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Speer T, Schunk SJ, Sarakpi T, Schmit D, Wagner M, Arnold L, Zewinger S, Azukaitis K, Bayazit A, Obrycki L, Kaplan Bulut I, Duzova A, Doyon A, Ranchin B, Caliskan S, Harambat J, Yilmaz A, Alpay H, Lugani F, Balat A, Arbeiter K, Longo G, Melk A, Querfeld U, Wühl E, Mehls O, Fliser D, Schaefer F. Urinary DKK3 as a biomarker for short-term kidney function decline in children with chronic kidney disease: an observational cohort study. Lancet Child Adolesc Health 2023; 7:405-414. [PMID: 37119829 DOI: 10.1016/s2352-4642(23)00049-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Childhood-onset chronic kidney disease is a progressive condition that can have a major effect on life expectancy and quality. We evaluated the usefulness of the kidney tubular cell stress marker urinary Dickkopf-related protein 3 (DKK3) in determining the short-term risk of chronic kidney disease progression in children and identifying those who will benefit from specific nephroprotective interventions. METHODS In this observational cohort study, we assessed the association between urinary DKK3 and the combined kidney endpoint (ie, the composite of 50% reduction of the estimated glomerular filtration rate [eGFR] or progression to end-stage kidney disease) or the risk of kidney replacement therapy (ie, dialysis or transplantation), and the interaction of the combined kidney endpoint with intensified blood pressure reduction in the randomised controlled ESCAPE trial. Moreover, urinary DKK3 and eGFR were quantified in children aged 3-18 years with chronic kidney disease and urine samples available enrolled in the prospective multicentre ESCAPE (NCT00221845; derivation cohort) and 4C (NCT01046448; validation cohort) studies at baseline and at 6-monthly follow-up visits. Analyses were adjusted for age, sex, hypertension, systolic blood pressure SD score (SDS), BMI SDS, albuminuria, and eGFR. FINDINGS 659 children were included in the analysis (231 from ESCAPE and 428 from 4C), with 1173 half-year blocks in ESCAPE and 2762 in 4C. In both cohorts, urinary DKK3 above the median (ie, >1689 pg/mg creatinine) was associated with significantly greater 6-month eGFR decline than with urinary DKK3 at or below the median (-5·6% [95% CI -8·6 to -2·7] vs 1·0% [-1·9 to 3·9], p<0·0001, in ESCAPE; -6·2% [-7·3 to -5·0] vs -1·5% [-2·9 to -0·1], p<0·0001, in 4C), independently of diagnosis, eGFR, and albuminuria. In ESCAPE, the beneficial effect of intensified blood pressure control was limited to children with urinary DKK3 higher than 1689 pg/mg creatinine, in terms of the combined kidney endpoint (HR 0·27 [95% CI 0·14 to 0·55], p=0·0003, number needed to treat 4·0 [95% CI 3·7 to 4·4] vs 250·0 [66·9 to ∞]) and the need for kidney replacement therapy (HR 0·33 [0·13 to 0·85], p=0·021, number needed to treat 6·7 [6·1 to 7·2] vs 31·0 [27·4 to 35·9]). In 4C, inhibition of the renin-angiotensin-aldosterone system resulted in significantly lower urinary DKK3 concentrations (least-squares mean 12 235 pg/mg creatinine [95% CI 10 036 to 14 433] in patients not on angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers vs 6861 pg/mg creatinine [5616 to 8106] in those taking angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers, p<0·0001). INTERPRETATION Urinary DKK3 indicates short-term risk of declining kidney function in children with chronic kidney disease and might allow a personalised medicine approach by identifying those who benefit from pharmacological nephroprotection, such as intensified blood pressure lowering. FUNDING None.
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Affiliation(s)
- Thimoteus Speer
- Department of Internal Medicine 4, Nephrology, Goethe-University, Frankfurt, Germany; Else Kroener Fresenius Center for Nephrological Research, Goethe-University, Frankfurt, Germany
| | - Stefan J Schunk
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tamim Sarakpi
- Department of Internal Medicine 4, Nephrology, Goethe-University, Frankfurt, Germany
| | - David Schmit
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Martina Wagner
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ludger Arnold
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Ipek Kaplan Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Salim Caliskan
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Jerome Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Alev Yilmaz
- Pediatric Nephrology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Harika Alpay
- Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Francesca Lugani
- Pediatric Nephrology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Ayse Balat
- Department of Pediatric Nephrology, Gaziantep University, Gaziantep, Turkey
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, Azienda Ospedaliera-University of Padova, Padova, Italy
| | - Anette Melk
- Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Department of Pediatrics, Division of Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Otto Mehls
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany; DiaRen, Homburg/Saar, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany.
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Schunk SJ, Hermann J, Sarakpi T, Triem S, Lellig M, Hahm E, Zewinger S, Schmit D, Becker E, Möllmann J, Lehrke M, Kramann R, Boor P, Lipp P, Laufs U, März W, Reiser J, Jankowski J, Fliser D, Speer T, Jankowski V. Guanidinylated Apolipoprotein C3 (ApoC3) Associates with Kidney and Vascular Injury. J Am Soc Nephrol 2021; 32:3146-3160. [PMID: 34588185 PMCID: PMC8638400 DOI: 10.1681/asn.2021040503] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Coexistent CKD and cardiovascular diseases are highly prevalent in Western populations and account for substantial mortality. We recently found that apolipoprotein C-3 (ApoC3), a major constituent of triglyceride-rich lipoproteins, induces sterile systemic inflammation by activating the NOD-like receptor protein-3 (NLRP3) inflammasome in human monocytes via an alternative pathway. METHODS To identify posttranslational modifications of ApoC3 in patients with CKD, we used mass spectrometry to analyze ApoC3 from such patients and from healthy individuals. We determined the effects of posttranslationally modified ApoC3 on monocyte inflammatory response in vitro, as well as in humanized mice subjected to unilateral ureter ligation (a kidney fibrosis model) and in a humanized mouse model for vascular injury and regeneration. Finally, we conducted a prospective observational trial of 543 patients with CKD to explore the association of posttranslationally modified ApoC3 with renal and cardiovascular events in such patients. RESULTS We identified significant posttranslational guanidinylation of ApoC3 (gApoC3) in patients with CKD. We also found that mechanistically, guanidine and urea induce guanidinylation of ApoC3. A 2D-proteomic analysis revealed that gApoC3 accumulated in kidneys and plasma in a CKD mouse model (mice fed an adenine-rich diet). In addition, gApoC3 augmented the proinflammatory effects of ApoC3 in monocytes in vitro . In humanized mice, gApoC3 promoted kidney tissue fibrosis and impeded vascular regeneration. In CKD patients, higher gApoC3 plasma levels (as determined by mass spectrometry) were associated with increased mortality as well as with renal and cardiovascular events. CONCLUSIONS Guanidinylation of ApoC3 represents a novel pathogenic mechanism in CKD and CKD-associated vascular injury, pointing to gApoC3 as a potential therapeutic target.
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Affiliation(s)
- Stefan J. Schunk
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
| | - Juliane Hermann
- Institute of Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Tamim Sarakpi
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
| | - Sarah Triem
- Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | - Michaela Lellig
- Institute of Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Eunsil Hahm
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephen Zewinger
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
| | - David Schmit
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
| | - Ellen Becker
- Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | - Julia Möllmann
- Department of Cardiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Lehrke
- Department of Cardiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rafael Kramann
- Department of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Lipp
- Präklinisches Zentrum für Molekulare Signalverarbeitung (PZMS), Institute of Cell Biology, Saarland University, Homburg/Saar, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Winfried März
- Vth Department of Medicine, University Heidelberg, Mannheim Medical Faculty, Mannheim, Germany
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
- Synlab Academy, Synlab Holding, Mannheim, Germany
| | - Jochen Reiser
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joachim Jankowski
- Institute of Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
- School for Cardiovascular Diseases, Maastricht University, Maastrich, The Netherlands
| | - Danilo Fliser
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
| | - Thimoteus Speer
- Nephrology and Hypertension, Department of Internal Medicine IV, Saarland University, Homburg/Saar, Germany
- Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | - Vera Jankowski
- Institute of Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
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3
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Schunk SJ, Triem S, Schmit D, Zewinger S, Sarakpi T, Becker E, Hütter G, Wrublewsky S, Küting F, Hohl M, Alansary D, Prates Roma L, Lipp P, Möllmann J, Lehrke M, Laschke MW, Menger MD, Kramann R, Boor P, Jahnen-Dechent W, März W, Böhm M, Laufs U, Niemeyer BA, Fliser D, Ampofo E, Speer T. Interleukin-1α Is a Central Regulator of Leukocyte-Endothelial Adhesion in Myocardial Infarction and in Chronic Kidney Disease. Circulation 2021; 144:893-908. [PMID: 34192892 DOI: 10.1161/circulationaha.121.053547] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiovascular diseases and chronic kidney disease (CKD) are highly prevalent, aggravate each other, and account for substantial mortality. Both conditions are characterized by activation of the innate immune system. The alarmin interleukin-1α (IL-1α) is expressed in a variety of cell types promoting (sterile) systemic inflammation. The aim of the present study was to examine the role of IL-1α in mediating inflammation in the setting of acute myocardial infarction (AMI) and CKD. METHODS We assessed the expression of IL-1α on the surface of monocytes from patients with AMI and patients with CKD and determined its association with atherosclerotic cardiovascular disease events during follow-up in an explorative clinical study. Furthermore, we assessed the inflammatory effects of IL-1α in several organ injury models in Il1a-/- and Il1b-/- mice and investigated the underlying mechanisms in vitro in monocytes and endothelial cells. RESULTS IL-1α is strongly expressed on the surface of monocytes from patients with AMI and CKD compared with healthy controls. Higher IL-1α surface expression on monocytes from patients with AMI and CKD was associated with a higher risk for atherosclerotic cardiovascular disease events, which underlines the clinical relevance of IL-1α. In mice, IL-1α, but not IL-1β, mediates leukocyte-endothelial adhesion as determined by intravital microscopy. IL-1α promotes accumulation of macrophages and neutrophils in inflamed tissue in vivo. Furthermore, IL-1α on monocytes stimulates their homing at sites of vascular injury. A variety of stimuli such as free fatty acids or oxalate crystals induce IL-1α surface expression and release by monocytes, which then mediates their adhesion to the endothelium via IL-1 receptor-1. IL-1α also promotes expression of the VCAM-1 (vascular cell adhesion molecule-1) on endothelial cells, thereby fostering the adhesion of circulating leukocytes. IL-1α induces inflammatory injury after experimental AMI, and abrogation of IL-1α prevents the development of CKD in oxalate or adenine-fed mice. CONCLUSIONS IL-1α represents a key mediator of leukocyte-endothelial adhesion and inflammation in AMI and CKD. Inhibition of IL-1α may serve as a novel anti-inflammatory treatment strategy.
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Affiliation(s)
- Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany.,Translational Cardiorenal Medicine (S.T., E.B., G.H., F.K., T. Speer), Saarland University, Homburg/Saar, Germany
| | - David Schmit
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Tamim Sarakpi
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Ellen Becker
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany.,Translational Cardiorenal Medicine (S.T., E.B., G.H., F.K., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Gregor Hütter
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany.,Translational Cardiorenal Medicine (S.T., E.B., G.H., F.K., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Selina Wrublewsky
- Institute of Clinical and Experimental Surgery (S.W., M.W.L., M.D.M., E.A.), Saarland University, Homburg/Saar, Germany
| | - Fabienne Küting
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany.,Translational Cardiorenal Medicine (S.T., E.B., G.H., F.K., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Mathias Hohl
- Department of Internal Medicine III, Cardiology, Angiology, and Intensity Care Medicine (M.H., M.B.), Saarland University, Homburg/Saar, Germany
| | - Dalia Alansary
- Institute of Biophysics, Center of Integrative Physiology and Molecular Medicine (CIPMM) (D.A., L.P.R., B.A.N.), Saarland University, Homburg/Saar, Germany
| | - Leticia Prates Roma
- Institute of Biophysics, Center of Integrative Physiology and Molecular Medicine (CIPMM) (D.A., L.P.R., B.A.N.), Saarland University, Homburg/Saar, Germany
| | - Peter Lipp
- Institute of Cell Biology (P.L.), Saarland University, Homburg/Saar, Germany
| | - Julia Möllmann
- Department of Cardiology (J.M., M.L.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany
| | - Michael Lehrke
- Department of Cardiology (J.M., M.L.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany
| | - Matthias W Laschke
- Institute of Clinical and Experimental Surgery (S.W., M.W.L., M.D.M., E.A.), Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute of Clinical and Experimental Surgery (S.W., M.W.L., M.D.M., E.A.), Saarland University, Homburg/Saar, Germany
| | - Rafael Kramann
- Department of Nephrology (R.K.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany.,Institute of Experimental Medicine and Systems Biology (R.K.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany
| | - Peter Boor
- Institute of Pathology (P.B.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany
| | - Willi Jahnen-Dechent
- Biointerface Laboratory (W.J.-D.), Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Germany
| | - Winfried März
- Vth Department of Medicine, University Heidelberg, Mannheim Medical Faculty, Mannheim, Germany (W.M.).,Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Austria (W.M.).,Synlab Academy, Synlab Holding, Mannheim, Germany (W.M.)
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, and Intensity Care Medicine (M.H., M.B.), Saarland University, Homburg/Saar, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Germany (U.L.)
| | - Barbara A Niemeyer
- Institute of Biophysics, Center of Integrative Physiology and Molecular Medicine (CIPMM) (D.A., L.P.R., B.A.N.), Saarland University, Homburg/Saar, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany
| | - Emmanuel Ampofo
- Institute of Clinical and Experimental Surgery (S.W., M.W.L., M.D.M., E.A.), Saarland University, Homburg/Saar, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension (S.J.S., S.T., D.S., S.Z., T. Sarakpi, E.B., G.H., F.K., D.F., T. Speer), Saarland University, Homburg/Saar, Germany.,Translational Cardiorenal Medicine (S.T., E.B., G.H., F.K., T. Speer), Saarland University, Homburg/Saar, Germany
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4
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Schunk SJ, Beisswenger C, Ritzmann F, Herr C, Wagner M, Triem S, Hütter G, Schmit D, Zewinger S, Sarakpi T, Honecker A, Mahadevan P, Boor P, Wagenpfeil S, Jörres R, Watz H, Welte T, Vogelmeier CF, Gröne HJ, Fliser D, Speer T, Bals R. Measurement of urinary Dickkopf-3 uncovered silent progressive kidney injury in patients with chronic obstructive pulmonary disease. Kidney Int 2021; 100:1081-1091. [PMID: 34237325 DOI: 10.1016/j.kint.2021.06.029] [Citation(s) in RCA: 9] [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: 02/03/2021] [Revised: 05/28/2021] [Accepted: 06/18/2021] [Indexed: 12/31/2022]
Abstract
Chronic kidney disease (CKD) represents a global public health problem with high disease related morbidity and mortality. Since CKD etiology is heterogeneous, early recognition of patients at risk for progressive kidney injury is important. Here, we evaluated the tubular epithelial derived glycoprotein dickkopf-3 (DKK3) as a urinary marker for the identification of progressive kidney injury in a non-CKD cohort of patients with chronic obstructive pulmonary disease (COPD) and in an experimental model. In COSYCONET, a prospective multicenter trial comprising 2,314 patients with stable COPD (follow-up 37.1 months), baseline urinary DKK3, proteinuria and estimated glomerular filtration rate (eGFR) were tested for their association with the risk of declining eGFR and the COPD marker, forced expiratory volume in one second. Baseline urinary DKK3 but not proteinuria or eGFR identified patients with a significantly higher risk for over a 10% (odds ratio: 1.54, 95% confidence interval: 1.13-2.08) and over a 20% (2.59: 1.28-5.25) decline of eGFR during follow-up. In particular, DKK3 was associated with a significantly higher risk for declining eGFR in patients with eGFR over 90 ml/min/1.73m2 and proteinuria under 30 mg/g. DKK3 was also associated with declining COPD marker (2.90: 1.70-4.68). The impact of DKK3 was further explored in wild-type and Dkk3-/- mice subjected to cigarette smoke-induced lung injury combined with a CKD model. In this model, genetic abrogation of DKK3 resulted in reduced pulmonary inflammation and preserved kidney function. Thus, our data highlight urinary DKK3 as a possible marker for early identification of patients with silent progressive CKD and for adverse outcomes in patients with COPD.
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Affiliation(s)
- Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Christoph Beisswenger
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Ritzmann
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Christian Herr
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Martina Wagner
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany; Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | - Gregor Hütter
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany; Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | - David Schmit
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Tamim Sarakpi
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Anja Honecker
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Peer Mahadevan
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Peter Boor
- Institute of Pathology, Department of Nephrology, RWTH University HospitalAachen, Aachen, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology, and Medical Informatics, Saarland University, Homburg/Saar
| | - Rudolf Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre Munich (CPC-M), University Hospital, LMU Munich, Munich, Germany
| | - Henrik Watz
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre Munich (CPC-M), University Hospital, LMU Munich, Munich, Germany; Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, German Centre for Lung Research (DZL), Marburg, Germany
| | | | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg/Saar, Germany; Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany.
| | - Robert Bals
- Department of Internal Medicine V, Pulmonology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Schunk SJ, Kleber ME, März W, Pang S, Zewinger S, Triem S, Ege P, Reichert MC, Krawczyk M, Weber SN, Jaumann I, Schmit D, Sarakpi T, Wagenpfeil S, Kramann R, Boerwinkle E, Ballantyne CM, Grove ML, Tragante V, Pilbrow AP, Richards AM, Cameron VA, Doughty RN, Dubé MP, Tardif JC, Feroz-Zada Y, Sun M, Liu C, Ko YA, Quyyumi AA, Hartiala JA, Tang WHW, Hazen SL, Allayee H, McDonough CW, Gong Y, Cooper-DeHoff RM, Johnson JA, Scholz M, Teren A, Burkhardt R, Martinsson A, Smith JG, Wallentin L, James SK, Eriksson N, White H, Held C, Waterworth D, Trompet S, Jukema JW, Ford I, Stott DJ, Sattar N, Cresci S, Spertus JA, Campbell H, Tierling S, Walter J, Ampofo E, Niemeyer BA, Lipp P, Schunkert H, Böhm M, Koenig W, Fliser D, Laufs U, Speer T. Genetically determined NLRP3 inflammasome activation associates with systemic inflammation and cardiovascular mortality. Eur Heart J 2021; 42:1742-1756. [PMID: 33748830 PMCID: PMC8244638 DOI: 10.1093/eurheartj/ehab107] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/19/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS Inflammation plays an important role in cardiovascular disease (CVD) development. The NOD-like receptor protein-3 (NLRP3) inflammasome contributes to the development of atherosclerosis in animal models. Components of the NLRP3 inflammasome pathway such as interleukin-1β can therapeutically be targeted. Associations of genetically determined inflammasome-mediated systemic inflammation with CVD and mortality in humans are unknown. METHODS AND RESULTS We explored the association of genetic NLRP3 variants with prevalent CVD and cardiovascular mortality in 538 167 subjects on the individual participant level in an explorative gene-centric approach without performing multiple testing. Functional relevance of single-nucleotide polymorphisms on NLRP3 inflammasome activation has been evaluated in monocyte-enriched peripheral blood mononuclear cells (PBMCs). Genetic analyses identified the highly prevalent (minor allele frequency 39.9%) intronic NLRP3 variant rs10754555 to affect NLRP3 gene expression. rs10754555 carriers showed significantly higher C-reactive protein and serum amyloid A plasma levels. Carriers of the G allele showed higher NLRP3 inflammasome activation in isolated human PBMCs. In carriers of the rs10754555 variant, the prevalence of coronary artery disease was significantly higher as compared to non-carriers with a significant interaction between rs10754555 and age. Importantly, rs10754555 carriers had significantly higher risk for cardiovascular mortality during follow-up. Inflammasome inducers (e.g. urate, triglycerides, apolipoprotein C3) modulated the association between rs10754555 and mortality. CONCLUSION The NLRP3 intronic variant rs10754555 is associated with increased systemic inflammation, inflammasome activation, prevalent coronary artery disease, and mortality. This study provides evidence for a substantial role of genetically driven systemic inflammation in CVD and highlights the NLRP3 inflammasome as a therapeutic target.
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Affiliation(s)
- Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Marcus E Kleber
- Vth Department of Medicine, University Heidelberg, Mannheim Medical Faculty, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- SYNLAB MVZ Humangenetik Mannheim, Harrlachweg 1, 68163 Mannheim, Germany
| | - Winfried März
- Vth Department of Medicine, University Heidelberg, Mannheim Medical Faculty, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Auenbruggerpl. 2, 8036 Graz, Austria
- Synlab Academy, Synlab Holding GmbH, Harrlachweg 1, 68163 Mannheim, Germany
| | - Shichao Pang
- Kardiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Philipp Ege
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Kirrberger Straße, 66424 Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Kirrberger Straße, 66424 Homburg, Germany
- Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1B, CePT, 02-097 Warsaw, Poland
| | - Susanne N Weber
- Department of Medicine II, Saarland University Medical Center, Kirrberger Straße, 66424 Homburg, Germany
| | - Isabella Jaumann
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - David Schmit
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Tamim Sarakpi
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology & Medical Informatics, Saarland University Campus Homburg/Saar, Kirrberger Straße, 66424 Homburg/Saar, Germany
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Pauwelsstrasse 30 52074 Aachen, Germany
- Institute of Experimental Medicine and Systems Biology, RWTH, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, BCM226, Houston, TX 77030, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
- Center of Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Vinicius Tragante
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Heidelberglaan 100 3584 CX Utrecht, Netherlands
| | - Anna P Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - A Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - Vicky A Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, Level 2 / 22-30 Park Ave, Grafton, Auckland, New Zealand
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Rue Bélanger, Montreal QC H1T 1C8, Canada
- Faculty of Medicine, Université der Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Rue Bélanger, Montreal QC H1T 1C8, Canada
- Faculty of Medicine, Université der Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | | | - Maxine Sun
- Faculty of Medicine, Université der Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Chang Liu
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, 1462 Clifton Road NE, Atlanta, GA 30322, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Healthy, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, 1462 Clifton Road NE, Atlanta, GA 30322, USA
| | - Jaana A Hartiala
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, 2001 N. Soto St. Los Angeles, CA 90033, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, NB 21, Cleveland, OH 44195, USA
| | - Stanley L Hazen
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, NB 21, Cleveland, OH 44195, USA
| | - Hooman Allayee
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, 2001 N. Soto St. Los Angeles, CA 90033, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, 1225 Center Drive, HPNP Building, Gainesville, FL 32610-0486, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, 1225 Center Drive, HPNP Building, Gainesville, FL 32610-0486, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, 1225 Center Drive, HPNP Building, Gainesville, FL 32610-0486, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, 1225 Center Drive, HPNP Building, Gainesville, FL 32610-0486, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany
| | - Andrej Teren
- LIFE Research Center for Civilization Diseases, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany
- Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Ralph Burkhardt
- LIFE Research Center for Civilization Diseases, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg,Germany
| | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Göteborg, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skane University Hospital, BMC F12, 221 84 Lund, Sweden
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset Entrance 40, 751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset Entrance 40, 751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset Entrance 40, 751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset Entrance 40, 751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Dawn Waterworth
- Genetics, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, USA
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Cernter, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building University Avenue, Glasgow G12 8QQ, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Naveed Sattar
- BHF Glasgow Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA UK
| | - Sharon Cresci
- Washington University School of Medicine, 2300 I St NW, Washington, DC 20052, USA
- Department of Medicine & Genetics, Campus Box 8232, 4515 McKinley Ave., St. Louis, MO 63110, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Hannah Campbell
- Washington University School of Medicine, 2300 I St NW, Washington, DC 20052, USA
- Department of Medicine & Genetics, Campus Box 8232, 4515 McKinley Ave., St. Louis, MO 63110, USA
| | - Sascha Tierling
- Faculty of Natural Sciences and Technology, Department of Genetics/Epigenetics, Saarland University, Postfach 151150, 66041 Saarbrücken, Germany
| | - Jörn Walter
- Faculty of Natural Sciences and Technology, Department of Genetics/Epigenetics, Saarland University, Postfach 151150, 66041 Saarbrücken, Germany
| | - Emmanuel Ampofo
- Institute of Clinical & Experimental Surgery, Saarland University, Kirrberger Straße, 66424 Homburg/Saar, Germany
| | - Barbara A Niemeyer
- Molecular Biophysics, CIPMM, Saarland University, Kirrberger Straße, 66424 Homburg/Saar, Germany
| | - Peter Lipp
- Center for Molecular Signaling (PZMS), Institute for Molecular Cell Biology, Research Center for Molecular Imaging and Screening, Medical Faculty, Saarland University, Kirrberger Straße, 66424 Homburg, Germany
| | - Heribert Schunkert
- Kardiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany
- Partner Site Munich Heart Alliance, German Centre of Cardiovascular Research (DZHK), Ismaninger Straße 22, 81675 Munich, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Wolfgang Koenig
- Kardiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany
- Partner Site Munich Heart Alliance, German Centre of Cardiovascular Research (DZHK), Ismaninger Straße 22, 81675 Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Medical Center Leipzig, Liebigstraße 20, Leipzig, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Strasse, Building 41, 66424 Homburg/Saar, Germany
- Translational Cardio-Renal Medicine, Saarland University, Kirrberger Straße, 66424 Homburg/Saar, Germany
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6
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Silbernagel G, Scharnagl H, Kleber ME, Hoffmann MM, Delgado GE, Stojakovic T, Gary T, Zeng L, Ritsch A, Zewinger S, Speer T, Schunkert H, Landmesser U, März W, Grammer TB. J-shaped association between circulating apoC-III and cardiovascular mortality. Eur J Prev Cardiol 2021; 29:e68-e71. [PMID: 33609030 DOI: 10.1093/eurjpc/zwaa169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Günther Silbernagel
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.,Department of Cardiology, Charité-Universitätsmedizin Berlin (CBF), Berlin Institute of Health (BIH) and DZHK (German Center for Cardiovascular Research) e.V., Partner Site Berlin, 12200 Berlin, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Marcus E Kleber
- Department of Internal Medicine 5 (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany
| | - Michael M Hoffmann
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Graciela E Delgado
- Department of Internal Medicine 5 (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, 8036 Graz, Austria
| | - Thomas Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Lingyao Zeng
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München and DZHK (German Center for Cardiovascular Research) e.V., Partner Site Munich Heart Alliance, 80638 Munich, Germany
| | - Andreas Ritsch
- Department of Internal Medicine 1, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephen Zewinger
- Department of Internal Medicine 4 (Nephrology and Hypertension), University of Homburg, 66421 Homburg/Saar, Germany
| | - Thimoteus Speer
- Department of Internal Medicine 4 (Nephrology and Hypertension), University of Homburg, 66421 Homburg/Saar, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München and DZHK (German Center for Cardiovascular Research) e.V., Partner Site Munich Heart Alliance, 80638 Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin (CBF), Berlin Institute of Health (BIH) and DZHK (German Center for Cardiovascular Research) e.V., Partner Site Berlin, 12200 Berlin, Germany
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.,Department of Internal Medicine 5 (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany.,Synlab Academy, Synlab Holding Germany GmbH, 68159 Mannheim, Germany
| | - Tanja B Grammer
- Mannheimer Institute for Public Health, Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany
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Nazir S, Jankowski V, Bender G, Zewinger S, Rye KA, van der Vorst EP. Interaction between high-density lipoproteins and inflammation: Function matters more than concentration! Adv Drug Deliv Rev 2020; 159:94-119. [PMID: 33080259 DOI: 10.1016/j.addr.2020.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
High-density lipoprotein (HDL) plays an important role in lipid metabolism and especially contributes to the reverse cholesterol transport pathway. Over recent years it has become clear that the effect of HDL on immune-modulation is not only dependent on HDL concentration but also and perhaps even more so on HDL function. This review will provide a concise general introduction to HDL followed by an overview of post-translational modifications of HDL and a detailed overview of the role of HDL in inflammatory diseases. The clinical potential of HDL and its main apolipoprotein constituent, apoA-I, is also addressed in this context. Finally, some conclusions and remarks that are important for future HDL-based research and further development of HDL-focused therapies are discussed.
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Schunk S, Beisswenger C, Herr C, Ritzmann F, Sarah T, Schmit D, Omlor A, Jörres R, Watz H, Welte T, Vogelmeier C, Zewinger S, Fliser D, Bals R, Speer T. SO080NOVEL EVIDENCE OF THE “PULMO-RENAL INTERACTION” AS A DISEASE DRIVER IN PATIENTS WITH CKD AND COPD. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa139.so080] [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) and chronic obstructive pulmonary disease (COPD) represent a global public health problem worldwide. As such, both conditions are associated with high disease-related morbidity and mortality. However, it is unclear whether the presence of CKD aggravates the clinical course of COPD and vice versa.
Method
In a novel murine model of cigarette smoke (CS)-induced lung injury combined with an adenine nephropathy model, kidney and lung inflammation, and fibrosis were studied. Moreover, in 2,314 patients with stable COPD enrolled in the prospective, multi-centre COSYCONET study, urinary Dickkopf-3 (DKK3), a biomarker of kidney injury and CKD progression was quantified. The association between urinary DKK3 and trajectories of forced expiratory pressure in 1 second (FEV1) and estimated glomerular filtration rate (eGFR) during a median follow-up of 37.1 months, exercise capacity, risk of exacerbation, and mortality was determined.
Results
In the CKD-COPD animal model, the presence of kidney injury was associated with increased systemic and pulmonary inflammation, impaired pulmonary function, as well as more severe damage of the lung architecture. Moreover, CS enhanced kidney fibrosis. Accordingly, in the COPD patients from the COSYCONET study, higher urinary DKK3 was associated with declining FEV1 during follow-up (OR 3.36, 95% CI 2.22-5.08). Moreover, high urinary DKK3 was associated with higher risk for exacerbation (OR 1.24, 95% CI 1.03-1.50), lower 6-minute walking distance, and higher all-cause mortality (HR 1.49, 95% CI 1.08-2.05). Importantly, high urinary DKK3 was associated with declining eGFR during follow-up (OR 2.23, 95% CI 1.22-4.07) independently from baseline kidney function and proteinuria, which was confirmed by a machine learning approach.
Conclusion
These data uncover a novel pathophysiological link between CKD and COPD. Patient with COPD and concomitant CKD are at high risk for worsening pulmonary function and adverse outcomes. Elevated urinary DKK3 allows identification of COPD patients with progressive CKD. Measurement of urinary DKK3 in patients with COPD may therefore represent a novel tool for risk stratification and the identification of patients, who might in particular benefit from preventive therapeutic strategies to prevent progression of COPD and CKD as well.
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Affiliation(s)
| | | | | | | | - Triem Sarah
- Saarland University Hospital, Homburg, Germany
| | | | | | | | - Henrik Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansd. GmbH, Großhansdorf, Germany
| | - Tobias Welte
- Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | - Robert Bals
- Saarland University Hospital, Homburg, Germany
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9
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Schunk S, Kleber ME, Maerz W, Zewinger S, Isabella J, Schmit D, Fliser D, Ulrich L, Speer T. SO003LIFE-LONG NLRP3 INFLAMMASOME-MEDIATED SYSTEMIC INFLAMMATION ASSOCIATES WITH CARDIOVASCULAR MORTALITY: A GENETIC ASSOCIATION STUDY OF >500,000 INDIVIDUALS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa139.so003] [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) represents one of the strongest cardiovascular risk factors. Recently, we have shown that activation of the NOD-like receptor protein-3 (NLRP3) inflammasome mediates progression of kidney injury and CKD-associated vascular disease (Zewinger et al. Nat Immunol 2013). Components of the NLRP3 inflammasome pathway such as interleukin-1β (IL-1β) can therapeutically be targeted. Associations of genetically determined life-long inflammasome-mediated systemic inflammation with CVD and mortality in humans are unknown.
Method
We explored the association of genetic NLRP3 variants with prevalent CVD and cardiovascular mortality in 3,061 patients enrolled in the LURIC study undergoing coronary angiography in a gene-centric approach. Functional relevance of the rs10754555 NLRP3 variant was studied in freshly isolated human monocytes. Findings were validated in 39,755 participants from eight independent studies (CV risk populations) as well as in 483,258 participants of the UKBiobank study (general population).
Results
Genetic analyses identified the highly prevalent (MAF 39.9%) intronic NLRP3 variant rs10754555 to affect NLRP3 gene expression. rs10754555 carriers showed significantly higher C-reactive protein and serum amyloid A plasma levels. Expression of NLRP3 mRNA and inflammasome-dependent effector responses of isolated human monocytes from rs10754555 carriers were significantly higher as compared to non-carriers. In homozygous rs10754555 carriers, the prevalence of coronary artery disease (CAD) was significantly higher as compared to non-carriers with a significant interaction between rs10754555 and age in LURIC and in UKBiobank. Importantly, in LURIC and in UKBiobank, homozygous rs10754555 carriers had significantly higher risk for cardiovascular mortality during follow-up (HR 1.37, 95%-CI 1.08-1.74 and HR 1.13, 95%-CI 1.02-1.25, respectively). Consistently, rs10754555 was associated with higher cardiovascular mortality (HR 1.11, 95%-CI 1.05-1.16; P<0.001) in an additive model in patients with prevalent CAD.
Conclusion
The NLRP3 intronic variant rs10754555 is associated with increased systemic inflammation, inflammasome activation, prevalent CAD and mortality. This study provides evidence for a substantial role of life-long, genetically-driven systemic inflammation in cardiovascular disease and highlights the NLRP3 inflammasome as a therapeutic target in the general population and particular in patients with CKD.
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Grupp C, Beckermann J, Köster E, Zewinger S, Knittel M, Walek T, Hohenstein B, Jaeger B, Spitthöver R, Klingel R, Fassbender CM, Tyczynski B, Grupp C. Relapsing and Progressive Complications of Severe Hypertriglyceridemia: Effective Long-Term Treatment with Double Filtration Plasmapheresis. Blood Purif 2020; 49:457-467. [PMID: 32191938 DOI: 10.1159/000506506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe hypertriglyceridemia (HTG) is associated with major complications such as acute or relapsing pancreatitis (AP) and atherosclerotic cardiovascular disease (ASCVD). Rapid elimination of triglyceride (TG)-rich lipoproteins (LP) with double filtration plasmapheresis (DFPP) without need for substitution has been found to be effective for the acute, short-term treatment of HTG-induced AP. Data on the long-term use of DFPP to prevent HTG-associated complications are scarce. OBJECTIVES To evaluate the use and efficacy of regular DFPP treatment in clinical practice for preventing recurrence of HTG-associated complications in thera-py refractory patients. METHODS Retrospective multicenter study in patients with severe symptomatic drug and diet refractory HTG with regular DFPP treatment. Patients' incidence of HTG-associated pancreatic or cardiovascular complications was compared before treatment and with regular DFPP treatment. RESULTS Ten patients (3 female) were identified with baseline maximal TG concentrations of 2,587-28,090 mg/dL (median 5,487 mg/dL; interquartile range [IQR] 4,340-12,636). The mean observation period was 3.9 ± 3.4 years before and 3.8 ± 3.0 years after commencement of DFPP. In 5 patients, severe HTG was related to chylomicronemia, 2 patients had familial partial lipodystrophy Dunnigan, and 1 patient had additional LP(a)-hyperlipoproteinemia. The main HTG-associated complication was recurrent AP in 8 patients, including 1 patient treated during pregnancy. Two patients presented severe progressive ASCVD. With long-term DFPP treatment, the annual rate of HTG-associa-ted pancreatic or cardiovascular complications declined from median 1.4 (IQR 0.7-2.6) to 0 (IQR 0.0-0.4; p < 0.005). The absolute number of events was reduced by 77%. In 6 patients (60%) episodes of AP did not occur, nor was progression of ASCVD detected clinically or by routine imaging techniques. DFPP was effective in the elimination of TG-rich LP from plasma, and was safe and well-tolerated. CONCLUSION Long-term, regular DFPP treatment resulted in stabilization of patients with severe HTG and related recurrent AP or progression of ASCVD, who were refractory to conventional dietary and drug therapy.
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Affiliation(s)
- Clemens Grupp
- Department of Nephrology, Academic Teaching Hospital Bamberg, Bamberg, Germany.,Department of Nephrology and Rheumatology, Georg-August University Goettingen, Göttingen, Germany
| | | | - Eric Köster
- Department of Internal Medicine II, Hospital of Barmherzige Brüder, Trier, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV-Nephrology, Saarland University Hospital, Homburg, Germany
| | | | | | | | - Beate Jaeger
- Dialysis and Lipid Center North Rhine, Mülheim an der Ruhr, Germany
| | | | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany.,First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | | | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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11
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Affiliation(s)
- Thimoteus Speer
- Saarland University Medical Center, Department of Internal Medicine IV, Homburg/Saar, Germany
| | - Stephen Zewinger
- Saarland University Medical Center, Department of Internal Medicine IV, Homburg/Saar, Germany
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12
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Llubani R, Vukadinović D, Werner C, Marx N, Zewinger S, Böhm M. Hyperkalaemia in Heart Failure-Pathophysiology, Implications and Therapeutic Perspectives. Curr Heart Fail Rep 2019; 15:390-397. [PMID: 30421355 DOI: 10.1007/s11897-018-0413-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Hyperkalaemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction. Evaluating the prevalence of hyperkalaemia in patients with heart failure (HF) and potential treatments of this condition is essential for patients using renin-angiotensin-aldosterone system inhibitors or angiotensin receptor-neprilysin inhibitor and mineralocorticoid receptor antagonists, which represent the cornerstone and highly proven life-saving therapy. RECENT FINDINGS Novel findings from the past few years include data regarding the epidemiology, pathomechanisms, implications and novel therapeutic approaches to counteract hyperkalaemia in patients with HF. Whilst older potassium-binding agents are associated with serious adverse events, novel potassium-binding drugs are effective in lowering potassium levels and are generally well tolerated. Hyperkalaemia represents both a direct risk of cardiovascular complication and an indirect biomarker of the severity of the underlying disease such as neurohormonal activation and renal dysfunction. Novel potassium-binding drugs such as patiromer and sodium zirconium cyclosilicate may help to optimize therapy in HF and achieve guideline-recommended doses.
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Affiliation(s)
- Redi Llubani
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany.
| | - Davor Vukadinović
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
| | - Christian Werner
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, RWTH Aachen University, Aachen, Germany
| | - Stephen Zewinger
- Department for Internal Medicine IV, Nephrology, Saarland University Medical Center, Homburg, Germany
| | - Michael Böhm
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
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13
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Schunk SJ, Zarbock A, Meersch M, Küllmar M, Kellum JA, Schmit D, Wagner M, Triem S, Wagenpfeil S, Gröne HJ, Schäfers HJ, Fliser D, Speer T, Zewinger S. Association between urinary dickkopf-3, acute kidney injury, and subsequent loss of kidney function in patients undergoing cardiac surgery: an observational cohort study. Lancet 2019; 394:488-496. [PMID: 31202596 DOI: 10.1016/s0140-6736(19)30769-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [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: 02/02/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiac surgery is associated with a high risk of postoperative acute kidney injury (AKI) and subsequent loss of kidney function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a renal tubular stress marker, for preoperative identification of patients at risk for AKI and subsequent kidney function loss. METHODS This observational cohort study included patients who had cardiac surgery in a derivation cohort and those who had cardiac surgery in a validation cohort (RenalRIP trial). The study comprised consecutive patients who had elective cardiac surgery at the Saarland University Medical Centre (Homburg, Germany; derivation cohort) and those undergoing elective cardiac surgery (selected on the basis of a Cleveland Clinical Foundation score of 6 or higher) who were enrolled in the prospective RenalRIP multicentre trial (validation cohort) and who were randomly assigned to remote ischaemic preconditioning or a sham procedure. The association between the ratio of preoperative urinary concentrations of DKK3 to creatinine (DKK3:creatinine) and postoperative AKI, defined according to the Kidney Disease Improving Global Outcomes criteria, and subsequent kidney function loss, as determined by estimated glomerular filtration rate, was assessed. FINDINGS In the 733 patient in the derivation cohort, urinary concentrations of DKK3 to creatinine that were higher than 471 pg/mg were associated with significantly increased risk for AKI (odds ratio [OR] 1·65, 95% CI 1·10-2·47, p=0·015), independent of baseline kidney function. Compared with clinical and other laboratory measurements, urinary concentrations of DKK3:creatinine significantly improved AKI prediction (net reclassification improvement 0·32, 95% CI 0·23-0·42, p<0·0001). High urinary DKK3:creatinine concentrations were independently associated with significantly lower kidney function at hospital discharge and after a median follow-up of 820 days (IQR 733-910). In the RenalRIP trial, preoperative urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with a significantly higher risk for AKI (OR 1·94, 95% CI 1·08-3·47, p=0·026), persistent renal dysfunction (OR 6·67, 1·67-26·61, p=0·0072), and dialysis dependency (OR 13·57, 1·50-122·77, p=0·020) after 90 days compared with DKK3:creatinine concentrations of 471 pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with significantly higher risk for AKI (OR 2·79, 95% CI 1·45-5·37) and persistent renal dysfunction (OR 3·82, 1·32-11·05) only in patients having a sham procedure, but not remote ischaemic preconditioning (AKI OR 1·35, 0·76-2·39 and persistent renal dysfunction OR 1·05, 0·12-9·45). INTERPRETATION Preoperative urinary DKK3 is an independent predictor for postoperative AKI and for subsequent loss of kidney function. Urinary DKK3 might aid in the identification of patients in whom preventive treatment strategies are effective. FUNDING No study funding.
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Affiliation(s)
- Stefan J Schunk
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Melanie Meersch
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Mira Küllmar
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Schmit
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Martina Wagner
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Sarah Triem
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Hermann-Josef Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Centre, Heidelberg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Centre, Homburg, Germany
| | - Danilo Fliser
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Thimoteus Speer
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany.
| | - Stephen Zewinger
- Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany; Department of Nephrology, Hôpitaux Robert Schuman, Hôpital Kirchberg, Luxembourg, Luxembourg
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14
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Trudzinski FC, Alqudrah M, Omlor A, Zewinger S, Fliser D, Speer T, Seiler F, Biertz F, Koch A, Vogelmeier C, Welte T, Watz H, Waschki B, Fähndrich S, Jörres R, Bals R. Consequences of chronic kidney disease in chronic obstructive pulmonary disease. Respir Res 2019; 20:151. [PMID: 31299972 PMCID: PMC6626422 DOI: 10.1186/s12931-019-1107-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/22/2018] [Accepted: 06/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background The combination of chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) is associated with a higher prevalence of comorbidities and increased mortality. The impact of kidney function on patient-centered outcomes in COPD has not been evaluated. Methods Patients from the German COPD and Systemic Consequences - Comorbidities Network (COSYCONET) cohort COPD were analysed. CKD was diagnosed if the estimated glomerular filtration rate (eGFR) measurements were < 60 mL/min/1.73m2 at study inclusion and six month later. The effect of CKD, on comorbidities, symptoms [modified British Medical Research Council dyspnoea scale], physical capacity [six-minute walk test, and timed up and go] and St George’s Respiratory Questionnaire were analysed. Restricted cubic spline models were used to evaluate a nonlinear relationship between eGFR with patient-centered outcomes, cox survival analysis was applied to evaluate mortality. Results 2274 patients were analysed, with CKD diagnosed in 161 (7.1%). Spline models adjusted for age, gender, BMI, FEV1 and cardiovascular comorbidities revealed independent associations between eGFR with modified British Medical Research Council dyspnoea scale, St George’s Respiratory Questionnaire, (p < 0.001 and p = 0.011), six-minute walk test (p = 0.015) and timed up and go (p < 0.001). CKD was associated with increased mortality, independently from for other cardiovascular comorbidities (hazard ratio 2.3; p < 0.001). Conclusion These data show that CKD is a relevant comorbidity in COPD patients which impacts on patient-centered outcomes and mortality. Trial registration NCT01245933 Electronic supplementary material The online version of this article (10.1186/s12931-019-1107-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franziska C Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Mohamad Alqudrah
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Albert Omlor
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - Timotheus Speer
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - Frederik Seiler
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Benjamin Waschki
- Pulmonary Research Institute at LungenClinic Grosshansdorf Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Sebastian Fähndrich
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Rudolf Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany.
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15
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Trudzinski FC, Kahnert K, Vogelmeier CF, Alter P, Seiler F, Fähndrich S, Watz H, Welte T, Speer T, Zewinger S, Biertz F, Kauczor HU, Jörres RA, Bals R. Combined effects of lung function, blood gases and kidney function on the exacerbation risk in stable COPD: Results from the COSYCONET cohort. Respir Med 2019; 154:18-26. [PMID: 31203096 DOI: 10.1016/j.rmed.2019.06.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE Alterations of acid-base metabolism are an important outcome predictor in acute exacerbations of COPD, whereas sufficient metabolic compensation and adequate renal function are associated with decreased mortality. In stable COPD there is, however, only limited information on the combined role of acid-base balance, blood gases, renal and respiratory function on exacerbation risk grading. METHODS We used baseline data of the COPD cohort COSYCONET, applying linear and logistic regression analyses, the results of which were implemented into a comprehensive structural equation model. As most informative parameters it comprised the estimated glomerular filtration rate (eGFR), lung function defined via forced expiratory volume in 1 s (FEV1), intrathoracic gas volume (ITGV) and (diffusing capacity for carbon monoxide (DLCO), moreover arterial oxygen content (CaO2), partial pressure of oxygen (PaCO2), base exess (BE) and exacerbation risk according to GOLD criteria. All measures were adjusted for age, gender, body-mass index, the current smoking status and pack years. RESULTS 1506 patients with stable COPD (GOLD grade 1-4; mean age 64.5 ± 8.1 y; mean FEV1 54 ± 18 %predicted, mean eGFR 82.3 ± 16.9 mL/min/1.73 m2) were included. BE was linked to eGFR, lung function and PaCO2 and played a role as indirect predictor of exacerbation risk via these measures; moreover, eGFR was directly linked to exacerbation risk. These associations remained significant after taking into account medication (diuretics, oral and inhaled corticosteroids), whereby corticosteroids had effects on exacerbation risk and lung function, diuretics on eGFR, BE and lung function. CONCLUSION Even in stable COPD acid-base metabolism plays a key integrative role in COPD risk assessment despite rather small deviations from normality. It partially mediates the effects of impairments in kidney function, which are also directly linked to exacerbation risk.
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Affiliation(s)
- F C Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany.
| | - K Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - P Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - F Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - S Fähndrich
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - H Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - T Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany
| | - T Speer
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - S Zewinger
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - F Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - H-U Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Member of the German Center of Lung Research, Heidelberg, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
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16
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Zewinger S, Jochen R, Jankowski V, Hahm E, Schunk S, Schmit D, März W, Jankowski J, Barbara N, Laufs U, Fliser D, Speer T. FO084APOLIPOPROTEIN C3 INDUCES SYSTEMIC INFLAMMATION AND ORGAN DAMAGE IN CKD BY ALTERNATIVE INFLAMMASOME ACTIVATION VIA A NOVEL PATHWAY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo084] [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: 11/12/2022] Open
Affiliation(s)
| | - Reiser Jochen
- Rush University Medical Center, Chicago, United States of America
| | | | - Eunsil Hahm
- Rush University Medical Center, Chicago, United States of America
| | | | - David Schmit
- Saarland University Hospital, Homburg/Saar, Germany
| | - Winfried März
- Medical Faculty Mannheim, Heidelberg University (CBTM), Mannheim, Germany
| | | | | | | | - Danilo Fliser
- Saarland University Medical Centre, Homburg/Saar, Germany
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17
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Schunk S, Zarbock A, Meersch M, Küllmar M, Kellum JA, Schmit D, Wagner M, Sarah T, Wagenpfeil S, Gröne HJ, Schäfers HJ, Fliser D, Zewinger S, Speer T. SaO038PREOPERATIVE URINARY DICKKOPF-3 (DKK3) PREDICTS POSTOPERATIVE ACUTE KIDNEY INJURY AND TRANSITION INTO CKD IN PATIENTS UNDERGOING CARDIAC SURGERY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao038] [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
Affiliation(s)
| | | | | | | | - John A Kellum
- University of Pittsburgh, Pittsburgh, United States of America
| | - David Schmit
- Saarland University Hospital, Homburg/Saar, Germany
| | | | - Triem Sarah
- Saarland University Hospital, Homburg/Saar, Germany
| | | | | | | | - Danilo Fliser
- Saarland University Medical Centre, Homburg/Saar, Germany
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18
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Zewinger S, Rauen T, Rudnicki M, Federico G, Wagner M, Triem S, Schunk SJ, Petrakis I, Schmit D, Wagenpfeil S, Heine GH, Mayer G, Floege J, Fliser D, Gröne HJ, Speer T. Dickkopf-3 (DKK3) in Urine Identifies Patients with Short-Term Risk of eGFR Loss. J Am Soc Nephrol 2018; 29:2722-2733. [PMID: 30279273 DOI: 10.1681/asn.2018040405] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 04/19/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The individual course of CKD may vary, and improved methods for identifying which patients will experience short-term eGFR loss are needed. Assessing urinary Dickkopf-3 (DKK3), a stress-induced tubular epithelia-derived profibrotic glycoprotein, may provide information about ongoing tubulointerstitial fibrosis and short-term eGFR loss. METHODS To investigate urinary DKK3's potential as a biomarker of short-term eGFR loss (over 12 months), we prospectively assessed eGFR and urinary DKK3 levels in patients with CKD of various etiologies at baseline and annual follow-ups. We also measured urinary DKK3 in a general population sample and patients with diagnostic kidney biopsies or IgA nephropathy under treatment. RESULTS Median urinary DKK3-to-creatinine concentration at baseline was significantly higher in patients with CKD than the general population sample (431 versus 33 pg/mg). In the CKD cohort, having a urinary DKK3-to-creatinine level >4000 pg/mg was independently and significantly associated after multiple adjustments with mean annual decline in eGFR of 7.6% over 12 months. Urinary DKK3 significantly improved prediction of kidney function decline compared with eGFR or albuminuria alone. Urinary DKK3-to-creatinine levels were related to the extent of tubulointerstitial fibrosis in kidney biopsies. In patients with IgA nephropathy, a rise in urinary DKK3 was associated with significant eGFR decline within 6 months, whereas stable or decreasing urinary DKK3 indicated a more favorable course. CONCLUSIONS Urinary DKK3 levels identify patients at high risk for eGFR decline over the next 12 months regardless of the cause of kidney injury and beyond established biomarkers, potentially providing a tool to monitor CKD progression and assess effects of interventions.
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Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany;
| | - Thomas Rauen
- Department of Internal Medicine II, Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Michael Rudnicki
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Giuseppina Federico
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany; and
| | - Martina Wagner
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ioannis Petrakis
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - David Schmit
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Gunnar H Heine
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Gert Mayer
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Jürgen Floege
- Department of Internal Medicine II, Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hermann-Josef Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany; and
| | - Thimoteus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
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19
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Werner C, Stojakovic T, Speer T, Zewinger S, Maerz W, Scharnagl H, Laufs U. P3632Apolipoprotein C-III concentrations in chylomicron-free serum predict cardiovascular outcomes in patients with coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Werner
- Universitätsklinikum des Saarlandes - Klinik für Innere Medizin III, Homburg, Germany
| | - T Stojakovic
- Medical University of Graz, Klinisches Institut für Medizinische und Chemische Labordiagnostik, Graz, Austria
| | - T Speer
- Saarland University Hospital, Klinik für Innere Medizin IV - Nephrologie, Homburg, Germany
| | - S Zewinger
- Saarland University Hospital, Klinik für Innere Medizin IV - Nephrologie, Homburg, Germany
| | - W Maerz
- Medical University of Graz, Klinisches Institut für Medizinische und Chemische Labordiagnostik, Graz, Austria
| | - H Scharnagl
- Medical University of Graz, Klinisches Institut für Medizinische und Chemische Labordiagnostik, Graz, Austria
| | - U Laufs
- Leipzig University Hospital, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
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Ritsch A, Duerr A, Kahler P, Hunjadi M, Stojakovic T, Zewinger S, Speer T, Silbernagl G, Scharnagl H, Kleber M, März W. Independent effects of kidney function and cholersterol efflux on cardiovascular mortality. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zewinger S, Rauen T, Rudnicki M, Federico G, Wagner M, Triem S, Petrakis I, Schunk S, Wagenpfeil S, Heine G, Mayer G, Flöge J, Gröne HJ, Fliser D, Speer T. LB06DKK3 IN URINE IDENTIFIES PATIENTS WITH PROGRESSIVE CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy146.lb06] [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: 11/12/2022] Open
Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine 4, Saarland University Hospital, Homburg, Germany
| | - Thomas Rauen
- Department of Internal Medicine II - Nephrology and Clinical Immunology, RWTH Aachen, Aachen, Germany
| | - Michael Rudnicki
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Guiseppina Federico
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany
| | - Martina Wagner
- Saarland University Medical Center, Homburg/Saar, Germany
| | - Sarah Triem
- Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Stefan Schunk
- Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Gunnar Heine
- Saarland University Medical Center, Homburg/Saar, Germany
| | - Gert Mayer
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Jürgen Flöge
- Department of Internal Medicine II - Nephrology and Clinical Immunology, RWTH Aachen, Aachen, Germany
| | - Hermann-Josef Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany
| | - Danilo Fliser
- Saarland University Medical Center, Homburg/Saar, Germany
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Zewinger S, Kleber ME, Rohrer L, Lehmann M, Triem S, Jennings RT, Petrakis I, Dressel A, Lepper PM, Scharnagl H, Ritsch A, Thorand B, Heier M, Meisinger C, de Las Heras Gala T, Koenig W, Wagenpfeil S, Schwedhelm E, Böger RH, Laufs U, von Eckardstein A, Landmesser U, Lüscher TF, Fliser D, März W, Meinitzer A, Speer T. Symmetric dimethylarginine, high-density lipoproteins and cardiovascular disease. Eur Heart J 2018; 38:1597-1607. [PMID: 28379378 DOI: 10.1093/eurheartj/ehx118] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/23/2017] [Indexed: 11/12/2022] Open
Abstract
Aims The vascular effects of high-density lipoproteins (HDL) differ under certain clinical conditions. The composition of HDL is modified in patients with chronic kidney disease (CKD). As a consequence, uremic HDL induces endothelial dysfunction. We have previously shown that accumulation of symmetric dimethylarginine (SDMA) in HDL causes these adverse effects of HDL in CKD. The aim of the study is to determine the impact of the accumulation of SDMA on the association between HDL and mortality. Methods and results Mortality, renal function, serum SDMA and HDL-cholesterol (HDL-C) were assessed in the LURIC study including 3310 subjects undergoing coronary angiography. All-cause mortality was 30.0% during median follow-up of 9.9 years. Serum SDMA levels significantly predicted all-cause and cardiovascular mortality, and were significantly correlated with SDMA accumulation in HDL. Notably, higher serum SDMA was independently associated with lower cholesterol efflux (P = 0.004) as a measure of HDL functionality. In subjects with low SDMA levels, higher HDL-C was associated with significantly lower mortality. In contrast, in subjects with high SDMA, HDL-C was associated with higher mortality. These findings were confirmed in 1424 participants of the MONICA/KORA S3 cohort. Of note, we derived an algorithm allowing for calculation of biologically effective HDL-C' based on measured HDL-C and SDMA. We corroborated these clinical findings with invitro evidence showing that SDMA accumulation abolishes the anti-inflammatory and regenerative properties of HDL. Conclusion The data identify SDMA as a marker of HDL dysfunction. These findings highlight on the pivotal role of SDMA accumulation in HDL as a mediator of pre-mature cardiovascular disease in patients with CKD.
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Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Marcus E Kleber
- Mannheim Medical Faculty, Medical Clinic V (Nephrology • Hypertensiology • Endocrinology • Diabetology • Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.,Institute of Nutrition, Dornburger Strasse, 07743 Friedrich Schiller University Jena, Germany
| | - Lucia Rohrer
- Institute of Clinical Chemistry, University Hospital Zurich, Rämistrasse, 8091 Zurich, Switzerland
| | - Marlene Lehmann
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Richard T Jennings
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Ioannis Petrakis
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Alexander Dressel
- Mannheim Medical Faculty, Medical Clinic V (Nephrology • Hypertensiology • Endocrinology • Diabetology • Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz, 8036 Graz, Austria
| | - Andreas Ritsch
- Department of Internal Medicine, Medical University of Innsbruck, Christoph-Probst-Platz, 6020 Innsbruck, Austria
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Ingolstaedter Landstrasse 1, 85764 Munich, Germany
| | - Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Ingolstaedter Landstrasse 1, 85764 Munich, Germany
| | - Christa Meisinger
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Ingolstaedter Landstrasse 1, 85764 Munich, Germany
| | - Tonia de Las Heras Gala
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Ingolstaedter Landstrasse 1, 85764 Munich, Germany.,Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein-Allee, 89081 Ulm, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein-Allee, 89081 Ulm, Germany.,German Centre of Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.,Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Stefan Wagenpfeil
- Epidemiology and Medical Informatics, Campus Homburg/Saar, Saarland University, Institute for Medical Biometry, Kirrberger Strasse, 66421 Homburg/Saar, Germany
| | - Edzard Schwedhelm
- University Medical Center Hamburg-Eppendorf, Institute of Experimental and Clinical Pharmacology and Toxicology, Martinistrasse, 20246 Hamburg, Germany
| | - Rainer H Böger
- University Medical Center Hamburg-Eppendorf, Institute of Experimental and Clinical Pharmacology and Toxicology, Martinistrasse, 20246 Hamburg, Germany
| | - Ulrich Laufs
- Department of Internal Medicine III, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich, Rämistrasse, 8091 Zurich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Charité University Hospital, Hindenburgdamm, 12203 Berlin, Germany
| | - Thomas F Lüscher
- University Heart Center Zurich, Department of Cardiology, University Hospital and Center for Molecular Cardiology, University of Zurich, Rämistrasse, 8091 Zurich, Switzerland.,Center of Molecular Cardiology, University of Zurich, Wagistrasse, 8952 Zurich, Switzerland
| | - Danilo Fliser
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
| | - Winfried März
- Mannheim Medical Faculty, Medical Clinic V (Nephrology • Hypertensiology • Endocrinology • Diabetology • Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz, 8036 Graz, Austria.,Synlab Academy, Synlab Holding Deutschland GmbH, P5, 7, 68161 Mannheim and Augsburg, Germany
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz, 8036 Graz, Austria
| | - Thimoteus Speer
- Department of Internal Medicine IV, Kirrberger Strasse, 66421 Homburg/Saar, Saarland University Medical Centre, Germany
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Noels H, Boor P, Goettsch C, Hohl M, Jahnen-Dechent W, Jankowski V, Kindermann I, Kramann R, Lehrke M, Linz D, Maack C, Niemeyer B, Roma LP, Schuett K, Speer T, Wagenpfeil S, Werner C, Zewinger S, Böhm M, Marx N, Floege J, Fliser D, Jankowski J. The new SFB/TRR219 Research Centre. Eur Heart J 2018; 39:975-977. [PMID: 29579229 DOI: 10.1093/eurheartj/ehy083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Heidi Noels
- Institute for Molecular Cardiovascular Research, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Claudia Goettsch
- Medical Clinic I - Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Mathias Hohl
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Campus Homburg, Homburg, Germany
| | - Wilhelm Jahnen-Dechent
- Institute for Biomedical Engineering - Biointerface Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Vera Jankowski
- Institute for Molecular Cardiovascular Research, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Ingrid Kindermann
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Campus Homburg, Homburg, Germany
| | - Rafael Kramann
- Medical Clinic II - Nephrology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Lehrke
- Medical Clinic I - Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dominik Linz
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Campus Homburg, Homburg, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Barbara Niemeyer
- Institute of Biophysics, Saarland University Campus Homburg, Homburg, Germany
| | - Leticia P Roma
- Institute of Biophysics, Saarland University Campus Homburg, Homburg, Germany
| | - Katharina Schuett
- Medical Clinic I - Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thimoteus Speer
- Internal Medicine IV - Nephrology, Saarland University Campus Homburg, Kirrberger Straße, D-66421 Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany
| | - Christian Werner
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Campus Homburg, Homburg, Germany
| | - Stephen Zewinger
- Internal Medicine IV - Nephrology, Saarland University Campus Homburg, Kirrberger Straße, D-66421 Homburg/Saar, Germany
| | - Michael Böhm
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Campus Homburg, Homburg, Germany
| | - Nikolaus Marx
- Medical Clinic I - Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jürgen Floege
- Medical Clinic II - Nephrology, University Hospital RWTH Aachen, Aachen, Germany
| | - Danilo Fliser
- Internal Medicine IV - Nephrology, Saarland University Campus Homburg, Kirrberger Straße, D-66421 Homburg/Saar, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany
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24
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Affiliation(s)
- Thimoteus Speer
- Saarland University Medical Center, Department of Internal Medicine IV, Homburg/Saar, Germany
| | - Stefan J Schunk
- Saarland University Medical Center, Department of Internal Medicine IV, Homburg/Saar, Germany
| | - Stephen Zewinger
- Saarland University Medical Center, Department of Internal Medicine IV, Homburg/Saar, Germany
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Silbernagel G, Scharnagl H, Kleber ME, Grammer TB, Delgado G, Stojakovic T, Gary T, Ritsch A, Zewinger S, Speer T, Landmesser U, März W. J-shaped association of circulating apolipoprotein C3 with cardiovascular mortality. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Zewinger S, Kleber ME, Tragante V, McCubrey RO, Schmidt AF, Direk K, Laufs U, Werner C, Koenig W, Rothenbacher D, Mons U, Breitling LP, Brenner H, Jennings RT, Petrakis I, Triem S, Klug M, Filips A, Blankenberg S, Waldeyer C, Sinning C, Schnabel RB, Lackner KJ, Vlachopoulou E, Nygård O, Svingen GFT, Pedersen ER, Tell GS, Sinisalo J, Nieminen MS, Laaksonen R, Trompet S, Smit RAJ, Sattar N, Jukema JW, Groesdonk HV, Delgado G, Stojakovic T, Pilbrow AP, Cameron VA, Richards AM, Doughty RN, Gong Y, Cooper-DeHoff R, Johnson J, Scholz M, Beutner F, Thiery J, Smith JG, Vilmundarson RO, McPherson R, Stewart AFR, Cresci S, Lenzini PA, Spertus JA, Olivieri O, Girelli D, Martinelli NI, Leiherer A, Saely CH, Drexel H, Mündlein A, Braund PS, Nelson CP, Samani NJ, Kofink D, Hoefer IE, Pasterkamp G, Quyyumi AA, Ko YA, Hartiala JA, Allayee H, Tang WHW, Hazen SL, Eriksson N, Held C, Hagström E, Wallentin L, Åkerblom A, Siegbahn A, Karp I, Labos C, Pilote L, Engert JC, Brophy JM, Thanassoulis G, Bogaty P, Szczeklik W, Kaczor M, Sanak M, Virani SS, Ballantyne CM, Lee VV, Boerwinkle E, Holmes MV, Horne BD, Hingorani A, Asselbergs FW, Patel RS, Krämer BK, Scharnagl H, Fliser D, März W, Speer T. Relations between lipoprotein(a) concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study. Lancet Diabetes Endocrinol 2017; 5:534-543. [PMID: 28566218 PMCID: PMC5651679 DOI: 10.1016/s2213-8587(17)30096-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/25/2017] [Accepted: 02/14/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. METHODS We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. FINDINGS The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14-1·83) and the presence of either LPA SNP (1·88, 1·40-2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81-1·11 and either LPA SNP 1·10, 0·92-1·31) or cardiovascular mortality (0·99, 0·81-1·2 and 1·13, 0·90-1·40, respectively) or in the validation studies. INTERPRETATION In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. FUNDING Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny.
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Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Marcus E Kleber
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany; Institute of Nutrition, Friedrich-Schiller University, Jena, Germany
| | - Vinicius Tragante
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amand F Schmidt
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Kenan Direk
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Ulrich Laufs
- Department of Internal Medicine III, Saarland University Hospital, Homburg/Saar, Germany
| | - Christian Werner
- Department of Internal Medicine III, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Centre, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre of Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Dietrich Rothenbacher
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Lutz P Breitling
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Herrmann Brenner
- Network Ageing Research, University Heidelberg, Mannheim, Germany; Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Richard T Jennings
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Ioannis Petrakis
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Mira Klug
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Alexandra Filips
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Blankenberg
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Waldeyer
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Sinning
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Renate B Schnabel
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Mainz, Germany
| | | | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Juha Sinisalo
- Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Reijo Laaksonen
- Medical School, Tampere University, Tampere, Finland; Finnish Clinical Biobank Tampere, University Hospital of Tampere, Tampere, Finland
| | - Stella Trompet
- Department of Geriatics and Gerontology, Leiden University Medical Centre, Leiden, Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Roelof A J Smit
- Department of Geriatics and Gerontology, Leiden University Medical Centre, Leiden, Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, BHF Glasgow, Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - J Wouter Jukema
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, Netherlands
| | - Heinrich V Groesdonk
- Department of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Graciela Delgado
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Anna P Pilbrow
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, New Zealand
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Rhonda Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Julie Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE Research Centre for Civilisation Diseases, University of Leipzig, Leipzig, Germany
| | | | - Joachim Thiery
- LIFE Research Centre for Civilisation Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - Ragnar O Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sharon Cresci
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Petra A Lenzini
- Statistical Genomics Division, Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Daniel Kofink
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands
| | - Imo E Hoefer
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, Netherlands
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Niclas Eriksson
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Axel Åkerblom
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Igor Karp
- University of Montreal Hospital Research Centre (CRCHUM), University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Louise Pilote
- Department of Medicine, McGill University, Montreal, QC, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - James C Engert
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - James M Brophy
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Peter Bogaty
- Department of Medicine, Université Laval, QC, Canada
| | | | - Marcin Kaczor
- Jagielonian University Medical College, Kraków, Poland
| | - Marek Sanak
- Jagielonian University Medical College, Kraków, Poland
| | - Salim S Virani
- Section of Cardiology, Michael E DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Vei-Vei Lee
- Department of Biostatistics 7, Epidemiology, Texas Heart Institute, Houston, TX, USA
| | - Eric Boerwinkle
- School of Public Health, University of Texas, Houston, TX, USA
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit at the University of Oxford, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aroon Hingorani
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands; Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK; Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, Netherlands
| | - Riyaz S Patel
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | | | - Bernhard K Krämer
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Winfried März
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria; Synlab Academy, Synlab Holding, Mannheim, Germany.
| | - Thimoteus Speer
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
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Holy EW, Akhmedov A, Speer T, Camici GG, Zewinger S, Bonetti N, Beer JH, Lüscher TF, Tanner FC. Carbamylated Low-Density Lipoproteins Induce a Prothrombotic State Via LOX-1: Impact on Arterial Thrombus Formation In Vivo. J Am Coll Cardiol 2017; 68:1664-1676. [PMID: 27712780 DOI: 10.1016/j.jacc.2016.07.755] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/22/2016] [Accepted: 07/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Carbamylation alters low-density lipoprotein (LDL) structure and is thought to promote vascular inflammation and dysfunction in patients with chronic kidney disease (CKD). OBJECTIVES This study sought to determine whether carbamylated LDL (cLDL) exerts prothrombotic effects in vascular cells and platelets and whether cLDL enhances arterial thrombus formation in vivo. METHODS LDL was isolated from healthy subjects or patients with CKD by sequential ultracentrifugation. Ex vivo carbamylation of LDL from healthy subjects was induced with potassium cyanate. Arterial thrombus formation was analyzed in a murine carotid artery photochemical injury model. Protein expression and mRNA levels were analyzed by Western blotting, flow cytometry, and real-time PCR. Platelet aggregation was measured by impedance aggregometry. RESULTS Intravenous administration of cLDL in mice accelerated arterial thrombus formation compared to treatment with native LDL (nLDL) or vehicle. Tissue lysates of mouse carotid arteries revealed that cLDL induced the expression of TF, PAI-1, and LOX-1 mRNA in vascular cells. In human aortic smooth muscle and endothelial cells, cLDL induced TF and PAI-1 expression. In contrast, nLDL had no effect on either cell type. While nLDL and cLDL had no aggregatory effect on resting platelets, cLDL enhanced platelet aggregation in response to different agonists. This effect was mediated by mitogen-activated protein kinase p38 phosphorylation and LOX-1 translocation to the surface. LDL isolated from patients with CKD mimicked the prothrombotic effects of cLDL on vascular cells, platelets, and thrombus formation in vivo. CONCLUSIONS We found that cLDL induces prothrombotic effects in vascular cells and platelets by activation of the LOX-1 receptor and enhances thrombus formation in vivo. This observation reveals a new mechanism underlying the increased incidence of acute thrombotic events observed in patients with CKD and may lead to the development of new lipid-targeting therapies in this population.
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Affiliation(s)
- Erik W Holy
- University Heart Center Zurich, University Hospital Zürich, Zürich, Switzerland.
| | - Alexander Akhmedov
- Center of Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Thimoteus Speer
- Department of Internal Medicine 4, Saarland University Hospital, Homburg, Germany
| | - Giovanni G Camici
- Center of Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Stephen Zewinger
- Department of Internal Medicine 4, Saarland University Hospital, Homburg, Germany
| | - Nicole Bonetti
- Center of Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Thomas F Lüscher
- University Heart Center Zurich, University Hospital Zürich, Zürich, Switzerland; Center of Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Felix C Tanner
- University Heart Center Zurich, University Hospital Zürich, Zürich, Switzerland; Center of Molecular Cardiology, University of Zürich, Zürich, Switzerland
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28
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Zewinger S, Kleber M, Scharnagl H, Fliser D, März W, Speer T. MP177LIPOPROTEIN(A) AND THE RISK OF MORTALITY IN PATIENTS WITH ESTABLISHED CORONARY HEART DISEASE: A PROSPECTIVE STUDY OF 116,548 PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx164.mp177] [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: 11/13/2022] Open
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29
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Zewinger S, Jankowski V, Jennings R, Petrakis I, März W, Jankowski J, Laufs U, Fliser D, Speer T. MO031APOLIPOPROTEIN C3 INDUCES SYSTEMIC INFLAMMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE BY ACTIVATING THE NALP3 INFLAMMASOME VIA A NOVEL MOLECULAR PATHWAY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx119] [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: 11/13/2022] Open
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30
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Zewinger S, Kleber M, Rohrer L, Dressel A, Scharnagl H, Ritsch A, Thorand B, Heier M, Meisinger C, de las Heras Gala T, Koenig W, Schwedhelm E, Böger R, Laufs U, von Eckardstein A, Landmesser U, Lüscher T, Fliser D, März W, Meinitzer A, Speer T. MP354SYMMETRIC DIMETHYLARGININE, HIGH-DENSITY LIPOPROTEINS AND CARDIOVASCULAR DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx169.mp354] [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: 11/13/2022] Open
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31
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März W, Kleber ME, Scharnagl H, Speer T, Zewinger S, Ritsch A, Parhofer KG, von Eckardstein A, Landmesser U, Laufs U. HDL cholesterol: reappraisal of its clinical relevance. Clin Res Cardiol 2017; 106:663-675. [PMID: 28342064 PMCID: PMC5565659 DOI: 10.1007/s00392-017-1106-1] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/14/2017] [Indexed: 12/31/2022]
Abstract
Background While several lines of evidence prove that elevated concentrations of low-density lipoproteins (LDL) causally contribute to the development of atherosclerosis and its clinical consequences, high-density lipoproteins are still widely believed to exert atheroprotective effects. Hence, HDL cholesterol (HDL-C) is in general still considered as “good cholesterol”. Recent research, however, suggests that this might not always be the case and that a fundamental reassessment of the clinical significance of HDL-C is warranted. Method This review article is based on a selective literature review. Results In individuals without a history of cardiovascular events, low concentrations of HDL-C are inversely associated with the risk of future cardiovascular events. This relationship may, however, not apply to patients with metabolic disorders or manifest cardiovascular disease. The classical function of HDL is to mobilise cholesterol from extrahepatic tissues for delivery to the liver for excretion. These roles in cholesterol metabolism as well as many other biological functions of HDL particles are dependent on the number as well as protein and lipid composition of HDL particles. They are poorly reflected by the HDL-C concentration. HDL can even exert negative vascular effects, if its composition is pathologically altered. High serum HDL-C is therefore no longer regarded protective. In line with this, recent pharmacological approaches to raise HDL-C concentration have not been able to show reductions of cardiovascular outcomes. Conclusion In contrast to LDL cholesterol (LDL-C), HDL-C correlates with cardiovascular risk only in healthy individuals. The calculation of the ratio of LDL-C to HDL-C is not useful for all patients. Low HDL-C should prompt examination of additional metabolic and inflammatory pathologies. An increase in HDL-C through lifestyle change (smoking cessation, physical exercise) has positive effects and is recommended. However, HDL-C is currently not a valid target for drug therapy.
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Affiliation(s)
- Winfried März
- Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetelogie), Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany.,Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Austria.,Synlab Akademie, synlab Holding Deutschland GmbH, Mannheim und Augsburg, Augsburg, Germany
| | - Marcus E Kleber
- Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetelogie), Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany.,Institut für Ernährungswissenschaften, Friedrich Schiller Universität Jena, Jena, Germany
| | - Hubert Scharnagl
- Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Austria
| | - Timotheus Speer
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, 66421, Homburg, Saarland, Germany
| | - Stephen Zewinger
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, 66421, Homburg, Saarland, Germany
| | - Andreas Ritsch
- Klinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Klaus G Parhofer
- Medizinische Klinik II, Klinikum der Universität München, 81377, Munich, Germany
| | | | | | - Ulrich Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, IMED, Universitätsklinikum des Saarlandes, 66421, Homburg, Saarland, Germany.
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Wehrfritz H, Trudzinski F, Assmann G, Zewinger S, Kamp A, Tauchnitz M, Seiler F, Alqudrah M, Tsitouras K, Bals R, Lepper PM. Extrakorporale Membranoxygenierung bei einem Patienten mit schwerem ARDS infolge einer Granulomatose mit Polyangiitis. Pneumologie 2017. [DOI: 10.1055/s-0037-1598323] [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: 10/20/2022]
Affiliation(s)
- H Wehrfritz
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - F Trudzinski
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - G Assmann
- Hämatologie, Klin. Immunologie und Rheumatologie, Universitätsklinikum des Saarlandes
| | - S Zewinger
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes
| | - A Kamp
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - M Tauchnitz
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - F Seiler
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - M Alqudrah
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - K Tsitouras
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - R Bals
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - PM Lepper
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
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März W, Kleber ME, Scharnagl H, Speer T, Zewinger S, Ritsch A, Parhofer KG, von Eckardstein A, Landmesser U, Laufs U. [Clinical importance of HDL cholesterol]. Herz 2016; 42:58-66. [PMID: 27844137 DOI: 10.1007/s00059-016-4499-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/28/2022]
Abstract
BACKROUND Each year 16-17 million determinations of high-density lipoprotein cholesterol (HDL-C) are conducted and interpreted in Germany. Recently acquired data have led to a fundamental reassessment of the clinical significance of HDL-C. METHOD This review article is based on a selective literature search. RESULTS Low HDL‑C levels usually indicate an increased cardiovascular risk, particularly in primary prevention but the epidemiological relationship between HDL‑C and the risk is complex. The HDL plays a role in the back transport and excretion of cholesterol; however, the biological functions of HDL are dependent on the protein and lipid composition, which is not reflected by the HDL‑C concentration. If the composition of HDL is pathologically altered it can also exert negative vascular effects. CONCLUSION Compared with low-density lipoprotein cholesterol (LDL-C), HDL‑C is of secondary importance for cardiovascular risk stratification and the calculation of the LDL-C:HDL‑C ratio is not useful for all patients. Low HDL‑C levels should prompt a search for additional metabolic and inflammatory pathologies. An increase in HDL‑C through lifestyle changes (e.g. smoking cessation and physical exercise) has positive effects and is recommended; however, HDL‑C is currently not a valid target for drug therapy.
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Affiliation(s)
- W März
- Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Deutschland.,Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Österreich.,Synlab Akademie, synlab Holding Deutschland GmbH, Mannheim und Augsburg, Deutschland
| | - M E Kleber
- Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Deutschland.,Institut für Ernährungswissenschaften, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - H Scharnagl
- Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Österreich
| | - T Speer
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - S Zewinger
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - A Ritsch
- Klinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - K G Parhofer
- Medizinische Klinik II, Klinikum der Universität München, 81377, München, Deutschland
| | - A von Eckardstein
- Institut für Klinische Chemie, Universitätsspital, 8091, Zürich, Schweiz
| | - U Landmesser
- Klinik für Kardiologie, Charité, Berlin, Deutschland
| | - U Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (IMED), Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
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Zewinger S, Kleber ME, Triem S, Lehmann M, Lepper PM, Silbernagel G, Scharnagl H, Ritsch A, Laufs U, Fliser D, März W, Speer T. SP280HIGH-DENSITY LIPOPROTEIN - SYMMETRIC DIMETHYLARGININE - A CKD-SPECIFIC ASSOCIATION PROMOTING PREMATURE CARDIOVASCULAR DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw164.24] [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: 11/13/2022] Open
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Zewinger S, Schumann T, Fliser D, Speer T. Innate immunity in CKD-associated vascular diseases. Nephrol Dial Transplant 2015; 31:1813-1821. [DOI: 10.1093/ndt/gfv358] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/09/2015] [Indexed: 12/11/2022] Open
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Zewinger S, Drechsler C, Kleber ME, Dressel A, Riffel J, Triem S, Lehmann M, Kopecky C, Säemann MD, Lepper PM, Silbernagel G, Scharnagl H, Ritsch A, Thorand B, de las Heras Gala T, Wagenpfeil S, Koenig W, Peters A, Laufs U, Wanner C, Fliser D, Speer T, März W. Serum amyloid A: high-density lipoproteins interaction and cardiovascular risk. Eur Heart J 2015; 36:3007-16. [PMID: 26248570 DOI: 10.1093/eurheartj/ehv352] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 07/10/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS High-density lipoproteins (HDLs) are considered as anti-atherogenic. Recent experimental findings suggest that their biological properties can be modified in certain clinical conditions by accumulation of serum amyloid A (SAA). The effect of SAA on the association between HDL-cholesterol (HDL-C) and cardiovascular outcome remains unknown. METHODS AND RESULTS We examined the association of SAA and HDL-C with mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, which included 3310 patients undergoing coronary angiography. To validate our findings, we analysed 1255 participants of the German Diabetes and Dialysis study (4D) and 4027 participants of the Cooperative Health Research in the Region of Augsburg (KORA) S4 study. In LURIC, SAA concentrations predicted all-cause and cardiovascular mortality. In patients with low SAA, higher HDL-C was associated with lower all-cause and cardiovascular mortality. In contrast, in patients with high SAA, higher HDL-C was associated with increased all-cause and cardiovascular mortality, indicating that SAA indeed modifies the beneficial properties of HDL. We complemented these clinical observations by in vitro experiments, in which SAA impaired vascular functions of HDL. We further derived a formula for the simple calculation of the amount of biologically 'effective' HDL-C based on measured HDL-C and SAA from the LURIC study. In 4D and KORA S4 studies, we found that measured HDL-C was not associated with clinical outcomes, whereas calculated 'effective' HDL-C significantly predicted better outcome. CONCLUSION The acute-phase protein SAA modifies the biological effects of HDL-C in several clinical conditions. The concomitant measurement of SAA is a simple, useful, and clinically applicable surrogate for the vascular functionality of HDL.
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Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Christiane Drechsler
- Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany
| | - Marcus E Kleber
- Mannheim Medical Faculty, Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Alexander Dressel
- Mannheim Medical Faculty, Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Julia Riffel
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Marlene Lehmann
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Chantal Kopecky
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marcus D Säemann
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Philipp M Lepper
- Department of Internal Medicine V, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Günther Silbernagel
- Department of Angiology, Swiss Cardiovascular Center, Inselspital Bern, Bern, Switzerland
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Andreas Ritsch
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Barbara Thorand
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Epidemiology II, Munich, Germany
| | - Tonia de las Heras Gala
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Epidemiology II, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology, and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany Deutsches Herzzentrum München, Technische Universität München, Munich, Germany DZHK (German Centre of Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Annette Peters
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Epidemiology II, Munich, Germany
| | - Ulrich Laufs
- Department of Internal Medicine III, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Winfried März
- Mannheim Medical Faculty, Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria Synlab Academy, Mannheim, Germany
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Zewinger S, Speer T, Drechsler C, Kleber ME, Dressel A, Riffel J, Lehmann M, Kopecky C, Säemann MD, Lepper PM, Silbernagel G, Scharnagl H, Ritsch A, Laufs U, Wanner C, Fliser D, März W. FO005SERUM AMYLOID A (SAA) AND HIGH DENSITY LIPOPROTEINS (HDL) INTERACTION AND CARDIOVASCULAR RISK IN RENAL PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv135.05] [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: 11/14/2022] Open
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Shroff R, Speer T, Colin S, Charakida M, Zewinger S, Staels B, Chinetti-Gbaguidi G, Hettrich I, Rohrer L, O'Neill F, McLoughlin E, Long D, Shanahan CM, Landmesser U, Fliser D, Deanfield JE. HDL in children with CKD promotes endothelial dysfunction and an abnormal vascular phenotype. J Am Soc Nephrol 2014; 25:2658-68. [PMID: 24854267 DOI: 10.1681/asn.2013111212] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Endothelial dysfunction begins in early CKD and contributes to cardiovascular mortality. HDL is considered antiatherogenic, but may have adverse vascular effects in cardiovascular disease, diabetes, and inflammatory conditions. The effect of renal failure on HDL properties is unknown. We studied the endothelial effects of HDL isolated from 82 children with CKD stages 2-5 (HDL(CKD)), who were free of underlying inflammatory diseases, diabetes, or active infections. Compared with HDL from healthy children, HDL(CKD) strongly inhibited nitric oxide production, promoted superoxide production, and increased vascular cell adhesion molecule-1 expression in human aortic endothelial cells, and reduced cholesterol efflux from macrophages. The effects on endothelial cells correlated with CKD grade, with the most profound changes induced by HDL from patients on dialysis, and partial recovery observed with HDL isolated after kidney transplantation. Furthermore, the in vitro effects on endothelial cells associated with increased aortic pulse wave velocity, carotid intima-media thickness, and circulating markers of endothelial dysfunction in patients. Symmetric dimethylarginine levels were increased in serum and fractions of HDL from children with CKD. In a longitudinal follow-up of eight children undergoing kidney transplantation, HDL-induced production of endothelial nitric oxide, superoxide, and vascular cell adhesion molecule-1 in vitro improved significantly at 3 months after transplantation, but did not reach normal levels. These results suggest that in children with CKD without concomitant disease affecting HDL function, HDL dysfunction begins in early CKD, progressing as renal function declines, and is partially reversed after kidney transplantation.
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Affiliation(s)
- Rukshana Shroff
- Nephrology Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Vascular Physiology Unit, University College London Institute of Child Health, London, United Kingdom;
| | - Thimoteus Speer
- Department of Internal Medicine, Nephrology, and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany
| | - Sophie Colin
- French Institute of Health and Medical Research Joint Research Unit 1011, European Genomic Institute for Diabetes, Lille Pasteur Institute, Lille 2 University, Lille, France
| | - Marietta Charakida
- Vascular Physiology Unit, University College London Institute of Child Health, London, United Kingdom
| | - Stephen Zewinger
- Department of Internal Medicine, Nephrology, and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany
| | - Bart Staels
- French Institute of Health and Medical Research Joint Research Unit 1011, European Genomic Institute for Diabetes, Lille Pasteur Institute, Lille 2 University, Lille, France
| | - Giulia Chinetti-Gbaguidi
- French Institute of Health and Medical Research Joint Research Unit 1011, European Genomic Institute for Diabetes, Lille Pasteur Institute, Lille 2 University, Lille, France
| | - Inga Hettrich
- Department of Internal Medicine, Nephrology, and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany
| | | | - Francis O'Neill
- Vascular Physiology Unit, University College London Institute of Child Health, London, United Kingdom
| | - Eve McLoughlin
- Vascular Physiology Unit, University College London Institute of Child Health, London, United Kingdom
| | - David Long
- Nephrology Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Ulf Landmesser
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland; and
| | - Danilo Fliser
- Department of Internal Medicine, Nephrology, and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany
| | - John E Deanfield
- Vascular Physiology Unit, University College London Institute of Child Health, London, United Kingdom
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Reyes-Bahamonde J, Raimann JG, Canaud B, Etter M, Kooman JP, Levin NW, Marcelli D, Marelli C, Power A, Van Der Sande FM, Thijssen S, Usvyat LA, Wang Y, Kotanko P, Blank PR, Szucs TD, Gibertoni D, Torroni S, Mandreoli M, Rucci P, Fantini MP, Santoro A, Van Der Veer SN, Nistor I, Bernaert P, Bolignano D, Brown EA, Covic A, Farrington K, Kooman J, Macias J, Mooney A, Van Munster BC, Van Den Noortgate N, Topinkova E, Wirnsberger G, Jager KJ, Van Biesen W, Stubnova V, Os I, Grundtvig M, Waldum B, Wu HY, Peng YS, Wu MS, Chu TS, Chien KL, Hung KY, Wu KD, Carrero JJ, Huang X, Sui X, Ruiz JR, Hirth V, Ortega FB, Blair SN, Coppolino G, Bolignano D, Rivoli L, Presta P, Mazza G, Fuiano G, Marx S, Petrilla A, Hengst N, Lee WC, Ruggajo P, Skrunes R, Svarstad E, Skjaerven R, Reisaether AV, Vikse BE, Fujii N, Hamano T, Akagi S, Watanabe T, Imai E, Nitta K, Akizawa T, Matsuo S, Makino H, Scalzotto E, Corradi V, Nalesso F, Zaglia T, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Occelli F, Genin M, Deram A, Glowacki F, Cuny D, Mansurova I, Alchinbayev M, Malikh MA, Song S, Shin MJ, Rhee H, Yang BY, Kim I, Seong EY, Lee DW, Lee SB, Kwak IS, Isnard Bagnis C, Speyer E, Beauger D, Caille Y, Baudelot C, Mercier S, Jacquelinet C, Gentile SM, Briancon S, Yu TM, Li CY, Krivoshiev S, Borissova AM, Shinkov A, Svinarov D, Vlachov J, Koteva A, Dakovska L, Mihaylov G, Popov A, Polner K, Mucsi I, Braunitzer H, Kiss A, Nadasdi Z, Haris A, Zdrojewski L, Zdrojewski T, Rutkowski B, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Dey V, Farrah T, Traynor J, Spalding E, Robertson S, Geddes CC, Mann MC, Hobbs A, Hemmelgarn BR, Roberts D, Ahmed SB, Rabi D, Elewa U, Fernandez B, Alegre ER, Mahillo I, Egido J, Ortiz A, Marx S, Pomerantz D, Vietri J, Zewinger S, Speer T, Kleber ME, Scharnagl H, Woitas R, Pfahler K, Seiler S, Heine GH, Lepper PM, Marz W, Silbernagel G, Fliser D, Caldararu CD, Gliga ML, Tarta ID, Szanto A, Carlan O, Dogaru GA, Battaglia Y, Del Prete MA, De Gregorio MG, Errichiello C, Gisonni P, Russo L, Scognamiglio B, Storari A, Russo D, Kuma A, Serino R, Miyamoto T, Tamura M, Otsuji Y, Kung LF, Naito S, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Kang YU, Kim HY, Choi JS, Kim CS, Bae EH, Ma SK, Kim SW, Muthuppalaniappan VM, Byrne C, Sheaff M, Rajakariar R, Blunden M, Delmas Y, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Bedrosian CL, Licht C, Marks A, Black C, Clark L, Prescott G, Robertson L, Simpson W, Simpson W, Fluck N, Wang SL, Hsu YH, Pai HC, Chang YM, Liu WH, Hsu CC, Shvetsov M, Nagaytseva S, Gerasimov A, Shalyagin Y, Ivanova E, Shilov E, Zhang Y, Zuo W, Marx S, Manthena S, Newmark J, Zdrojewski L, Rutkowski M, Zdrojewski T, Bandosz P, Gaciong Z, Solnica B, Rutkowski B, Wyrzykowski B, Ensergueix G, Karras A, Levi C, Chauvet S, Trivin C, Ficheux M, Augusto JF, Boudet R, Chambaraud T, Boudou-Rouquette P, Tubiana-Mathieu N, Aldigier JC, Jacquot C, Essig M, Thervet E, Oh YJ, Lee CS, Malho Guedes A, Silva AP, Goncalves C, Sampaio S, Morgado E, Santos V, Bernardo I, Leao Neves P, Onuigbo M, Agbasi N. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Poesen R, Viaene L, Bammens B, Claes K, Evenepoel P, Meijers B, Bozic M, De Pablo C, Alvarez A, Sanchez-Nino MD, Ortiz A, Fernandez E, Valdivielso JM, Speer T, Zewinger S, Holy EW, Stahli BE, Triem S, Cvija H, Rohrer L, Seiler S, Heine GH, Jankowski V, Jankowski J, Camici G, Akhmedov A, Luscher TF, Tanner FC, Fliser D, Isoyama N, Leurs P, Qureshi AR, Anderstam B, Heimburger O, Barany P, Stenvinkel P, Lindholm B, Bolasco P, Palleschi S, Rossi B, Atti M, Amore A, Coppo R, Loiacono E, Ghezzi PM, Palladino G, Caiazzo M, Di Napoli A, Tazza L, Franco F, Chicca S, Bossola M, Di Lallo D, Michelozzi P, Davoli M, Lucisano S, Arena A, Lupica R, Cernaro V, Trimboli D, Aloisi C, Montalto G, Santoro D, Buemi M, Burtey S, Poitevin S, Darbousset R, Gondouin B, Dubois C, Erkmen Uyar M, Bal Z, Bayraktar N, Gurlek Demirci B, Sayin B, Sezer S, Rogacev K, Zawada A, Emrich I, Seiler S, Bohm M, Fliser D, Woollard K, Heine G, Gbandjaba NY, Ghalim N, Saile R, Khalil A, Fujii H, Yamashita Y, Yonekura Y, Nakai K, Kono K, Goto S, Sugano M, Goto S, Ito Y, Nishi S, Leurs P, Meuwese C, Carrero JJ, Qureshi AR, Anderstam B, Barany P, Heimburger O, Stenvinkel P, Lindholm B, Riccio E, Sabbatini M, Bellizzi V, Pisani A, Svedberg O, Stenvinkel P, Qureshi AR, Barany P, Heimburger O, Leurs P, Isoyama N, Lindholm B, Anderstam B, Barreto-Silva MI, Lemos C, Costa-Silva F, Mendes R, Bregman R, Barreto - Silva MI, Lemos C, Vargas S, Barja-Fidalgo TC, Bregman R, Sidoti A, Lusini ML, Biagioli M, Sereni L, Ghezzi PM, Caiazzo M, Palladino G, Kara E, Ahbap E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Sevinc M, Akgol C, Unsal A, Snaedal S, Qureshi AR, Carrero JJ, Heimburger O, Stenvinkel P, Barany P, Paliouras C, Haviatsos T, Lamprianou F, Papagiannis N, Ntetskas G, Roufas K, Karvouniaris N, Anastasakis E, Moschos N, Alivanis P, Santoro D, Ingegneri MT, Vita G, Pisacane A, Bellinghieri G, Savica V, Buemi M, Lucisano S, Kim HK, Kim SC, Kim MG, Jo SK, Cho WY, Altunoglu A, Yavuz D, Canoz MB, Yavuz R, Karakas LA, Bayraktar N, Colak T, Sezer S, Ozdemir FN, Haberal M, Akbasli AC, Keven K, Erbay B, Nebio lu S, Loboda O, Dudar I, Krot V, Alekseeva V, Grabulosa CC, De Carvalho JTG, Manfredi SR, Canziani ME, Quinto BMR, Peres AT, Batista MC, Cendoroglo M, Dalboni MA, Zingerman B, Azoulay O, Gamzo Z, Rozen-Zvi B, Stefan G, Capusa C, Stancu S, Ilyes A, Viasu L, Mircescu G, Yilmaz MI, Solak Y, Saglam M, Cayci T, Acikel C, Unal HU, Eyileten T, Oguz Y, Sari S, Carrero JJ, Stenvinkel P, Covic A, Kanbay M, Kim YN, Park K, Gwoo S, Shin HS, Jung YS, Rim H, Rhew HY, Gok M, Kurt Y, Unal HU, CetInkaya H, Karaman M, EyIeten T, Vural A, Yilmaz MI, Oguz Y, Flisi Ski M, Brymora A, StrozEcki P, Stefa Ska A, Manitius J, Donderski R, Mi Kowiec-Wi Niewska I, Kretowicz M, Johnson R, Kami Ska A, Junik R, Siodmiak J, Stefa Ska A, Odrowaz-Sypniewska G, Manitius J, Tasic D, Radenkovic S, Kocic G, Wyskida K, Spiechowicz-Zato U, Rotkegel S, Ciepal J, Klein D, Bozentowicz-Wikarek M, Brzozowska A, Olszanecka-Glinianowicz M, Chudek J, Dimitrijevic Z, Cvetkovic T, Mitic B, Paunovic K, Paunovic G, Stojanovic M, Velickovic-Radovanovic R, Gliga ML, Gliga PM, Stoica C, Tarta D, Dogaru G. CKD NUTRITION, INFLAMMATION AND OXIDATIVE STRESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu168] [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: 11/14/2022] Open
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Speer T, Owala FO, Holy EW, Zewinger S, Frenzel FL, Stähli BE, Razavi M, Triem S, Cvija H, Rohrer L, Seiler S, Heine GH, Jankowski V, Jankowski J, Camici GG, Akhmedov A, Fliser D, Lüscher TF, Tanner FC. Carbamylated low-density lipoprotein induces endothelial dysfunction. Eur Heart J 2014; 35:3021-32. [PMID: 24658767 DOI: 10.1093/eurheartj/ehu111] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS Cardiovascular events remain the leading cause of death in Western world. Atherosclerosis is the most common underlying complication driven by low-density lipoproteins (LDL) disturbing vascular integrity. Carbamylation of lysine residues, occurring primarily in the presence of chronic kidney disease (CKD), may affect functional properties of lipoproteins; however, its effect on endothelial function is unknown. METHODS AND RESULTS Low-density lipoprotein from healthy donors was isolated and carbamylated. Vascular reactivity after treatment with native LDL (nLDL) or carbamylated LDL (cLDL) was examined in organ chambers for isometric tension recording using aortic rings of wild-type or lectin-like-oxidized LDL receptor-1 (LOX-1) transgenic mice. Reactive oxygen species (ROS) and nitric oxide (NO) production were determined using electron spin resonance spectroscopy. The effect of LDL-carbamyl-lysine levels on cardiovascular outcomes was determined in patients with CKD during a median follow-up of 4.7 years. Carbamylated LDL impaired endothelium-dependent relaxation to acetylcholine or calcium-ionophore A23187, but not endothelium-independent relaxation to sodium nitroprusside. In contrast, nLDL had no effect. Carbamylated LDL enhanced aortic ROS production by activating NADPH-oxidase. Carbamylated LDL stimulated endothelial NO synthase (eNOS) uncoupling at least partially by promoting S-glutathionylation of eNOS. Carbamylated LDL-induced endothelial dysfunction was enhanced in LOX-1 transgenic mice. In patients with CKD, LDL-carbamyl-lysine levels were significant predictors for cardiovascular events and all-cause mortality. CONCLUSIONS Carbamylation of LDL induces endothelial dysfunction via LOX-1 activation and increased ROS production leading to eNOS uncoupling. This indicates a novel mechanism in the pathogenesis of atherosclerotic disease which may be pathogenic and prognostic in patients with CKD and high plasma levels of cLDL.
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Affiliation(s)
- Thimoteus Speer
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Frederick O Owala
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Erik W Holy
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Stephen Zewinger
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix L Frenzel
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Barbara E Stähli
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Marjan Razavi
- Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Sarah Triem
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Hrvoje Cvija
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Lucia Rohrer
- Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Seiler
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Gunnar H Heine
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Vera Jankowski
- Department of Internal Medicine IV, Charité-Universitätsmedizin, Berlin, Germany
| | - Joachim Jankowski
- Department of Internal Medicine IV, Charité-Universitätsmedizin, Berlin, Germany
| | - Giovanni G Camici
- Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Alexander Akhmedov
- Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Danilo Fliser
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
| | - Thomas F Lüscher
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
| | - Felix C Tanner
- University Heart Center, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Center of Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
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Zewinger S, Speer T, Kleber ME, Scharnagl H, Woitas R, Lepper PM, Pfahler K, Seiler S, Heine GH, März W, Silbernagel G, Fliser D. HDL cholesterol is not associated with lower mortality in patients with kidney dysfunction. J Am Soc Nephrol 2014; 25:1073-82. [PMID: 24610925 DOI: 10.1681/asn.2013050482] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In the general population, HDL cholesterol (HDL-C) is associated with reduced cardiovascular events. However, recent experimental data suggest that the vascular effects of HDL can be heterogeneous. We examined the association of HDL-C with all-cause and cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health study comprising 3307 patients undergoing coronary angiography. Patients were followed for a median of 9.9 years. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. The effect of increasing HDL-C serum levels was assessed using Cox proportional hazard models. In participants with normal kidney function (eGFR>90 ml/min per 1.73 m(2)), higher HDL-C was associated with reduced risk of all-cause and cardiovascular mortality and coronary artery disease severity (hazard ratio [HR], 0.51, 95% confidence interval [95% CI], 0.26-0.92 [P=0.03]; HR, 0.30, 95% CI, 0.13-0.73 [P=0.01]). Conversely, in patients with mild (eGFR=60-89 ml/min per 1.73 m(2)) and more advanced reduced kidney function (eGFR<60 ml/min per 1.73 m(2)), higher HDL-C did not associate with lower risk for mortality (eGFR=60-89 ml/min per 1.73 m(2): HR, 0.68, 95% CI, 0.45-1.04 [P=0.07]; HR, 0.84, 95% CI, 0.50-1.40 [P=0.50]; eGFR<60 ml/min per 1.73 m(2): HR, 1.18, 95% CI, 0.60-1.81 [P=0.88]; HR, 0.82, 95% CI, 0.40-1.69 [P=0.60]). Moreover, Cox regression analyses revealed interaction between HDL-C and eGFR in predicting all-cause and cardiovascular mortality (P=0.04 and P=0.02, respectively). We confirmed a lack of association between higher HDL-C and lower mortality in an independent cohort of patients with definite CKD (P=0.63). In summary, higher HDL-C levels did not associate with reduced mortality risk and coronary artery disease severity in patients with reduced kidney function. Indeed, abnormal HDL function might confound the outcome of HDL-targeted therapies in these patients.
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Affiliation(s)
| | | | - Marcus E Kleber
- Medical Faculty Mannheim, University of Heidelberg, Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Rainer Woitas
- Division of Nephrology, Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Philipp M Lepper
- Internal Medicine V, Saarland University Hospital, Homburg/Saar, Germany
| | | | | | | | - Winfried März
- Medical Faculty Mannheim, University of Heidelberg, Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Synlab Academy, Synlab Services LLC, Mannheim, Germany; and
| | - Günther Silbernagel
- Department of Angiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
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Abstract
Chronic kidney disease (CKD) is accompanied by strong cardiovascular risk. In a rather rigid picture of lipoprotein biology, low-density lipoprotein (LDL) is referred to as 'bad cholesterol', while high-density lipoprotein (HDL) is referred to as 'good cholesterol'. However, recent experimental evidence suggests that HDL may be rendered dysfunctional regarding its effects on the vasculature under various clinical conditions such as CKD. Indeed, HDL from the blood of CKD patients has been shown to transform into a particle which promotes endothelial dysfunction, endothelial proinflammatory activation and, thereby, sets the conditions for the development of atherosclerotic disease. Notably, pharmaceutical interventions to raise serum HDL-cholesterol levels have not been proven beneficial so far. Collectively, these findings indicate that HDL cholesterol levels do not represent a valuable marker for indicating the vascular properties of HDL.
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Affiliation(s)
- Thimoteus Speer
- Department of Internal Medicine 4, Saarland University Hospital, Homburg/Saar, Germany
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Wong MMY, Thijssen S, Usvyat LA, Kotanko P, Maddux FW, Speer T, Rohrer L, Blyzszuk P, Krankel N, Zewinger S, Martin T, von Eckardstein A, Luscher T, Landmesser U, Fliser D, Prats M, Font R, Garcia C, Cabre C, Jariod M, Martinez Vea A, Costa E, Ribeiro S, do Sameiro-Faria M, Rocha-Pereira P, Kohlova M, Fernandes J, Reis F, Miranda V, Quintanilha A, Bronze-da-Rocha E, Belo L, Santos-Silva A, do Sameiro-Faria M, Kohlova M, Ribeiro S, Rocha-Pereira P, Fernandes J, Nascimento H, Reis F, Miranda V, Bronze-da-Rocha E, Quintanilha A, Belo L, Costa E, Santos-Silva A, Schepers E, Glorieux G, Van den Abeele T, Neirynck N, Vanholder R, Neirynck N, Glorieux G, Boelaert J, Liabeuf S, Massy Z, Vanholder R, Kaynar K, Kural BV, Ulusoy S, Cansiz M, Akcan B, Misir N, Yaman S, Kaya N, Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Pitsalidis CG, Karamouzis IM, Didaggelos TP, Adamidou AP, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Flisinski M, Brymora A, Stefanska A, Strozecki P, Manitius J, Khalfina TN, Maksudova AN, Valeeva IK, Bantis C, Kouri NM, Bamichas G, Stangou M, Tsantekidou E, Natse T, Fazio MR, Basile G, Lucisano S, Montalto G, Valeria C, Donato V, Lupica R, Trimboli D, Aloisi C, Buemi M, Henze A, Raila J, Scholze A, Schweigert F, Tepel M, Nakamichi R, Prates E, Redublo Quinto BM, Zanella MT, Batista MC, Masajtis-Zagajewska A, Kurnatowska I, Wajdlich M, Nowicki M, Mennini F, Russo S, Marcellusi A, Quintaliani G, Andrulli S, Chiavenna C, Bigi MC, Tentori F, Crepaldi M, Corti MM, Dell'Oro C, Bacchini G, Limardo M, Pontoriero G, Williams C, Abbas SR, Zhu F, Flores-Gama C, Moskowitz J, Cartagena C, Carter M, Levin N, Kotanko P, de Oliveira RB, Liabeuf S, Okazaki H, Lenglet A, Desjardins L, Lemke HD, Valholder R, Choukroun G, Massy ZA. Nutrition / inflammation. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft111] [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: 11/15/2022] Open
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Zewinger S, Speer T, Kleber ME, Martin T, Marz W, Fliser D, Ivanov DD, Ivanova MD, Ciocalteu A, Radulescu D, Niculae A, Checherita AI, Peride I, Marcantoni C, Rastelli S, Zanoli L, Blanco J, Tripepi G, Tamburino C, Castellino P, Eldehni MT, Odudu A, McIntyre CW. Lipids and other risk factors. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft169] [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: 11/14/2022] Open
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Speer T, Rohrer L, Blyszczuk P, Shroff R, Kuschnerus K, Kränkel N, Kania G, Zewinger S, Akhmedov A, Shi Y, Martin T, Perisa D, Winnik S, Müller MF, Sester U, Wernicke G, Jung A, Gutteck U, Eriksson U, Geisel J, Deanfield J, von Eckardstein A, Lüscher TF, Fliser D, Bahlmann FH, Landmesser U. Abnormal high-density lipoprotein induces endothelial dysfunction via activation of Toll-like receptor-2. Immunity 2013; 38:754-68. [PMID: 23477738 DOI: 10.1016/j.immuni.2013.02.009] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [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: 06/01/2012] [Accepted: 02/11/2013] [Indexed: 01/06/2023]
Abstract
Endothelial injury and dysfunction (ED) represent a link between cardiovascular risk factors promoting hypertension and atherosclerosis, the leading cause of death in Western populations. High-density lipoprotein (HDL) is considered antiatherogenic and known to prevent ED. Using HDL from children and adults with chronic kidney dysfunction (HDL(CKD)), a population with high cardiovascular risk, we have demonstrated that HDL(CKD) in contrast to HDL(Healthy) promoted endothelial superoxide production, substantially reduced nitric oxide (NO) bioavailability, and subsequently increased arterial blood pressure (ABP). We have identified symmetric dimethylarginine (SDMA) in HDL(CKD) that causes transformation from physiological HDL into an abnormal lipoprotein inducing ED. Furthermore, we report that HDL(CKD) reduced endothelial NO availability via toll-like receptor-2 (TLR-2), leading to impaired endothelial repair, increased proinflammatory activation, and ABP. These data demonstrate how SDMA can modify the HDL particle to mimic a damage-associated molecular pattern that activates TLR-2 via a TLR-1- or TLR-6-coreceptor-independent pathway, linking abnormal HDL to innate immunity, ED, and hypertension.
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Affiliation(s)
- Thimoteus Speer
- Cardiovascular Center, Cardiology, University Hospital Zurich and Cardiovascular Research, Institute of Physiology, University of Zurich, Zurich, Switzerland.
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Kuo KL, Hung SC, Tarng DC, Selim G, Stojceva-Taneva O, Tozija L, Gelev S, Stojcev N, Dzekova P, Trajcevska L, Severova G, Pavleska S, Sikole A, Combe C, Thumma J, Gillespie B, De Sequera P, Yamamoto H, Robinson B, Matsushita Y, Tasaki H, Tohara Y, Yamauchi E, Matsuoka K, Arizono K, Bellasi A, Ferramosca E, Ratti C, Block G, Raggi P, Drozdz M, Krasniak A, Chmiel G, Podolec P, Pasowicz M, Tracz W, Kowalczyk-Michalek M, Sulowicz W, Kalantzi K, Korantzopoulos P, Bechlioulis A, Vlachopanou A, Foulidis V, Pagiati E, Nikolopoulos P, Gouva C, Arroyave I, Rodelo J, Cardona M, Garcia A, Henao J, Mejia G, Rico J, Arbelaez M, Fujimori A, Okada S, Yamamoto K, Okamoto S, Kamiura N, Sakai M, Tanikake M, Kutlay S, Sengul S, Keven K, Nergizoglu G, Erturk S, Ates K, Duman N, Karatan O, Erbay B, Sameiro-Faria M, Costa E, Rocha-Pereira P, Borges A, Nascimento H, Mendonca D, Amado L, Reis F, Miranda V, Quintanilha A, Belo L, Santos-Silva A, Oh JS, Kim SM, Sin YH, Kim JK, Ishihara M, Otsubo S, Kimata N, Akiba T, Nitta K, Kim KM, Baek CH, Kim SB, Testa A, Sanguedolce MC, Spoto B, Mallamaci F, Malatino L, Tripepi G, Zoccali C, Lee JE, Moon SJ, Kim JK, An HR, Ha SK, Pakr HC, Bahlmann FH, Becker E, Sperber V, Triem S, Noll C, Zewinger S, Fliser D, Laufs U, Thijssen S, Usvyat LA, Raimann JG, Balter P, Kotanko P, Levin NW, Hornum M, Bay JT, Clausen P, Melchior Hansen J, Mathiesen ER, Feldt-Rasmussen B, Garred P, Sural S, Panja CS, Bhattacharya SK, Cernaro V, Lacquaniti A, Lorenzano G, Romeo A, Donato V, Buemi M, Raimann JG, Usvyat L, Thijssen S, Rogus J, Lacson E, Kotanko P, Levin NW, Robinson BM, Karaboyas A, Sen A, Hecking M, Mendelssohn D, Jadoul M, Kawanishi H, Saran R, Kolarz M, Undas A, Wyroslak J, Malyszko J, Klejna K, Naumnik B, Koc-Zurawska E, Mysliwiec M, Piecha G, Kuczera P, Adamczak M, Fedorova OV, Bagrov AY, Wiecek A, Gungor O, Kircelli F, Asci G, Carrero JJ, Tatar E, Demirci M, Toz H, Ozkahya M, Ok E, Bansal V, Shareain K, Hoppensteadt D, Litinas E, Fareed J, Kim MJ, Lee SW, Song JH, Kweon J, Kim WH, Sasaki K, Yasuda K, Hatanaka M, Hayashi T, Katsipi I, Tatsiopoulos A, Papanikolaou P, Doulgerakis C, Kollia K, Kardouli E, Asmanis E, Gennadiou M, Kyriazis J, Panizo S, Barrio-Vazquez S, Carrillo-Lopez N, Fernandez-Vazquez A, Braga S, Rodriguez-Rebollar A, Naves-Diaz M, Cannata-Andia JB, Nikodimopoulou M, Liakos S, Kapoulas S. Cardiovascular complications in CKD 5D (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.38] [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: 11/12/2022] Open
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Schenk J, Stephan B, Zewinger S, Speer T, Pindur G. Comparison of the plasminogen activator inhibitor-1 4G/5G gene polymorphism in females with venous thromboembolism during pregnancy or spontaneous abortion. Clin Hemorheol Microcirc 2008. [DOI: 10.3233/ch-2008-1098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schenk JF, Stephan B, Zewinger S, Speer T, Pindur G. Comparison of the plasminogen activator inhibitor-1 4G/5G gene polymorphism in females with venous thromboembolism during pregnancy or spontaneous abortion. Clin Hemorheol Microcirc 2008; 39:329-332. [PMID: 18503142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Genetic polymorphisms in plasminogen activator inhibitor-1 gene-675 4G/5G (PAI-1 4G/5G) are claimed to contribute to an increased risk of venous thromboembolism. Inherited thrombophilia, on the other hand, is associated with the occurrence of spontaneous abortions. The objective of this study was, to explore the significance of genetic polymorphisms of PAI-1 4G/5G with particular emphasis on 4G alleles in pregnant women suffering from venous thromboembolism or early spontaneous abortion, respectively. Therefore genetic PAI-1 4G/5G polymorphisms were studied in 108 pregnant females suffering from venous thromboembolism (n=69) or from spontaneous abortion (<20 week, n=39), respectively. Healthy volunteers (n=238) were taken as controls. The frequencies of 4G alleles (4G/4G or 4G/5G genotypes) of PAI-1 were significantly higher in venous thromboembolism (OR: 3.40, p=0.0088) and slightly higher, but not significantly, in abortions (RR: 2.33; p=0.1162) compared to controls. The incidence of 4G-carriers in females with abortion was 0.68 (-32%) compared to women suffering from venous thromboembolism alone. We conclude from these data, that the occurrence of PAI-1 4G/4G or 4G/5G genotypes, respectively, is clinically significant for the pathogenesis of venous thromboembolism in pregnancy but not for early abortion.
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