) plasma concentrations of representative uremic toxins and (b) mortality in HD patients. A total of 53 healthy volunteers and 84 consecutive HD patients were enrolled in this cross-sectional cohort study. Standard laboratory methods were used to measure routine parameters, whereas levels of uremic toxins were determined using reversed-phase high-performance liquid chromatography (RP-HPLC). Spectra of distal fingernail clippings were obtained using an Avantes NIR spectrometer and processed using chemometric data analysis. The second derivative of the peak intensity at 1494 nm attributed to N-H amide bands from NH2 of carbamoyl (-CONH2) groups was higher in HD patients than in control subjects (p < 0.0001). Peak intensity levels were associated with age and plasma levels of representative uremic toxins. Cox-regression analysis revealed a significant association with all-cause mortality, even after adjustment for age. In conclusion, our data revealed that carbamoylation as assessed by NIR analysis of nail proteins is associated with plasma concentrations of uremic toxins and also with mortality in HD patients. Further research to explore whether it is a surrogate marker or a hard indicator of mortality risk is warranted.
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Affiliation(s)
- Sander De Bruyne
- Department of Clinical Chemistry, Ghent University, 9000 Ghent, Belgium; (S.D.B.); (J.H.)
| | - Jonas Himpe
- Department of Clinical Chemistry, Ghent University, 9000 Ghent, Belgium; (S.D.B.); (J.H.)
| | - Sigurd E. Delanghe
- Department of Nephrology, Ghent University, 9000 Ghent, Belgium; (S.E.D.); (G.G.); (W.V.B.); (M.M.S.)
| | - Griet Glorieux
- Department of Nephrology, Ghent University, 9000 Ghent, Belgium; (S.E.D.); (G.G.); (W.V.B.); (M.M.S.)
| | - Wim Van Biesen
- Department of Nephrology, Ghent University, 9000 Ghent, Belgium; (S.E.D.); (G.G.); (W.V.B.); (M.M.S.)
| | - Marc L. De Buyzere
- Department of Cardiology, Heart Center, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University, 9000 Ghent, Belgium; (S.E.D.); (G.G.); (W.V.B.); (M.M.S.)
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Joris R. Delanghe
- Department of Clinical Chemistry, Ghent University, 9000 Ghent, Belgium; (S.D.B.); (J.H.)
- Correspondence: ; Tel.: +32-9-332-29-56
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Steenbeke M, De Bruyne S, Van Aken E, Glorieux G, Van Biesen W, Himpe J, De Meester G, Speeckaert M, Delanghe J. UV Fluorescence-Based Determination of Urinary Advanced Glycation End Products in Patients with Chronic Kidney Disease. Diagnostics (Basel) 2020; 10:diagnostics10010034. [PMID: 31936498 PMCID: PMC7168138 DOI: 10.3390/diagnostics10010034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
Advanced glycation end products (AGEs) are a class of proteins or lipids that are non-enzymatically glycated and oxidized after contact with aldose sugars. The accumulation of AGEs results in carbonyl stress, which is characteristic for diabetes mellitus, uremia, atherosclerosis and vascular dysfunction. In recent decades, several innovative methods have been developed to measure the concentration of AGEs in blood or urine. In the present study, we evaluated the use of UV fluorescence as an alternative tool to detect urinary AGEs in four groups of well characterized chronic kidney disease (CKD) patients over a wide range of kidney insufficiency and in a group of healthy subjects. Using an excitation wavelength of 365 nm, the fluorescence spectra of urinary AGEs were recorded in the 400–620 nm emission range. When considering the emission peaks at 440 nm and 490 nm, a significantly higher AGE-specific fluorescence intensity was detected in CKD patients compared to healthy subjects (p < 0.0001 and p = 0.0001, respectively). The urinary creatinine adjusted fluorescence emission spectra in the group of CKD patients with diabetes mellitus were comparable with those of CKD patients without diabetes mellitus. Creatinine-adjusted fluorescence emission spectra were highest in CKD patients with proteinuria, moderate in CKD patients without proteinuria and lowest in healthy controls (p < 0.0001 at both emission wavelengths). In a multiple regression analysis, age, CRP and insulin treatment were predictors of fluorescence intensity at the emission wavelength of 440 nm. Age and insulin treatment were predictors at 490 nm. The presented method is a simple, cheap, alternative method to monitor the AGE-load in the CKD population.
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Affiliation(s)
- Mieke Steenbeke
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (G.G.); (W.V.B.)
| | - Sander De Bruyne
- Department of Laboratory Medicine, Clinical Chemistry, Ghent University Hospital, 9000 Ghent, Belgium; (S.D.B.); (J.H.); (G.D.M.)
| | - Elisabeth Van Aken
- Department of Ophthalmology, Sint-Elisabeth Ziekenhuis, 9620 Zottegem, Belgium;
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (G.G.); (W.V.B.)
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (G.G.); (W.V.B.)
| | - Jonas Himpe
- Department of Laboratory Medicine, Clinical Chemistry, Ghent University Hospital, 9000 Ghent, Belgium; (S.D.B.); (J.H.); (G.D.M.)
| | - Gilles De Meester
- Department of Laboratory Medicine, Clinical Chemistry, Ghent University Hospital, 9000 Ghent, Belgium; (S.D.B.); (J.H.); (G.D.M.)
| | - Marijn Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium; (M.S.); (G.G.); (W.V.B.)
- Research Foundation Flanders, 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-933-245-09; Fax: +32-933-238-47
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium;
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Rodrigues SD, Santos SS, Meireles T, Romero N, Glorieux G, Pecoits-Filho R, Zhang DD, Nakao LS. Uremic toxins promote accumulation of oxidized protein and increased sensitivity to hydrogen peroxide in endothelial cells by impairing the autophagic flux. Biochem Biophys Res Commun 2019; 523:123-129. [PMID: 31837804 DOI: 10.1016/j.bbrc.2019.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/05/2019] [Indexed: 01/12/2023]
Abstract
Chronic kidney disease (CKD) is associated with high mortality rates, mainly due to cardiovascular diseases (CVD). Uremia has been considered a relevant risk factor for CVD in CKD patients, since uremic toxins (UTs) promote systemic and vascular inflammation, oxidative stress and senescence. Here, we demonstrate that uremic toxins indoxyl sulfate (IxS), p-cresyl sulfate (pCS) and indole acetic acid (IAA) are incorporated by human endothelial cells and inhibit the autophagic flux, demonstrated by cellular p62 accumulation. Moreover, isolated and mixed UTs impair the lysosomal stage of autophagy, as determined by cell imaging of the mRFP-GFP-LC3 protein. Endothelial cells exposed to UTs display accumulation of carbonylated proteins and increased sensitivity to hydrogen peroxide. Rapamycin, an autophagy activator which induces both autophagosome formation and clearance, prevented these effects. Collectively, our findings demonstrate that accumulation of oxidized proteins and enhanced cell sensitivity to hydrogen peroxide are consequences of impaired autophagic flux. These data provide evidence that UTs-induced impaired autophagy may be a novel contributor to endothelial dysfunction.
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Affiliation(s)
- Silvia D Rodrigues
- Department of Basic Pathology, Universidade Federal do Paraná, 81531-980, Curitiba, Brazil
| | - Sabrina S Santos
- Department of Basic Pathology, Universidade Federal do Paraná, 81531-980, Curitiba, Brazil
| | - Tassiana Meireles
- Department of Basic Pathology, Universidade Federal do Paraná, 81531-980, Curitiba, Brazil
| | - Natalia Romero
- Cell Analysis Division, Agilent Technologies, 02421, Lexington, MA, USA
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Roberto Pecoits-Filho
- Center for Health and Biological Sciences, Pontific Catholic University of Paraná, 80215-901, Curitiba, Brazil
| | - Donna D Zhang
- Department of Pharmacology and Toxicology, University of Arizona, 85721, Tucson, AZ, USA
| | - Lia S Nakao
- Department of Basic Pathology, Universidade Federal do Paraná, 81531-980, Curitiba, Brazil.
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Verbeke F, Siwy J, Van Biesen W, Mischak H, Pletinck A, Schepers E, Neirynck N, Magalhães P, Pejchinovski M, Pontillo C, Lichtinghagen R, Brand K, Vlahou A, De Bacquer D, Glorieux G. The urinary proteomics classifier chronic kidney disease 273 predicts cardiovascular outcome in patients with chronic kidney disease. Nephrol Dial Transplant 2019; 36:811-818. [DOI: 10.1093/ndt/gfz242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
The urinary proteomic classifier chronic kidney disease 273 (CKD273) is predictive for the development and progression of chronic kidney disease (CKD) and/or albuminuria in type 2 diabetes. This study evaluates its role in the prediction of cardiovascular (CV) events in patients with CKD Stages G1–G5.
Methods
We applied the CKD273 classifier in a cohort of 451 patients with CKD Stages G1–G5 followed prospectively for a median of 5.5 years. Primary endpoints were all-cause mortality, CV mortality and the composite of non-fatal and fatal CV events (CVEs).
Results
In multivariate Cox regression models adjusting for age, sex, prevalent diabetes and CV history, the CKD273 classifier at baseline was significantly associated with total mortality and time to fatal or non-fatal CVE, but not CV mortality. Because of a significant interaction between CKD273 and CV history (P = 0.018) and CKD stages (P = 0.002), a stratified analysis was performed. In the fully adjusted models, CKD273 classifier was a strong and independent predictor of fatal or non-fatal CVE only in the subgroup of patients with CKD Stages G1–G3b and without a history of CV disease. In those patients, the highest tertile of CKD273 was associated with a >10-fold increased risk as compared with the lowest tertile.
Conclusions
The urinary CKD273 classifier provides additional independent information regarding the CV risk in patients with early CKD stage and a blank CV history. Determination of CKD273 scores on a random urine sample may improve the efficacy of intensified surveillance and preventive strategies by selecting patients who potentially will benefit most from early risk management.
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Affiliation(s)
- Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | - Anneleen Pletinck
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Eva Schepers
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Neirynck
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Antonia Vlahou
- Biotechnology Division, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
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Joossens M, Faust K, Gryp T, Nguyen ATL, Wang J, Eloot S, Schepers E, Dhondt A, Pletinck A, Vieira-Silva S, Falony G, Vaneechoutte M, Vanholder R, Van Biesen W, Huys GRB, Raes J, Glorieux G. Gut microbiota dynamics and uraemic toxins: one size does not fit all. Gut 2019; 68:2257-2260. [PMID: 30464044 PMCID: PMC6872439 DOI: 10.1136/gutjnl-2018-317561] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/25/2018] [Accepted: 11/01/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Marie Joossens
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium
| | - Karoline Faust
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Tessa Gryp
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium,Department of Clinical Chemistry, Microbiology and Immunology, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium
| | - Anh Thi Loan Nguyen
- Address of current employer: Clinical Research SGS, Life Science Services, Mechelen, Belgium
| | - Jun Wang
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium,Current address: CAS Key Laboratory for Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Sunny Eloot
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Eva Schepers
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Annemieke Dhondt
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Anneleen Pletinck
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Sara Vieira-Silva
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium
| | - Gwen Falony
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium
| | - Mario Vaneechoutte
- Department of Clinical Chemistry, Microbiology and Immunology, Laboratory Bacteriology Research, Ghent University, Ghent, Belgium
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Geert Roger Bertrand Huys
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium
| | - Jeroen Raes
- Laboratory of Molecular Bacteriology– Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium,Center for Microbiology, VIB, Leuven, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
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Vollmer T, Ljungberg B, Jankowski V, Jankowski J, Glorieux G, Stegmayr BG. An in-vitro assay using human spermatozoa to detect toxicity of biologically active substances. Sci Rep 2019; 9:14525. [PMID: 31601841 PMCID: PMC6787250 DOI: 10.1038/s41598-019-50929-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/05/2019] [Indexed: 12/24/2022] Open
Abstract
Identifying the key toxic players within an in-vivo toxic syndrome is crucial to develop targeted therapies. Here, we established a novel method that characterizes the effect of single substances by means of an ex-vivo incubation set-up. We found that primary human spermatozoa elicit a distinct motile response on a (uremic) toxic milieu. Specifically, this approach describes the influence of a bulk toxic environment (uremia) as well as single substances (uremic toxins) by real-time analyzing motile cellular behavior. We established the human spermatozoa-based toxicity testing (HSTT) for detecting single substance-induced toxicity to be used as a screening tool to identify in-vivo toxins. Further, we propose an application of the HSTT as a method of clinical use to evaluate toxin-removing interventions (hemodialysis).
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Affiliation(s)
- Tino Vollmer
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden. .,Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin-Brandenburg School for Regenerative Therapies (BSRT) & Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, Umea, Sweden
| | - Vera Jankowski
- Institute for Cardiovascular Research, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Joachim Jankowski
- Institute for Cardiovascular Research, University Hospital, RWTH Aachen University, Aachen, Germany.,School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Bernd G Stegmayr
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Snauwaert E, Van Biesen W, Raes A, Glorieux G, Van Bogaert V, Van Hoeck K, Coppens M, Roels S, Vande Walle J, Eloot S. Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population. Nephrol Dial Transplant 2019; 33:978-986. [PMID: 28992139 DOI: 10.1093/ndt/gfx224] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022] Open
Abstract
Background Chronic kidney disease (CKD) in childhood is poorly explained by routine markers (e.g. urea and creatinine) and is better depicted in adults by other uraemic toxins. This study describes concentrations of representative uraemic toxins in non-dialysis CKD versus healthy children. Methods In 50 healthy children and 57 children with CKD Stages 1-5 [median estimated glomerular filtration rate 48 (25th-75th percentile 24-71) mL/min/1.73 m2; none on dialysis], serum concentrations of small solutes [symmetric and asymmetric dimethyl-arginine (SDMA and ADMA, respectively)], middle molecules [β2-microglobuline (β2M), complement factor D (CfD)] and protein-bound solutes [p-cresylglucuronide (pCG), hippuric acid (HA), indole-acetic acid (IAA), indoxyl sulphate (IxS), p-cresyl sulphate (pCS) and 3-carboxy-4-methyl-5-propyl-furanpropionic acid (CMPF)] were measured. Concentrations in the CKD group were expressed as z-score relative to controls and matched for age and gender. Results SDMA, CfD, β2M, IxS, pCS, IAA, CMPF and HA concentrations were higher in the overall CKD group compared with controls, ranging from 1.7 standard deviations (SD) for IAA and HA to 11.1 SD for SDMA. SDMA, CfD, β2M, IxS and CMPF in CKD Stages 1-2 with concentrations 4.8, 2.8, 4.5, 1.9 and 1.6 SD higher, respectively. In contrast, pCS, pCG and IAA concentrations were only higher than controls from CKD Stages 3-4 onwards, but only in CKD Stage 5 for ADMA and HA (z-score 2.6 and 20.2, respectively). Conclusions This is the first study to establish reference values for a wide range of uraemic toxins in non-dialysis CKD and healthy children. We observed an accumulation of multiple uraemic toxins, each with a particular retention profile according to the different CKD stages.
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Affiliation(s)
- Evelien Snauwaert
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Valerie Van Bogaert
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Koen Van Hoeck
- Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc Coppens
- Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Sanne Roels
- Department of Data Analysis, Faculty of Psychology and Pedagogy, Ghent University, Ghent, Belgium
| | - Johan Vande Walle
- Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
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43
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Barba C, Soulage C, Glorieux G, Picard C, Fouque D, Koppe L. Un régime appauvri en acides aminés aromatiques freine la progression de l’insuffisance rénale chronique chez la souris. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Van Laecke S, Kerre T, Nagler EV, Maes B, Caluwe R, Schepers E, Glorieux G, Van Biesen W, Verbeke F. Hereditary polycystic kidney disease is characterized by lymphopenia across all stages of kidney dysfunction: an observational study. Nephrol Dial Transplant 2019; 33:489-496. [PMID: 28387829 DOI: 10.1093/ndt/gfx040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/08/2017] [Indexed: 01/08/2023] Open
Abstract
Background Polycystic kidney disease (PKD) is characterized by urinary tract infections and extrarenal abnormalities such as an increased risk of cancer. As mutations in polycystin-1 and -2 are associated with decreased proliferation of immortalized lymphoblastoid cells in PKD, we investigated whether lymphopenia could be an unrecognized trait of PKD. Methods We studied 700 kidney transplant recipients with (n = 126) or without PKD at the time of kidney transplantation between 1 January 2003 and 31 December 2014 at Ghent University Hospital. We also studied 204 patients with chronic kidney disease (CKD) with PKD and 204 matched CKD patients without PKD across comparable CKD strata with assessment between 1 January 1999 and 1 February 2016 at three renal outpatient clinics. We compared lymphocyte counts with multiple linear regression analysis to adjust for potential confounders. We analysed flow cytometric immunophenotyping data and other haematological parameters. Results Lymphocyte counts were 264/µL [95% confidence interval (CI) 144-384] and 345/µL (95% CI 245-445) (both P < 0.001) lower in the end-stage kidney disease (ESKD) and CKD cohort, respectively, after adjustment for age, sex, ln(C-reactive protein) and estimated glomerular filtration rate (in the CKD cohort only). In particular, CD8+ T and B lymphocytes were significantly lower in transplant recipients with versus without PKD (P < 0.001 for both). Thrombocyte and monocyte counts were lower in patients with versus without PKD in both cohorts (P < 0.001 for all analyses except P = 0.01 for monocytes in the ESKD cohort). Conclusion PKD is characterized by distinct cytopenias and especially lymphopenia, independent of kidney function. This finding has the potential to alter our therapeutic approach to patients with PKD.
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Affiliation(s)
| | - Tessa Kerre
- Department of Haematology and Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Evi V Nagler
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Bart Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | | | - Eva Schepers
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
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45
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Chinnappa S, White E, Lewis N, Baldo O, Tu YK, Glorieux G, Vanholder R, El Nahas M, Mooney A. Early and asymptomatic cardiac dysfunction in chronic kidney disease. Nephrol Dial Transplant 2019; 33:450-458. [PMID: 28525624 DOI: 10.1093/ndt/gfx064] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure (HF) is highly prevalent and associated with high mortality in chronic kidney disease (CKD). However, the pathophysiology of cardiac dysfunction in CKD, especially in the early asymptomatic stage, is not well understood. We studied subclinical cardiac dysfunction in asymptomatic CKD patients without comorbid cardiac disease or diabetes mellitus by evaluating peak cardiac performance. Methods In a cross-sectional study (n = 130) we investigated 70 male non-diabetic CKD patients (21 CKD stage 2-3a, 27 CKD stage 3b-4 and 22 CKD stage 5) employing specialized cardiopulmonary exercise testing to measure peak cardiac output and cardiac power output non-invasively. Data from 35 age-matched healthy male volunteers were obtained for comparison. In addition, as a positive control, data from 25 age-matched male HF patients in New York Heart Association class II and III were also obtained. Results The study subjects showed a graded reduction in peak cardiac power, with 6.13 ± 1.11 W in controls, 5.02 ± 0.78 W in CKD 2-3a, 4.59 ± 0.53 W in CKD 3b-4 and 4.02 ± 0.73 W in CKD 5, although not as impaired as in HF, with 2.34 ± 0.63 W (all P < 0.005 versus control). The central haemodynamic characteristics of the cardiac impairment in CKD mirrored that of HF, with reduced flow and pressure-generating capacities, reduced chronotropic reserve and impaired contractility. Conclusions The study demonstrates for the first time impaired peak cardiac performance and cardiac functional reserve in asymptomatic CKD patients. The evidence of myocardial dysfunction in the absence of comorbid cardiac disease and diabetes warrants further evaluation of current pathophysiological concepts of cardiovascular disease in CKD.
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Affiliation(s)
- Shanmugakumar Chinnappa
- Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Edward White
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Nigel Lewis
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Omer Baldo
- Department of Urology, Airedale NHS Foundation Trust, Keighley, UK
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National University of Taiwan, Taiwan
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - Meguid El Nahas
- Department of Nephrology, University of Sheffield, Sheffield, UK
| | - Andrew Mooney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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46
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Snauwaert E, Van Biesen W, Raes A, Glorieux G, Vande Walle J, Roels S, Vanholder R, Askiti V, Azukaitis K, Bayazit A, Canpolat N, Fischbach M, Saoussen K, Litwin M, Obrycki L, Paglialonga F, Ranchin B, Samaille C, Schaefer F, Schmitt CP, Spasojevic B, Stefanidis CJ, Shroff R, Eloot S. Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population. Nephrol Dial Transplant 2019; 35:648-656. [DOI: 10.1093/ndt/gfz132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Haemodiafiltration (HDF) is accepted to effectively lower plasma levels of middle molecules in the long term, while data are conflicting with respect to the additive effect of convection on lowering protein-bound uraemic toxins (PBUTs). Here we compared pre-dialysis β2-microglobulin (β2M) and PBUT levels and the percentage of protein binding (%PB) in children on post-dilution HDF versus conventional high- (hf) or low-flux (lf) haemodialysis (HD) over 12 months of treatment.
Methods
In a prospective multicentre, non-randomized parallel-arm intervention study, pre-dialysis levels of six PBUTs and β2M were measured in children (5–20 years) on post-HDF (n = 37), hf-HD (n = 42) and lf-HD (n = 18) at baseline and after 12 months. Analysis of variance was used to compare levels and %PB in post-HDF versus conventional hf-HD and lf-HD cross-sectionally at 12 months and longitudinal from baseline to 12 months.
Results
For none of the PBUTs, no difference was found in either total and free plasma levels or %PB between post-HDF versus the hf-HD and lf-HD groups. Children treated with post-HDF had lower pre-dialysis β2M levels [median 23.2 (21.5; 26.6) mg/dL] after 12 months versus children on hf-HD [P<0.01; 35.2 (29.3; 41.2) mg/dL] and children on lf-HD [P<0.001; 47.2 (34.3; 53.0) mg/dL]. While β2M levels remained steady in the hf-HD and lf-HD group, a decrease in β2M was demonstrated for children on post-HDF (P<0.01).
Conclusions
While post-HDF successfully decreased β2M, no additive effect on PBUT over 12 months of treatment was found. PBUT removal is complex and hampered by several factors. In children, these factors might be different from adults and should be explored in future research.
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Affiliation(s)
- Evelien Snauwaert
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Ann Raes
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Sanne Roels
- Department of Data Analysis, Faculty of Psychology and Pedagogy, Ghent University, Ghent, Belgium
| | - Raymond Vanholder
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | | | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | | | - Mieczyslaw Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Fabio Paglialonga
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Charlotte Samaille
- Nephrologie pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | | | - Brankica Spasojevic
- University Children's Hospital, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sunny Eloot
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
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47
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Deltombe O, Glorieux G, Marzouki S, Masereeuw R, Schneditz D, Eloot S. Selective Transport of Protein-Bound Uremic Toxins in Erythrocytes. Toxins (Basel) 2019; 11:toxins11070385. [PMID: 31266243 PMCID: PMC6669440 DOI: 10.3390/toxins11070385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/20/2022] Open
Abstract
To better understand the kinetics of protein-bound uremic toxins (PBUTs) during hemodialysis (HD), we investigated the distribution of hippuric acid (HA), indole-3-acetic acid (IAA), indoxyl sulfate (IS), and p-cresyl sulfate (pCS) in erythrocytes of HD patients. Their transport across the erythrocyte membrane was explored in the absence of plasma proteins in vitro in a series of loading and unloading experiments of erythrocytes from healthy subjects and HD patients, respectively. Furthermore, the impact of three inhibitors of active transport proteins in erythrocytes was studied. The four PBUTs accumulated in erythrocytes from HD patients. From loading and unloading experiments, it was found that (i) the rate of transport was dependent on the studied PBUT and increased in the following sequence: HA < IS < pCS < IAA and (ii) the solute partition of intra- to extra-cellular concentrations was uneven at equilibrium. Finally, inhibiting especially Band 3 proteins affected the transport of HA (both in loading and unloading), and of IS and pCS (loading). By exploring erythrocyte transmembrane transport of PBUTs, their kinetics can be better understood, and new strategies to improve their dialytic removal can be developed.
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Affiliation(s)
- Olivier Deltombe
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sami Marzouki
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium
| | - Rosalinde Masereeuw
- Department of Pharmaceutical Sciences, Pharmacology, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Daniel Schneditz
- Otto Loewi Research Center, Physiology, Medical University of Graz, 8010 Graz, Austria
| | - Sunny Eloot
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium.
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48
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Gryp T, De Paepe K, Kerckhof FM, Van Biesen W, Vanholder R, Joossens M, Vaneechoutte M, Glorieux G. FO079CONCENTRATIONS OF P-CRESYL - AND INDOXYL SULFATE AND THEIR PRECURSORS IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE: FROM FECES TO URINE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Perna AF, Glorieux G, Zacchia M, Trepiccione F, Capolongo G, Vigorito C, Anishchenko E, Ingrosso D. The role of the intestinal microbiota in uremic solute accumulation: a focus on sulfur compounds. J Nephrol 2019; 32:733-740. [PMID: 30673975 DOI: 10.1007/s40620-019-00589-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
The gut microbiota is considered to be a novel important factor to take into account in the pathogenesis of chronic kidney disease and uremia. Much attention has been paid to specific uremic retention solutes of microbial origin, such as indoxyl sulfate, p-cresyl sulfate, and trimethylamine-N-oxide. However, other novel less well studied compounds, such as hydrogen sulfide and related sulfur metabolites (sulfane sulfur, lanthionine, etc.), should be included in a more comprehensive appraisal of this topic, in light of the potential therapeutic opportunities for the future.
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Affiliation(s)
- Alessandra F Perna
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Miriam Zacchia
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Francesco Trepiccione
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Giovanna Capolongo
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Carmela Vigorito
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Evgeniya Anishchenko
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Diego Ingrosso
- Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio 7, 80138, Naples, Italy
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Veldeman L, Vanmassenhove J, Van Biesen W, Massy ZA, Liabeuf S, Glorieux G, Vanholder R. Evolution of protein-bound uremic toxins indoxyl sulphate and p-cresyl sulphate in acute kidney injury. Int Urol Nephrol 2019; 51:293-302. [PMID: 30604232 DOI: 10.1007/s11255-018-2056-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a gradual increase in serum concentrations of protein-bound colon-derived uremic toxins indoxyl sulphate (IxS) and p-cresyl sulphate (pCS) as chronic kidney disease (CKD) progresses. In acute kidney injury (AKI), up till now, the retention pattern has not been studied. METHODS In this study, 194 adult patients admitted with sepsis to the intensive care unit were included. IxS, pCS and serum creatinine (sCrea) were quantified at inclusion (D0) and at day 4, unless follow-up ended earlier (Dend). RESULTS Serum levels of sCrea (P < 0.001), IxS (P < 0.001) and pCS (P < 0.05) were higher in patients with AKI according to RIFLE classification at D0. In contrast with sCrea, IxS and pCS levels only increased from stage I (IxS) and F (pCS) on. When grouped according to evolution in RIFLE class from D0 to Dend, all solute concentrations were higher (P < 0.001) in the group with unfavourable evolution. In this group, there was a marked rise in sCrea (P < 0.001), a moderate one for pCS (P < 0.05), but no change for IxS (P = 0.112). There was a decrease (P < 0.001) of all solute concentrations in the group with favourable evolution. Comparing AKI with CKD patients matched for sCrea, total levels of both IxS and pCS were higher (P < 0.01) in patients with CKD. CONCLUSIONS Although concentrations of IxS and pCS both tend to rise in sepsis patients with AKI, their evolution does not conform with that of sCrea. For the same level of sCrea, IxS and pCS concentrations are lower in AKI compared with CKD.
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Affiliation(s)
- Laurens Veldeman
- Nephrology Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jill Vanmassenhove
- Nephrology Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ziad A Massy
- Nephrology Division, Ambroise Paré Hospital, APHP, and Paris Ile de France West (UVSQ) University, Boulogne Billancourt, France.,Inserm U1018 Team5, UVSQ, University Paris, Saclay Villejuif, France
| | - Sophie Liabeuf
- Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Griet Glorieux
- Nephrology Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Raymond Vanholder
- Nephrology Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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