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Coutinho-Wolino KS, Melo MFS, Mota JC, Mafra D, Guimarães JT, Stockler-Pinto MB. Blueberry, cranberry, raspberry, and strawberry as modulators of the gut microbiota: target for treatment of gut dysbiosis in chronic kidney disease? From current evidence to future possibilities. Nutr Rev 2024; 82:248-261. [PMID: 37164634 DOI: 10.1093/nutrit/nuad048] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Gut dysbiosis is common in patients with chronic kidney disease (CKD) and is associated with uremic toxin production, inflammation, oxidative stress, and cardiovascular disease development. Therefore, healthy dietary patterns are essential modulators of gut microbiota. In this context, studies suggest that consuming berry fruits, rich in polyphenols and nutrients, may positively affect the gut microbiota, promoting the selective growth of beneficial bacteria and improving clinical status. However, studies on the effects of berry fruits on gut microbiota in CKD are scarce, and a better understanding of the possible mechanisms of action of berry fruits on gut microbiota is needed to guide future clinical studies and clinical practice in CKD. The objective was to discuss how berry fruits (blueberry, cranberry, raspberry, and strawberry) could be a therapeutic strategy to modulate the gut microbiota and possibly reverse the dysbiosis in CKD. Overall, available evidence shows that berry fruits can promote an increase in diversity by affecting the abundance of mucus-producing bacteria and short-chain fatty acids. Moreover, these fruits can increase the expression of mRNA involved in tight junctions in the gut such as occludin, tight junction protein 1 (TJP1), and mucin. Studies on the exact amount of berries leading to these effects show heterogeneous findings. However, it is known that, with 5 mg/day, it is already possible to observe some effects in animal models. Wild berries could possibly improve the uremic condition by reducing the levels of uremic toxins via modulation of the gut microbiota. In the long term, this could be an excellent strategy for patients with CKD. Therefore, clinical studies are encouraged to evaluate better these effects on CKD as well as the safe amount of these fruits in order to promote a better quality of life or even the survival of these patients.
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Affiliation(s)
- Karen S Coutinho-Wolino
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Manuela F S Melo
- Graduate Program in Nutrition, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil
| | - Jessica C Mota
- Graduate Program in Nutrition, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil
| | - Denise Mafra
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil
- Postgraduate Program in Medical Sciences, Faculty of Medicine, Fluminense Federal University, Niterói, Brazil
| | - Jonas T Guimarães
- Department of Food Technology, Faculty of Veterinary, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Milena B Stockler-Pinto
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil
- Postgraduate Program in Pathology, Faculty of Medicine, Fluminense Federal University, Niterói, Brazil
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Alvarenga L, Saldanha JF, Stockler-Pinto MB, Fouque D, Soulage CO, Mafra D. Effects of resveratrol on inflammation and oxidative stress induced by the uremic toxin indoxyl sulfate in Murine macrophage-like RAW 264.7. Biochimie 2023; 213:22-29. [PMID: 37142118 DOI: 10.1016/j.biochi.2023.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/15/2022] [Revised: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Abstract
Indoxyl sulfate (IS) is a uremic toxin produced by the gut microbiota that commonly accumulates in patients with chronic kidney disease (CKD) and can be harmful. Resveratrol is a polyphenol with properties that attenuate oxidative stress and inflammation. This study aims to evaluate the effect of resveratrol against the damage caused by IS in RAW 264.7 murine macrophages. Cells were treated with 0, 250, 500 and 1000 μmol/L of IS, in the presence of 50 μmol/L of resveratrol. The mRNA and protein expressions of erythroid-related nuclear factor 2 (Nrf2) and nuclear factor kappa-B (NF-κB) were measured using rt-PCR and Western blot analysis, respectively. Malondialdehyde (MDA) and reactive oxygen species (ROS) levels were also analyzed. As a result, it was demonstrated that resveratrol induces the activation of the Nrf2 pathway that enhances cytoprotective response. IS upregulated the NF-κB expression and downregulated the Nrf2 expression. In contrast, resveratrol treatment significantly reduced the MDA and ROS production and inhibited the IS-induced expression of NF-κB in macrophage-like RAW 264.7. In conclusion, resveratrol can mitigate inflammation and oxidative stress caused by uremic toxins produced by the gut microbiota, such as IS.
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Affiliation(s)
- Livia Alvarenga
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil; Graduate Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil.
| | - Juliana F Saldanha
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil
| | - Milena B Stockler-Pinto
- Graduate Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil; Graduate Program in Pathology, Federal Fluminense University (UFF), Niterói-RJ, Brazil
| | - Denis Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, France
| | - Christophe O Soulage
- Univ. Lyon, CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Denise Mafra
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil; Graduate Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói-RJ, Brazil; Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, (RJ), Brazil
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Monteiro EB, Ajackson M, Stockler-Pinto MB, Guebre-Egziabher F, Daleprane JB, Soulage CO. Sulforaphane exhibits potent renoprotective effects in preclinical models of kidney diseases: A systematic review and meta-analysis. Life Sci 2023; 322:121664. [PMID: 37023957 DOI: 10.1016/j.lfs.2023.121664] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS Sulforaphane (SFN), a naturally occurring isothiocyanate found in cruciferous vegetables, has received extensive attention as a natural activator of the Nrf2/Keap1 cytoprotective pathway. In this review, a meta-analysis and systematic review of the renoprotective effects of SFN were performed in various preclinical models of kidney diseases. MAIN METHODS The primary outcome was the impact of SFN on renal function biomarkers (uremia, creatininemia, proteinuria or creatinine clearance) and secondary outcomes were kidney lesion histological indices/kidney injury molecular biomarkers. The effects of SFN were evaluated according to the standardized mean differences (SMDs). A random-effects model was applied to estimate the overall summary effect. KEY FINDINGS Twenty-five articles (out of 209 studies) were selected from the literature. SFN administration significantly increased creatinine clearance (SMD +1.88 95 % CI: [1.09; 2.68], P < 0.0001, I2 = 0 %) and decreased the plasma creatinine (SMD -1.24, [-1.59; -0.88], P < 0.0001, I2 = 36.0 %) and urea (SMD -3.22 [-4.42, -2.01], P < 0.0001, I2 = 72.4 %) levels. SFN administration (median dose: 2.5 mg/kg, median duration: 3 weeks) significantly decreased urinary protein excretion (SMD -2.20 [-2.68; -1.73], P < 0.0001, I2 = 34.1 %). It further improved two kidney lesion histological indices namely kidney fibrosis (SMD -3.08 [-4.53; -1.63], P < 0.0001, I2 = 73.7 %) and glomerulosclerosis (SMD -2.24 [-2.96; -1.53], P < 0.0001, I2 = 9.7 %) and decreased kidney injury molecular biomarkers (SMD -1.51 [-2.00; -1.02], P < 0.0001, I2 = 0 %). SIGNIFICANCE These findings provide new insights concerning preclinical strategies for treating kidney disease or kidney failure with SFN supplements and should stimulate interest in clinical evaluations of SFN in patients with kidney disease.
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Affiliation(s)
- Elisa B Monteiro
- Nutrition and Genomics Laboratory, Basic and Experimental Nutrition Department, Institute of Nutrition, Rio de Janeiro State University, 20550-900 Rio de Janeiro, Brazil
| | - Matheus Ajackson
- Nutrition and Genomics Laboratory, Basic and Experimental Nutrition Department, Institute of Nutrition, Rio de Janeiro State University, 20550-900 Rio de Janeiro, Brazil
| | - Milena B Stockler-Pinto
- Graduate Program in Pathology, Federal Fluminense University (UFF), Niterói, RJ, Brazil; Graduate Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil
| | - Fitsum Guebre-Egziabher
- Hospices Civils de Lyon, Department of Nephrology, Hôpital E Herriot, Lyon F-69003, France; Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA-Lyon, Université Claude Bernard Lyon 1, 69500, Bron, France
| | - Julio B Daleprane
- Nutrition and Genomics Laboratory, Basic and Experimental Nutrition Department, Institute of Nutrition, Rio de Janeiro State University, 20550-900 Rio de Janeiro, Brazil
| | - Christophe O Soulage
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA-Lyon, Université Claude Bernard Lyon 1, 69500, Bron, France.
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Coutinho-Wolino KS, Almeida PP, Mafra D, Stockler-Pinto MB. Bioactive compounds modulating Toll-like 4 receptor (TLR4)-mediated inflammation: pathways involved and future perspectives. Nutr Res 2022; 107:96-116. [PMID: 36209684 DOI: 10.1016/j.nutres.2022.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 04/26/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 12/27/2022]
Abstract
Chronic inflammation is associated with the development and progression of several noncommunicable diseases, such as diabetes, cardiovascular disease, chronic kidney disease, cancer, and nonalcoholic fatty liver disease. Evidence suggests that pattern recognition receptors that identify pathogen-associated molecular patterns and danger-associated molecular patterns are crucial in chronic inflammation. Among the pattern recognition receptors, Toll-like receptor 4 (TLR4) stimulates several inflammatory pathway agonists, such as nuclear factor-κB, interferon regulator factor 3, and nod-like receptor pyrin domain containing 3 pathways, which consequently trigger the expression of pro-inflammatory biomarkers, increasing the risk of noncommunicable disease development and progression. Studies have focused on the antagonistic potential of bioactive compounds, following the concept of food as a medicine, in which nutritional strategies may mitigate inflammation via TLR4 modulation. Thus, this review discusses preclinical evidence concerning bioactive compounds from fruit, vegetable, spice, and herb extracts (curcumin, resveratrol, catechin, cinnamaldehyde, emodin, ginsenosides, quercetin, allicin, and caffeine) that may regulate the TLR4 pathway and reduce the inflammatory response. Bioactive compounds can inhibit TLR4-mediated inflammation through gut microbiota modulation, improvement of intestinal permeability, inhibition of lipopolysaccharide-TLR4 binding, and decreasing TLR4 expression by modulation of microRNAs and antioxidant pathways. The responses directly mitigated inflammation, especially nuclear factor-κB activation and inflammatory cytokines release. These findings should be considered for further clinical studies on inflammation-mediated diseases.
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Affiliation(s)
- Karen S Coutinho-Wolino
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
| | - Patricia P Almeida
- Postgraduate Program in Pathology, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Denise Mafra
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil; Postgraduate Program in Medical Sciences, Faculty of Medicine, Fluminense Federal University, Niterói, Brazil
| | - Milena B Stockler-Pinto
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil; Postgraduate Program in Pathology, Fluminense Federal University (UFF), Niterói, RJ, Brazil; Postgraduate Program in Nutrition Sciences, Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil
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Guimarães JT, Almeida PP, Brito ML, Cruz BO, Costa NS, Almeida Ito RV, Mota JC, Bertolo MR, Morais ST, Neto RP, Tavares MIB, Souto F, Bogusz Junior S, Pimentel TC, Stockler-Pinto MB, Freitas MQ, Cruz AG. In vivo functional and health benefits of a prebiotic soursop whey beverage processed by high-intensity ultrasound: Study with healthy Wistar rats. Food Chem 2022; 380:132193. [DOI: 10.1016/j.foodchem.2022.132193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/21/2021] [Accepted: 01/16/2022] [Indexed: 12/31/2022]
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6
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Borges NA, Stenvinkel P, Bergman P, Qureshi AR, Lindholm B, Moraes C, Stockler-Pinto MB, Mafra D. Effects of Probiotic Supplementation on Trimethylamine-N-Oxide Plasma Levels in Hemodialysis Patients: a Pilot Study. Probiotics Antimicrob Proteins 2020; 11:648-654. [PMID: 29651635 DOI: 10.1007/s12602-018-9411-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 12/13/2022]
Abstract
Components present in the diet, L-carnitine, choline, and betaine are metabolized by gut microbiota to produce metabolites such as trimethylamine-N-oxide (TMAO) that appear to promote cardiovascular disease in chronic kidney disease (CKD) patients. The objective of this pilot study was to evaluate the effects of probiotic supplementation for 3 months on plasma TMAO levels in CKD patients on hemodialysis (HD). A randomized, double-blind trial was performed in 21 patients [54.8 ± 10.4 years, nine men, BMI 26.1 ± 4.8 kg/m2, dialysis vintage 68.5 (34.2-120.7) months]. Ten patients were randomly allocated to the placebo group and 11 to the probiotic group [three capsules, totaling 9 × 1013 colony-forming units per day of Streptococcus thermophilus (KB19), Lactobacillus acidophilus (KB27), and Bifidobacteria longum (KB31). Plasma TMAO, choline, and betaine levels were measured by LC-MS/MS at baseline and after 3 months. While TMAO did not change after probiotic supplementation, there was a significant increase in betaine plasma levels. In contrast, the placebo group showed a significant decrease in plasma choline levels. Short-term probiotic supplementation does not appear to influence plasma TMAO levels in HD patients. Long-term studies are needed to determine whether probiotics may affect TMAO production in CKD patients.
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Affiliation(s)
- Natália A Borges
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil. .,Unidade de Pesquisa Clínica, Rua Marques do Paraná, 303, Niterói, RJ, 24033-900, Brazil.
| | - P Stenvinkel
- Department of Clinical Science Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - P Bergman
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - A R Qureshi
- Department of Clinical Science Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - B Lindholm
- Department of Clinical Science Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - C Moraes
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - M B Stockler-Pinto
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.,Unidade de Pesquisa Clínica, Rua Marques do Paraná, 303, Niterói, RJ, 24033-900, Brazil
| | - D Mafra
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.,Unidade de Pesquisa Clínica, Rua Marques do Paraná, 303, Niterói, RJ, 24033-900, Brazil.,Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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da Cruz BO, Cardozo LFMDF, Magliano DC, Stockler-Pinto MB. Nutritional strategies to modulate inflammation pathways via regulation of peroxisome proliferator-activated receptor β/δ. Nutr Rev 2020; 78:207-214. [PMID: 31584650 DOI: 10.1093/nutrit/nuz058] [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] [Indexed: 11/14/2022] Open
Abstract
The peroxisome proliferator-activated receptor (PPAR) β/δ has an important role in multiple inflammatory conditions, including obesity, hypertension, cancer, cardiovascular disease, diabetes mellitus, and autoimmune diseases. PPARβ/δ forms a heterodimer with the retinoic acid receptor and binds to peroxisome proliferator response elements to initiate transcription of its target genes. PPARβ/δ is also able to suppress the activities of several transcription factors, including nuclear factor κB, and activator protein 1, thus regulating anti-inflammatory cellular responses and playing a protective role in several diseases. Recent studies have shown that nutritional compounds, including nutrients and bioactive compounds, can regulate PPARβ/δ expression. This review discusses key nutritional compounds that are known to modulate PPARβ/δ and are likely to affect human health.
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Affiliation(s)
- Beatriz O da Cruz
- B.O. da Cruz, L.F.M. de F. Cardozo, D.C. Magliano, and M.B. Stockler-Pinto are with the Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil
| | - Ludmila F M de França Cardozo
- B.O. da Cruz, L.F.M. de F. Cardozo, D.C. Magliano, and M.B. Stockler-Pinto are with the Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil
| | - D'Angelo C Magliano
- B.O. da Cruz, L.F.M. de F. Cardozo, D.C. Magliano, and M.B. Stockler-Pinto are with the Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil.,D.C. Magliano is with Laboratory of Morphological and Metabolic Analyses, Fluminense Federal University (UFF), Niterói-RJ, Brazil
| | - Milena B Stockler-Pinto
- B.O. da Cruz, L.F.M. de F. Cardozo, D.C. Magliano, and M.B. Stockler-Pinto are with the Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil.,M.B. Stockler-Pinto is with the Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil
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Esgalhado M, Kemp JA, Azevedo R, Paiva BR, Stockler-Pinto MB, Dolenga CJ, Borges NA, Nakao LS, Mafra D. Could resistant starch supplementation improve inflammatory and oxidative stress biomarkers and uremic toxins levels in hemodialysis patients? A pilot randomized controlled trial. Food Funct 2019; 9:6508-6516. [PMID: 30468238 DOI: 10.1039/c8fo01876f] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An imbalance of gut microbiota is considered a new cardiovascular risk factor for chronic kidney disease (CKD) patients, since it is directly associated with increased uremic toxin production, inflammation and oxidative stress. Strategies such as prebiotic supplementation have been suggested to mitigate these complications. We hypothesized that prebiotic-resistant starch could ameliorate uremic toxins levels, oxidative stress, and inflammatory states in hemodialysis (HD) patients. This pilot study evaluated 31 HD patients assigned to either resistant starch (16 g of resistant starch Hi-Maize® 260) or placebo (manioc flour) supplementation, which they received for 4 weeks on alternate days through cookies on dialysis days and powder in a sachet on non-dialysis days. Levels of interleukin (IL)-6, high-sensitive C-reactive protein, thiobarbituric acid reactive substances plasma (TBARS), protein carbonylation, indoxyl sulfate (IS) and p-cresyl sulfate were measured. Anthropometric and biochemical parameters, as well as, food intake were also evaluated. As expected, resistant starch group increased fiber intake (p > 0.01), in addition the prebiotic supplementation reduced IL-6 (p = 0.01), TBARS (p > 0.01), and IS (p > 0.01) plasma levels. No significant differences were evident in the placebo group. Prebiotic-resistant starch supplementation seems to be a promising nutritional strategy to improve inflammation, oxidative stress and to reduce IS plasma levels in CKD patients on HD.
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Affiliation(s)
- Marta Esgalhado
- Post-Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
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Mafra D, Esgalhado M, Borges NA, Cardozo LFMF, Stockler-Pinto MB, Craven H, Buchanan SJ, Lindholm B, Stenvinkel P, Shiels PG. Methyl Donor Nutrients in Chronic Kidney Disease: Impact on the Epigenetic Landscape. J Nutr 2019; 149:372-380. [PMID: 30796783 DOI: 10.1093/jn/nxy289] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/19/2018] [Revised: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 12/28/2022] Open
Abstract
Epigenetic alterations, such as those linked to DNA methylation, may potentially provide molecular explanations for complications associated with altered gene expression in illnesses, such as chronic kidney disease (CKD). Although both DNA hypo- and hypermethylation have been observed in the uremic milieu, this remains only a single aspect of the epigenetic landscape and, thus, of any biochemical dysregulation associated with CKD. Nevertheless, the role of uremia-promoting alterations on the epigenetic landscape regulating gene expression is still a novel and scarcely studied field. Although few studies have actually reported alterations of DNA methylation via methyl donor nutrient intake, emerging evidence indicates that nutritional modification of the microbiome can affect one-carbon metabolism and the capacity to methylate the genome in CKD. In this review, we discuss the nutritional modifications that may affect one-carbon metabolism and the possible impact of methyl donor nutrients on the microbiome, CKD, and its phenotype.
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Affiliation(s)
- Denise Mafra
- Post Graduation Program in Medical Sciences.,Post Graduation Program in Cardiovascular Sciences
| | | | - Natalia A Borges
- Post Graduation Program in Cardiovascular Sciences.,Post Graduation Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói-Rio de Janeiro (RJ), Brazil
| | | | - Milena B Stockler-Pinto
- Post Graduation Program in Cardiovascular Sciences.,Post Graduation Program in Nutrition Sciences, Federal Fluminense University (UFF), Niterói-Rio de Janeiro (RJ), Brazil
| | - Hannah Craven
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, UK
| | - Sarah J Buchanan
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, UK
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Paul G Shiels
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, UK
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Stockler-Pinto MB, Soulage CO, Borges NA, Cardozo LFMF, Dolenga CJ, Nakao LS, Pecoits-Filho R, Fouque D, Mafra D. From bench to the hemodialysis clinic: protein-bound uremic toxins modulate NF-κB/Nrf2 expression. Int Urol Nephrol 2017; 50:347-354. [PMID: 29151180 DOI: 10.1007/s11255-017-1748-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/11/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Uremic toxins produced by gut microbiota (indoxyl sulfate-IS, p-cresyl sulfate-p-CS, and indole-3-acetic acid-IAA) accumulate in hemodialysis (HD) patients and exhibit potent inflammatory effects. However, the impact of these toxins on nuclear E2-related factor 2 (Nrf2) and nuclear factor-kappa B (NF-κB) expression in HD patients remains poorly defined. The aim of this study was to evaluate the association between uremic toxins and Nrf2/NF-κB expression in vitro (RAW 264.7 macrophage-like cells) and in peripheral blood mononuclear cells from HD patients. METHODS Uremic toxins, C-reactive protein (CRP), interleukin-6 (IL-6) and malondialdehyde (MDA) levels were measured in fifteen HD patients and nine healthy individuals. RAW 264.7 macrophage-like cells were incubated with IS, as a prototype of protein-bound uremic toxin. Nrf2 and NF-κB expressions were analyzed by RT-qPCR. RESULTS HD patients presented high levels of inflammatory markers, MDA and uremic toxins. In addition, they presented high NF-κB and low Nrf2 expression. Uremic toxins were positively correlated with NF-κB expression (IS, ρ = 0.58, p < 0.003; p-CS, ρ = 0.71, p < 0.001; IAA, ρ = 0.62, p < 0.001) and negatively with Nrf2 (IS, ρ = - 0.48, p = 0.01; p-CS, ρ = - 0.46, p < 0.02). Uremic toxins also exhibited positive correlations with CRP and MDA levels. Multivariate analysis revealed that p-CS is a determinant factor of NF-κB expression. In RAW 264.7 culture, NF-κB mRNA expression was stimulated by IS, while Nrf2 was downregulated. CONCLUSIONS Thus, uremic toxins may stimulate NF-κB mRNA and decrease Nrf2 expression in HD patients and, consequently, trigger inflammation and oxidative stress.
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Affiliation(s)
- Milena B Stockler-Pinto
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
| | - Christophe O Soulage
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INSA Lyon, INRA U1397, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Natália A Borges
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Carla J Dolenga
- Departamento de Patologia Básica, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Lia S Nakao
- Departamento de Patologia Básica, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Denis Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, Lyon, France
| | - Denise Mafra
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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Borges NA, Carmo FL, Stockler-Pinto MB, de Brito JS, Dolenga CJ, Ferreira DC, Nakao LS, Rosado A, Fouque D, Mafra D. Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial. J Ren Nutr 2017; 28:28-36. [PMID: 28888762 DOI: 10.1053/j.jrn.2017.06.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the effects of probiotic supplementation on the gut microbiota profile and inflammatory markers in chronic kidney disease patients undergoing maintenance hemodialysis (HD). DESIGN AND METHODS This was a randomized, double-blind, placebo-controlled study. Forty-six HD patients were assigned to receive 1 of 2 treatments: probiotic (n = 23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacterialongum, 90 billion colony-forming units per day) or placebo (n = 23) daily for 3 months. Blood and feces were collected at baseline and after intervention. The inflammatory markers (C-reactive protein and interleukin-6) were analyzed by immunoenzymatic assay (enzyme-linked immunosorbent assay). Uremic toxins plasma levels (indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid) were obtained by Reversed-Phase High-Performance Liquid Chromatography. Routine laboratory parameters were measured by standard techniques. Fecal pH was measured by the colorimetric method, and the gut microbiota profile was assessed by Denaturing Gradient Gel Electrophoresis analysis. RESULTS Sixteen patients remained in the probiotic group (11 men, 53.6 ± 11.0 year old, 25.3 ± 4.6 kg/m2) and 17 in the placebo group (10 men, 50.3 ± 8.5 year old, 25.2 ± 5.7 kg/m2). After probiotic supplementation there was a significant increase in serum urea (from 149.6 ± 34.2 mg/dL to 172.6 ± 45.0 mg/dL, P = .02), potassium (from 4.4 ± 0.4 mmol/L to 4.8 ± 0.4 mmol/L, P = .02), and indoxyl sulfate (from 31.2 ± 15.9 to 36.5 ± 15.0 mg/dL, P = .02). The fecal pH was reduced from 7.2 ± 0.8 to 6.5 ± 0.5 (P = .01). These parameters did not change significantly in placebo group. Changes in the percentage delta (Δ) between groups were exhibited with no statistical differences observed. The inflammatory markers and gut profile were not altered by supplementation. CONCLUSIONS Aprobiotic supplementation failed to reduce uremic toxins and inflammatory markers. Therefore, probiotic therapy should be chosen with caution in HD patients. Further studies addressing probiotic therapy in chronic kidney disease patients are needed.
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Affiliation(s)
- Natália A Borges
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil; Medical Sciences Graduate Program, Federal University Fluminense (UFF), Niterói-RJ, Brazil.
| | - Flávia L Carmo
- Institute of Microbiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Milena B Stockler-Pinto
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil
| | - Jessyca S de Brito
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil
| | - Carla J Dolenga
- Basic Pathology Department, Federal University of Paraná (UFPR), Curitiba-PR, Brazil
| | - Dennis C Ferreira
- Faculty of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - Lia S Nakao
- Basic Pathology Department, Federal University of Paraná (UFPR), Curitiba-PR, Brazil
| | - Alexandre Rosado
- Institute of Microbiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Univ Lyon, UCBL, Inserm Carmen, CENS, F-69622 Lyon, France
| | - Denise Mafra
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil; Medical Sciences Graduate Program, Federal University Fluminense (UFF), Niterói-RJ, Brazil
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Abreu CC, Cardozo LFMF, Stockler-Pinto MB, Esgalhado M, Barboza JE, Frauches R, Mafra D. Does resistance exercise performed during dialysis modulate Nrf2 and NF-κB in patients with chronic kidney disease? Life Sci 2017; 188:192-197. [PMID: 28887058 DOI: 10.1016/j.lfs.2017.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 04/25/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Studies have shown that nuclear factor erythroid 2-related factor 2 (Nrf2) can be modulated by physical exercise. However, the impact of resistance exercise has never been investigated in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the effects of resistance exercise programs on the expression of transcription factors Nrf2 and nuclear factor κB (NF-κB) in CKD patients on hemodialysis (HD). Patients on an HD program were randomly assigned to an exercise group of 25 patients (54.5% women, aged 45.7±15.2years and time on dialysis=71.2±45.5months) or a control group of 19 patients who had no exercise intervention (61.5% women, aged 42.5±13.5years and time on dialysis=70.1±49.9months). A strength exercise program was performed 3 times a week during the HD sessions. Peripheral blood mononuclear cells were isolated and processed for the expression of Nrf2 and NF-κB by quantitative real-time polymerase chain reaction 3months before and after the exercise program. Using an enzyme-linked immunosorbent assay, the activity of glutathione peroxidase (GPx) as well as the products of high-sensitivity C-reactive protein and nitric oxide (NO) were assessed. Nrf2 expression (ranging from 0.86±0.4 to 1.76±0.8) and GPx activity were significantly increased after exercise intervention. In the exercise group, no difference in the levels of NO was observed; however, there was a significant reduction in the control group. In conclusion, these data suggest that resistance exercises seem to be capable of inducing Nrf2 activation in CKD patients on HD.
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Affiliation(s)
- C C Abreu
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil.
| | - L F M F Cardozo
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil
| | - M B Stockler-Pinto
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil
| | - M Esgalhado
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil
| | - J E Barboza
- Medical Sciences Graduate Program, Federal Fluminense University (UFF), Niterói, Rio de Janeiro (RJ), Brazil
| | - R Frauches
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil
| | - D Mafra
- Cardiovascular Sciences Graduate Program, Federal University Fluminense (UFF), Niterói, Rio de Janeiro (RJ), Brazil; Medical Sciences Graduate Program, Federal Fluminense University (UFF), Niterói, Rio de Janeiro (RJ), Brazil
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13
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Pedruzzi LM, Cardozo LFMDF, Medeiros RF, Stockler-Pinto MB, Mafra D. Association between serum ferritin and lipid peroxidation in hemodialysis patients. J Bras Nefrol 2017; 37:171-6. [PMID: 26154636 DOI: 10.5935/0101-2800.20150028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/10/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Iron supplementation is one of the recommendations found in patients with chronic kidney disease (CKD), however, an overload of this mineral can contribute to oxidative stress, a condition closely related to the cardiovascular risk in these patients, as well as disease progression. OBJECTIVE The objective of this study was to investigate whether ferritin levels are associated with oxidative stress marker MDA in patients on hemodialysis (HD). METHODS Twenty HD patients (55.0 ± 15.2 years, time of dialysis 76.5 ± 46.3 months, BMI 23.6 ± 3.0 kg/m2) were compared with 11 healthy subjects (50.9 ± 8.0 years, BMI 23.8 ± 1.9 kg/m2). Malondialdehyde (MDA) was measured by reaction with thiobarbituric acid and routine biochemical data were obtained from medical records. RESULTS MDA levels were significantly higher in HD patients compared to the control group (13.2 ± 5.3 nmol/mL vs. 5.1 ± 2.7nmol/mL, p < 0.01). Twelve patients (60%) had ferritin values greater than the 500 ng/mL and there was a positive correlation between ferritin and MDA in HD (r = 0.66, p = 0.005, n = 17) patients. CONCLUSION The excess iron stores in HD patients results in increased lipid peroxidation, and consequently contributes to increased oxidative stress in these patients.
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Cardozo LFMF, Stockler-Pinto MB, Mafra D. Brazil nut consumption modulates Nrf2 expression in hemodialysis patients: A pilot study. Mol Nutr Food Res 2016; 60:1719-24. [DOI: 10.1002/mnfr.201500658] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Ludmila F. M. F. Cardozo
- Graduate Program in Cardiovascular Sciences; Universidade Federal Fluminense (UFF); Niterói-Rio de Janeiro Brazil
| | - Milena B. Stockler-Pinto
- Graduate Program in Cardiovascular Sciences; Universidade Federal Fluminense (UFF); Niterói-Rio de Janeiro Brazil
| | - Denise Mafra
- Graduate Program in Cardiovascular Sciences; Universidade Federal Fluminense (UFF); Niterói-Rio de Janeiro Brazil
- Graduate Program in Medical Sciences; Universidade Federal Fluminense (UFF); Niterói-Rio de Janeiro Brazil
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Saldanha JF, Yi D, Stockler-Pinto MB, Soula HA, Chambert S, Fouque D, Mafra D, Soulage CO. Determination of the binding properties of the uremic toxin phenylacetic acid to human serum albumin. Biochimie 2016; 125:53-8. [PMID: 26945842 DOI: 10.1016/j.biochi.2016.03.002] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
Uremic toxins are compounds normally excreted in urine that accumulate in patients with chronic kidney disease as a result of decreased renal clearance. Phenylacetic acid (PAA) has been identified as a new protein bound uremic toxin. The purpose of this study was to investigate in vitro the interaction between PAA and human serum albumin (HSA) at physiological and pathological concentrations. We used ultrafiltration to show that there is a single high-affinity binding site for PAA on HSA, with a binding constant on the order of 3.4 × 10(4) M(-1) and a maximal stoichiometry of 1.61 mol per mole. The PAA, at the concentration reported in end-stage renal patients, was 26% bound to albumin. Fluorescent probe competition experiments demonstrated that PAA did not bind to Sudlow's site I (in subdomain IIA) and only weakly bind to Sudlow's site II (in subdomain IIIA). The PAA showed no competition with other protein-bound uremic toxins such as p-cresyl-sulfate or indoxyl sulfate for binding to serum albumin. Our results provide evidence that human serum albumin can act as carrier protein for phenylacetic acid.
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Affiliation(s)
- Juliana F Saldanha
- Medical Sciences Graduate Program, Federal University Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Dan Yi
- Univ Lyon, INSA-Lyon, UMR 1060 INSERM, CarMeN, F-69621 Villeurbanne, France
| | - Milena B Stockler-Pinto
- Cardiovascular Sciences Graduate Program, Federal University Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Hédi A Soula
- Univ Lyon, INSA-Lyon, UMR 1060 INSERM, CarMeN, F-69621 Villeurbanne, France
| | - Stéphane Chambert
- Univ Lyon, INSA-Lyon, UMR 5246 CNRS, ICBMS, F-69621 Villeurbanne, France
| | - Denis Fouque
- Univ Lyon, INSA-Lyon, UMR 1060 INSERM, CarMeN, F-69621 Villeurbanne, France; Department of Nephrology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Denise Mafra
- Medical Sciences Graduate Program, Federal University Fluminense, Niteroi, Rio de Janeiro, Brazil; Cardiovascular Sciences Graduate Program, Federal University Fluminense, Niteroi, Rio de Janeiro, Brazil
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Stockler-Pinto MB, Saldanha JF, Yi D, Mafra D, Fouque D, Soulage CO. The uremic toxin indoxyl sulfate exacerbates reactive oxygen species production and inflammation in 3T3-L1 adipose cells. Free Radic Res 2016; 50:337-44. [PMID: 26617268 DOI: 10.3109/10715762.2015.1125996] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Inflammation and oxidative stress are common features of patients with chronic kidney disease (CKD) and many uremic solutes retained in these patients could be involved in these processes, among which protein-bound solutes such as indoxyl sulfate (IS). White adipose tissue recently gained attention as an important source of inflammation and oxidative stress. To examine the effect of IS on adipocytes, 3T3-L1 adipose cells were incubated with IS to mimic the conditions encountered in uremic patients. Incubation of adipose cells with IS increased reactive oxygen species production generated mainly through activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase since it was prevented by the NADPH oxidase inhibitor apocynin. Exposure to IS furthermore exacerbated the secretion of tumor necrosis factor-α and interleukin-6 by adipose cells. This inflammatory response was prevented by NADPH oxidase inhibition pinpointing the pivotal role of intracellular oxidative stress. IS induces adipocyte perturbation and promotes inflammatory state mainly through induction of oxidative stress. IS, a uremic toxin, accumulates in CKD patients could, therefore, be an important mediator of adipocyte dysfunction in these patients.
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Affiliation(s)
- Milena B Stockler-Pinto
- a Cardiovascular Sciences Graduate Program, Federal Fluminense University , Niterói , Brazil
| | - Juliana F Saldanha
- b Medical Sciences Graduate Program, Federal Fluminense University , Niterói , Brazil
| | - Dan Yi
- c Université De Lyon, INSA De Lyon, CarMeN, INSERM U1060 , Villeurbanne , France
| | - Denise Mafra
- a Cardiovascular Sciences Graduate Program, Federal Fluminense University , Niterói , Brazil ;,b Medical Sciences Graduate Program, Federal Fluminense University , Niterói , Brazil
| | - Denis Fouque
- c Université De Lyon, INSA De Lyon, CarMeN, INSERM U1060 , Villeurbanne , France ;,d Department of Nephrology , Centre Hopitalier Lyon Sud , Pierre-Bénite , France
| | - Christophe O Soulage
- c Université De Lyon, INSA De Lyon, CarMeN, INSERM U1060 , Villeurbanne , France
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Leal VO, Saldanha JF, Stockler-Pinto MB, Cardozo LFMF, Santos FR, Albuquerque ASD, Leite M, Mafra D. NRF2 and NF-κB mRNA expression in chronic kidney disease: a focus on nondialysis patients. Int Urol Nephrol 2015; 47:1985-91. [PMID: 26490557 DOI: 10.1007/s11255-015-1135-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/08/2015] [Accepted: 10/07/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate nuclear factor erythroid 2-related factor 2 (Nrf2) and nuclear factor-kappaB (NF-κB) mRNA expression in nondialysis chronic kidney disease (CKD) patients, comparing with data from hemodialysis (HD) patients and healthy individuals. METHODS Twenty nondialysis CKD patients (62.0 ± 8.1 years old, 11 men, estimated glomerular filtration rate of 36.8 ± 13.6 mL/min/1.73 m(2)), twenty HD patients (55.0 ± 15.2 years old, 13 men, and dialysis vintage of 76.5 ± 46.3 months) and eleven healthy individuals (50.9 ± 8.0 years old, 6 men) were enrolled in the study. The peripheral blood mononuclear cells were isolated and processed for the evaluation of expression of NF-κB and Nrf2 by quantitative real-time polymerase chain reaction. RESULTS Nrf2 mRNA expression was significantly higher in nondialysis (1.12 ± 0.57) when compared to HD patients (0.58 ± 0.35, p = 0,006) but similar to healthy individuals (1.13 ± 0.64). Inversely, NF-κB mRNA expression was lower in nondialysis (1.21 ± 0.71) when compared to HD patients (2.08 ± 0.7, p < 0.0001) and similar to healthy individuals (1.04 ± 0.22). Nrf2 mRNA was positively correlated with NF-κB mRNA expression in nondialysis CKD patients (r = 0.52, p = 0.02) and healthy individuals (r = 0.77, p < 0.006). By contrast, Nrf2 mRNA was inversely correlated with NF-κB mRNA expression (r = -0.65, p = 0.003) in HD patients. CONCLUSION Nondialysis CKD patients may conserve regular homeostatic balance between Nrf2 and NF-κB expressions, being comparable to healthy individuals. However, HD patients seem to have Nrf2 downregulation and NF-κB upregulation. Thus, the association among Nrf2 and NF-κB expressions and nutritional status, kidney disease progression or immune deregulation deserve further investigation.
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Affiliation(s)
- Viviane O Leal
- Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Rua Marques do Paraná, 303. Prédio Anexo, 6º andar., Niterói, RJ, 24033-900, Brazil.
| | - Juliana F Saldanha
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil
| | - Milena B Stockler-Pinto
- Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Rua Marques do Paraná, 303. Prédio Anexo, 6º andar., Niterói, RJ, 24033-900, Brazil
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Rua Marques do Paraná, 303. Prédio Anexo, 6º andar., Niterói, RJ, 24033-900, Brazil
| | | | - Alex S D Albuquerque
- Division of Nephrology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maurilo Leite
- Division of Nephrology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Denise Mafra
- Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Rua Marques do Paraná, 303. Prédio Anexo, 6º andar., Niterói, RJ, 24033-900, Brazil.,Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil
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Moraes C, Marinho S, Lobo JC, Stockler-Pinto MB, Barros AF, Jacobson LV, da Nobrega ACL, Rosa MLG, Denise M. Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients. Ren Fail 2015; 37:851-7. [PMID: 25897771 DOI: 10.3109/0886022x.2015.1033634] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 02/03/2023] Open
Abstract
BACKGROUND Patients undergoing hemodialysis (HD) present altered levels of appetite hormones such as acyl-ghrelin (orexigenic) and obestatin (anorexigenic), which may contribute to anorexia. Physical exercise may affect these hormones and improve appetite in these patients. OBJECTIVES The objective of this study is to evaluate the effects of a resistance exercise program in appetite hormones, body composition, and nutritional status in HD patients. DESIGN Intervention study with the control group. SUBJECTS Fifty-two patients on regular HD program were enrolled into two groups: 37 patients performed exercises (56.7% male, 45 ± 12.8 years, 57 (9-192) months on HD) and 15 patients comprised the control group (66.7% men, 50 ± 10.6 years, 57 (11-153) months on HD). MEASUREMENTS Exercise program (performed with elastic bands and ankle cuffs in both lower limbs) was supervised three times a week during 6 months (72 sessions). Patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Obestatin, acyl-ghrelin, routine biochemical parameters, quality of life, and anthropometric data were collected and analyzed before and after 6 months. RESULTS After 6 months of exercise, obestatin levels reduced [from 3.0 ng/mL (2.3-3.4) to 1.9 ng/mL (0.6-3.4)] and acyl-ghrelin levels increased [from 21.5 pg/mL (1.3-77.7) to 37.2 pg/mL (16.7-94.1)] and the control group presented no significant differences in both plasma levels of hormones. Body composition and physical functional assessed by SF-36 and albumin levels (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05) improved after exercises. CONCLUSION Six months of resistance exercises contributed to changes in plasma appetite hormones, body composition, and nutritional status in hemodialysis patients.
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Affiliation(s)
- Cristiane Moraes
- a Graduate Program in Cardiovascular Sciences, Hospital Universitário Antônio Pedro, Unidade de Pesquisa Clínica, Fluminense Federal University (UFF) , Niterói, Rio de Janeiro , Brazil
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Stockler-Pinto MB, Malm O, Moraes C, Farage NE, Silva WS, Cozzolino SMF, Mafra D. A follow-up study of the chronic kidney disease patients treated with Brazil nut: focus on inflammation and oxidative stress. Biol Trace Elem Res 2015; 163:67-72. [PMID: 25395121 DOI: 10.1007/s12011-014-0167-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
Brazil nut is the richest known food source of selenium. The supplementation with Brazil nut during 3 months was effective in reducing oxidative stress and inflammation in hemodialysis (HD) patients. However, there are no available data on the antioxidant effect after that supplementation. The objective of this work was to determine if the beneficial effects of one Brazil nut supplementation per day during 3 months for the HD patients could be sustained after 12 months. Twenty-nine HD patients (58.6 % men, 51.0 ± 3.3 years) from RenalCor Clinic, Rio de Janeiro, Brazil, were followed up 12 months after the supplementation study had finished. The plasma levels of antioxidant substances as selenium, glutathione peroxidase (GPx), 8-isoprostane, 8-hydroxy-2-deoxyguanosine (8-OHdG) and cytokines (tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6)) were determined before, after 3 months of supplementation and after 12 months. After 3-months supplementation, cytokines, 8-OHdG and 8-isoprostane plasma levels have decreased and the activity of GPx and selenium plasma levels have increased significantly. Additionally, after 12 months, the values of 8-isoprostane, 8-OHdG and cytokines increased and the activity of GPx and selenium plasma levels decreased significantly. The levels of oxidative stress and inflammation biomarkers after 12 months increased compared to the basal levels. Consequently, it is necessary to motivate patients to adopt different dietary intake patterns.
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Affiliation(s)
- M B Stockler-Pinto
- Carlos Chagas Filho Biophysics Institute, Health Sciences Centre, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil,
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20
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Pedruzzi LM, Cardozo LFMF, Daleprane JB, Stockler-Pinto MB, Monteiro EB, Leite M, Vaziri ND, Mafra D. Systemic inflammation and oxidative stress in hemodialysis patients are associated with down-regulation of Nrf2. J Nephrol 2015; 28:495-501. [PMID: 25585822 DOI: 10.1007/s40620-014-0162-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/18/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oxidative stress and inflammation are common features and the main mediators of progression of chronic kidney disease (CKD) and its cardiovascular complications. Under normal conditions, oxidative stress activates the transcription factor, nuclear factor E2-related factor 2 (Nrf2), which is the master regulator of genes encoding antioxidant and detoxifying enzymes and related proteins. The available data on expression of Nrf2 and its key target gene products in CKD patients is limited. We therefore investigated this topic in a group of CKD patients on hemodialysis. METHODS Twenty adult hemodialysis (HD) patients (aged 54.9 ± 15.2 years) and 11 healthy individuals (aged 50.9 ± 8.0 years) were enrolled. Peripheral blood mononuclear cells (PBMC) were isolated and processed for expression of nuclear factor-κB (NF-κB), Nrf2, heme oxygenase-1 and NADPH: quinoneoxidoreductase 1 (NQO1) by quantitative real-time polymerase chain reaction and western blot analysis. Plasma malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α) levels were measured. RESULTS Peripheral blood mononuclear cells from HD patients had significantly lower NQO1 and Nrf2 mRNA expressions (0.58 ± 0.35 vs. 1.13 ± 0.64, p = 0.005), and significantly higher NF-κB expression (2.18 ± 0.8 vs. 1.04 ± 0.22, p = 0.0001) compared to the healthy individuals. The NF-κB expression was inversely correlated with Nrf2 levels (r = -0.54, p < 0.01) in CKD patients. Plasma MDA and TNF-α levels were significantly higher in CKD patients than in the healthy individuals. CONCLUSIONS Up-regulation of NFκB in the CKD patients' PBMC is coupled to down-regulation of Nrf2 and NQO1 expression. These observations are consistent with recent findings in CKD animals and point to the contribution of the impaired Nrf2 system in the pathogenesis of oxidative stress and inflammation in hemodialysis patients.
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Affiliation(s)
- Liliana M Pedruzzi
- Graduate Program in Cardiovascular Sciences, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil,
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Cardozo LFMF, Pedruzzi LM, Stenvinkel P, Stockler-Pinto MB, Daleprane JB, Leite M, Mafra D. Nutritional strategies to modulate inflammation and oxidative stress pathways via activation of the master antioxidant switch Nrf2. Biochimie 2013; 95:1525-33. [PMID: 23643732 DOI: 10.1016/j.biochi.2013.04.012] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/22/2013] [Indexed: 12/16/2022]
Abstract
The nuclear factor E2-related factor 2 (Nrf2) plays an important role in cellular protection against cancer, renal, pulmonary, cardiovascular and neurodegenerative diseases where oxidative stress and inflammation are common conditions. The Nrf2 regulates the expression of detoxifying enzymes by recognizing the human Antioxidant Response Element (ARE) binding site and it can regulate antioxidant and anti-inflammatory cellular responses, playing an important protective role on the development of the diseases. Studies designed to investigate how effective Nrf2 activators or modulators are need to be initiated. Several recent studies have shown that nutritional compounds can modulate the activation of Nrf2-Keap1 system. This review aims to discuss some of the key nutritional compounds that promote the activation of Nrf2, which may have impact on the human health.
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Affiliation(s)
- Ludmila F M F Cardozo
- Federal Fluminense University, Graduate Programme in Cardiovascular Sciences, Niterói-RJ, Brazil.
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Velarde GC, Fouque D, Leite M, Mafra D. Zinc-α2-glycoprotein: is there association between this new adipokine and body composition in hemodialysis patients? Ren Fail 2012; 34:1062-7. [PMID: 22906217 DOI: 10.3109/0886022x.2012.712859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peptides involved in the regulation of body composition are of interest in hemodialysis (HD) patients because protein wasting associated with high fat mass (FM) is present in these patients. Zinc-α2-glycoprotein (ZAG), a new adipokine, is involved in the regulation of lipid metabolism, adiposity, and energy balance. The purpose of this study was to evaluate ZAG levels and its relationship with body composition and dietary intake in HD patients. Forty-nine HD patients (28 men, 53.1 ± 12.5 years, and BMI 24.0 ± 4.3 kg/m2) were studied and compared with 20 healthy subjects (9 men, 49.5 ± 15.2 years, and BMI 25.6 ± 4.1 kg/m(2)). Plasma ZAG levels were measured using the ELISA methods and body composition was evaluated through anthropometric data. Dietary intake was assessed 3 days by 24-hour food recall. Although most of the HD patients (59.2%) were eutrophic according to BMI, 92.3% presented high percentage of body fat (BF), and 43.5%, reduced fat-free mass according to midarm muscle circumference values. ZAG levels were ∼2.5-fold higher in HD patients (135.9 ± 40.9 mg/L) compared with healthy individuals (54.6 ± 23.0 mg/L) (p < 0.0001). Circulating ZAG was not associated with dietary intake; however, this peptide was negatively correlated with %BF and, for each 1% reduction in BF, ZAG levels increased by 2.4 mg/L (p = 0.02). In summary, circulating ZAG is increased and inversely correlated with adiposity in HD patients; however, in spite of its higher plasma levels, the majority of HD patients did not show low BF.
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Affiliation(s)
- Viviane O Leal
- Programa de Pós Graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, Brasil.
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Mafra D, Lobo JC, Farage NE, Stockler-Pinto MB, Leal VO, Calixto A, Geloneze B. The Relationship between Apelin and Parathyroid Hormone in Hemodialysis Patients. Ren Fail 2012; 34:970-3. [DOI: 10.3109/0886022x.2012.700675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Stockler-Pinto MB, Lobo J, Moraes C, Leal VO, Farage NE, Rocha AV, Boaventura GT, Cozzolino SM, Malm O, Mafra D. Effect of Brazil Nut Supplementation on Plasma Levels of Selenium in Hemodialysis Patients: 12 Months of Follow-up. J Ren Nutr 2012; 22:434-9. [DOI: 10.1053/j.jrn.2011.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/05/2011] [Accepted: 08/09/2011] [Indexed: 11/11/2022] Open
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GPR Janiques A, Stockler-Pinto MB, Leal VO, Moreira NX, Mafra D. EFFECTS OF grape powder SUPPLEMENTATION ON INFLAMMATION IN hemodialysis patients. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.475] [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: 10/28/2022] Open
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Calixto A, Geloneze B, Mafra D. Apelin in hemodialysis patients: is there relationship with oxidative and inflammation markers? Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.456] [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: 11/30/2022] Open
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Stockler-Pinto MB, Mafra D, Lobo JC, Moraes C, Farage NE, Boaventura GT, Silva W, Wady MTB, Malm O. Effect of brazilian nut supplementation on antioxidant, inflammatory and lipids status in hemodialysis patients. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.556] [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] Open
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Moraes C, Stockler-Pinto MB, Lobo JC, Barros AF, Wady MTB, Seguins WS, Bessa B, Fouque D, Mafra D. Resistance Exercise Program: Intervention To Reduce Inflammation And Improve Nutritional Status In Hemodialysis Patients. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Leal VO, Stockler-Pinto MB, Lobo JC, Farage NE, Fouque D, Mafra D. inflammation increases the resting energy expenditure in hemodialysis patients. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.474] [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: 10/28/2022] Open
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Leal VO, Moraes C, Stockler-Pinto MB, Barros A, Farage NE, Mafra D. Skinfold thicknesses method to analyse body fat in hemodialysis patients: comparison with dual energy x-ray absorptiometry. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.455] [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: 11/24/2022] Open
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Stockler-Pinto MB, Velarde LGC, Mafra D. Is selenium status associated with mortality risk in hemodialysis patients? Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.558] [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: 11/29/2022] Open
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Calixto A, Geloneze B, Mafra D. Apelin: A Peptide Involved in Cardiovascular Risk in Hemodialysis Patients? Ren Fail 2012; 34:577-81. [DOI: 10.3109/0886022x.2012.668490] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Mafra D, Moraes C, Leal VO, Farage NE, Stockler-Pinto MB, Fouque D. Underreporting of energy intake in maintenance hemodialysis patients: a cross-sectional study. J Ren Nutr 2012; 22:578-83. [PMID: 22227181 DOI: 10.1053/j.jrn.2011.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To analyze the reported energy intake (EI(rep)) in hemodialysis (HD) patients by total energy expenditure (TEE) measured by a dedicated device. DESIGN Cross-sectional study. SETTING RenalCor and RenalVida Clinics (Rio de Janeiro, Brazil). PATIENTS AND OTHERS PARTICIPANTS Forty-eight HD patients (51.4 ± 12.2 years, 62% men, body mass index [BMI], 23.8 ± 4.5 kg/m(2)) were studied. MAIN OUTCOME MEASURE EI(rep) was evaluated using a 3-day food record. TEE was measured over a 2-day period by SWA (SenseWear Pro2 Armband, BodyMedia Inc., Pittsburgh, PA). Subjects were identified as underreporters (URs), acceptable reporters (ARs), or overreporters (ORs) from their EI(rep)/TEE ratio. ARs were defined as having the EI(rep)/TEE ratio in the range of 0.76 to 1.24, URs as EI(rep)/TEE <0.76, ORs as EI(rep)/TEE >1.24 according to Goldberg index. RESULTS The mean TEE and EI(rep) were 34.7 ± 9.4 kcal/kg/day and 22.8 ± 10.6 kcal/kg/day, respectively, and 37.5% of patients presented overweight or obesity. Thirty-one patients (65%) were identified as URs, and the mean of Goldberg index was 0.54 ± 0.12 (0.23 to 0.75), versus 0.95 ± 0.12 (0.79 to 1.2) for ARs. There were no ORs among the patients studied. There were negative correlations between Goldberg index and BMI (r = -0.35, P < .01) and % body fat (r = -0.4, P < .01) and between EI(rep) and BMI (r = -0.58, P < .001). CONCLUSION These results confirm a high prevalence of underreporting of EI in HD patients, particularly in patients with high BMI.
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Affiliation(s)
- Denise Mafra
- Medical Sciences Post-Graduate Program, Federal University Fluminense, Niterói, Brazil.
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Abdalla DSP, Leite M, Mafra D. Is zinc-α2-glycoprotein a cardiovascular protective factor for patients undergoing hemodialysis? Clin Chim Acta 2011; 413:616-9. [PMID: 22178218 DOI: 10.1016/j.cca.2011.12.002] [Citation(s) in RCA: 28] [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: 10/10/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Zinc-α2-glycoprotein (ZAG) is a lipid mobilizing factor. Its anti-inflammatory action and expression pattern suggest that ZAG could act by protecting against the obesity-associated disorders. In hemodialysis (HD) patients, ZAG levels were described to be elevated but its effects on markers of inflammation and LDL oxidation are still unclear. We investigated the relationship between ZAG and markers of systemic inflammation and LDL atherogenic modification profile in HD patients. METHODS Forty-three patients regularly on HD were studied and compared to 20 healthy subjects. Plasma ZAG, adiponectin, electronegative LDL [LDL(-)], an atherosclerotic negatively charged LDL subfraction, and anti-LDL(-) autoantibodies levels were measured by ELISA. Markers of inflammation and atherogenic cell recruitment (TNF-α, interleukin-6, VCAM-1, ICAM-1, MCP-1 and PAI-1) were also determined. RESULTS Inflammatory markers and atherogenic cell recruitment were higher in HD patients when compared to healthy subjects. ZAG levels were also higher in HD patients (151.5 ± 50.1 mg/l vs 54.6 ± 23.0 mg/l; p<0.0001) and its levels were negatively correlated with TNF-α (r=-0.39; p=0.001) and VCAM-1 (r=-0.52; p<0.0001) and, positively correlated with anti-LDL(-) autoantibodies (r=0.38; p=0.016). On multivariate analyses, plasma ZAG levels were independently associated with VCAM-1 (p=0.01). CONCLUSION ZAG is inversely associated with markers of pro-atherogenic factors linked to systemic inflammation and oxidative stress. Thus, this adipokine may constitute a novel marker of a favorable metabolic profile regarding cardiovascular risk factors in HD population.
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Affiliation(s)
- Viviane O Leal
- Pós-graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, RJ, Brazil.
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Leal VO, Stockler-Pinto MB, Farage NE, Aranha LN, Fouque D, Anjos LA, Mafra D. Handgrip strength and its dialysis determinants in hemodialysis patients. Nutrition 2011; 27:1125-9. [DOI: 10.1016/j.nut.2010.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/25/2010] [Accepted: 12/13/2010] [Indexed: 01/04/2023]
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Saldanha JF, Carrero JJ, Lobo JC, Stockler-Pinto MB, Leal VO, Calixto A, Geloneze B, Mafra D. The newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: Are there associations with food intake, body composition and inflammation? ACTA ACUST UNITED AC 2011; 173:82-5. [PMID: 22036920 DOI: 10.1016/j.regpep.2011.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/06/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
Abstract
Nesfatin-1 is a recently identified anorexigenic peptide that has been implicated in appetite regulation, weight loss and/or malnutrition. Anorexia and malnutrition are common features of chronic kidney disease (CKD) that predispose patients to worse outcomes. However, the reasons for the occurrence of anorexia in CKD patients are not fully elucidated. The aim of this study was to investigate the association between nesfatin-1 and protein intake and body composition in patients undergoing hemodialysis (HD). Twenty five HD patients from a private Clinic in Rio de Janeiro, Brazil were studied and compared with 15 healthy subjects that were matched for body mass index (BMI), % body fat mass (by anthropometrics) and age. Appetite was measured using a specific questionnaire, and food intake was evaluated based on 3-day food records. Nesfatin-1 levels were measured by ELISA and leptin, TNF-α and IL-6 levels were determined by a multiplex assay kit. Serum nesfatin-1 levels did not differ between HD patients (0.16±0.07ng/mL) and healthy subjects (0.17±0.10ng/mL). Nesfatin-1 levels showed significant negative correlations with protein intake (r=-0.42; p=0.03), but did not associate with inflammatory markers or appetite scores. Combining patients and controls, we observed positive correlations with BMI (r=0.33; p=0.03), % body fat (r=0.35; p=0.03), leptin (r=0.45; p=0.006) and the triceps skinfold thickness (r=0.36; p=0.02). In multivariate analysis % body fat was the main determinant of nesfatin-1 variance. In conclusion, nesfatin-1 levels did not differ between HD patients and healthy subjects and negatively correlated with protein intake. This pathway is likely not dysregulated in uremia.
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Affiliation(s)
- J F Saldanha
- Clinical Nutrition Department, Nutrition Faculty, Federal University Fluminense (UFF), Niterói, Brazil.
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Mafra D, Farage NE, Lobo JC, Stockler-Pinto MB, Leal VO, Carvalho DP, Leite M. Relationship between total ghrelin and inflammation in hemodialysis patients. Peptides 2011; 32:358-61. [PMID: 21129426 DOI: 10.1016/j.peptides.2010.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
In hemodialysis (HD) patients studies have shown that plasma ghrelin is increased and it has been speculated that ghrelin levels might be related to systemic inflammation. The present study attempted to correlate the serum levels of total ghrelin with serum TNF-α and IL-6, and with nutritional status and body composition in HD patients. Forty-seven HD patients from a single dialysis unit (18 women, mean age 55.3±12.2 yr; BMI 24.4±4.2kg/m(2); % body fat 29.4±7.4%) were studied and compared to 21 healthy subjects (12 women, 50.7±15.7 yr and BMI 25.6±4.0kg/m(2); % body fat 30.0±5.7%). Biochemical data, serum total ghrelin, TNF-α and IL-6 levels were measured. The body composition was evaluated by dual energy X-ray absortiometry (DEXA) and energy and protein intake were evaluated. Patients showed elevated plasma ghrelin levels when compared to healthy subjects (1.14±1.0ng/mL vs 0.58±0.4; p<0.001). There was a positive correlation between ghrelin levels and TNF-α (r=0.25; p<0.04), IL-6 (r=0.42; p<0.02), and a negative correlation between TNF-α and protein intake (r=-0.28; p<0.03), and energy intake (r=-0.34; p<0.01). No correlation was observed with any aspect of body composition. Plasma ghrelin levels are elevated in HD patients and associated with the state of systemic inflammation. We suggest that the inflammatory state may affect ghrelin bioactivity and metabolism in hemodialysis patients.
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Affiliation(s)
- D Mafra
- Department of Clinical Nutrition, Federal University Fluminense, Niterói, Brazil.
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