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DNA Methylation Dysfunction in Chronic Kidney Disease. Genes (Basel) 2020; 11:genes11070811. [PMID: 32708735 PMCID: PMC7397141 DOI: 10.3390/genes11070811] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
Renal disease is the common denominator of a number of underlying disease conditions, whose prevalence has been dramatically increasing over the last two decades. Two aspects are particularly relevant to the subject of this review: (I) most cases are gathered under the umbrella of chronic kidney disease since they require—predictably for several lustrums—continuous clinical monitoring and treatment to slow down disease progression and prevent complications; (II) cardiovascular disease is a terrible burden in this population of patients, in that it claims many lives yearly, while only a scant minority reach the renal disease end stage. Why indeed a review on DNA methylation and renal disease? As we hope to convince you, the present evidence supports the role of the existence of various derangements of the epigenetic control of gene expression in renal disease, which hold the potential to improve our ability, in the future, to more effectively act toward disease progression, predict outcomes and offer novel therapeutic approaches.
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Vitamin B Supplementation and Nutritional Intake of Methyl Donors in Patients with Chronic Kidney Disease: A Critical Review of the Impact on Epigenetic Machinery. Nutrients 2020; 12:nu12051234. [PMID: 32349312 PMCID: PMC7281987 DOI: 10.3390/nu12051234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular morbidity and mortality are several-fold higher in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in the general population. Hyperhomocysteinemia has undoubtedly a central role in such a prominent cardiovascular burden. The levels of homocysteine are regulated by methyl donors (folate, methionine, choline, betaine), and cofactors (vitamin B6, vitamin B12,). Uremia-induced hyperhomocysteinemia has as its main targets DNA methyltransferases, and this leads to an altered epigenetic control of genes regulated through methylation. In renal patients, the epigenetic landscape is strictly correlated with the uremic phenotype and dependent on dietary intake of micronutrients, inflammation, gut microbiome, inflammatory status, oxidative stress, and lifestyle habits. All these factors are key contributors in methylome maintenance and in the modulation of gene transcription through DNA hypo- or hypermethylation in CKD. This is an overview of the epigenetic changes related to DNA methylation in patients with advanced CKD and ESRD. We explored the currently available data on the molecular dysregulations resulting from altered gene expression in uremia. Special attention was paid to the efficacy of B-vitamins supplementation and dietary intake of methyl donors on homocysteine lowering and cardiovascular protection.
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Perna AF, Glorieux G, Zacchia M, Trepiccione F, Capolongo G, Vigorito C, Anishchenko E, Ingrosso D. The role of the intestinal microbiota in uremic solute accumulation: a focus on sulfur compounds. J Nephrol 2019; 32:733-740. [PMID: 30673975 DOI: 10.1007/s40620-019-00589-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
The gut microbiota is considered to be a novel important factor to take into account in the pathogenesis of chronic kidney disease and uremia. Much attention has been paid to specific uremic retention solutes of microbial origin, such as indoxyl sulfate, p-cresyl sulfate, and trimethylamine-N-oxide. However, other novel less well studied compounds, such as hydrogen sulfide and related sulfur metabolites (sulfane sulfur, lanthionine, etc.), should be included in a more comprehensive appraisal of this topic, in light of the potential therapeutic opportunities for the future.
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Affiliation(s)
- Alessandra F Perna
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Miriam Zacchia
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Francesco Trepiccione
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Giovanna Capolongo
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Carmela Vigorito
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Evgeniya Anishchenko
- First Division of Nephrology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, Bldg 17, 80131, Naples, Italy
| | - Diego Ingrosso
- Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio 7, 80138, Naples, Italy
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Cianciolo G, De Pascalis A, Di Lullo L, Ronco C, Zannini C, La Manna G. Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First? Cardiorenal Med 2017; 7:255-266. [PMID: 29118764 DOI: 10.1159/000471813] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Hyperhomocysteinemia (Hhcy) occurs in about 85% of chronic kidney disease (CKD) patients because of impaired renal metabolism and reduced renal excretion. Folic acid (FA), the synthetic form of vitamin B9, is critical in the conversion of homocysteine (Hcy) to methionine. If there is not enough intake of FA, there is not enough conversion, and Hcy levels are raised. Summary Hhcy is regarded as an independent predictor of cardiovascular morbidity and mortality in end-stage renal disease. Hhcy exerts its pathogenic action on the main processes involved in the progression of vascular damage. Research has shown Hhcy suggests enhanced risks for inflammation and endothelial injury which lead to cardiovascular disease (CVD), stroke, and CKD. FA has also been shown to improve endothelial function without lowering Hcy, suggesting an alternative explanation for the effect of FA on endothelial function. Recently, the role of FA and Hhcy in CVD and in CKD progression was renewed in some randomized trials. Key Messages In the general population and in CKD patients, it remains a topic of discussion whether any beneficial effects of FA therapy are to be referred to its direct effect or to a reduction of Hhcy. While waiting for the results of confirmatory trials, it is reasonable to consider FA with or without methylcobalamin supplementation as appropriate adjunctive therapy in patients with CKD.
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Affiliation(s)
- Giuseppe Cianciolo
- Nephrology, Dialysis, and Transplantation Unit, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), St. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Luca Di Lullo
- Nephrology and Dialysis Unit, Parodi-Delfino Hospital, Colleferro, Italy
| | - Claudio Ronco
- International Renal Research Institute (IRRIV), S. Bortolo Hospital, Vicenza, Italy
| | - Chiara Zannini
- Nephrology, Dialysis, and Transplantation Unit, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis, and Transplantation Unit, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), St. Orsola Hospital, University of Bologna, Bologna, Italy
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The Sulfur Metabolite Lanthionine: Evidence for a Role as a Novel Uremic Toxin. Toxins (Basel) 2017; 9:toxins9010026. [PMID: 28075397 PMCID: PMC5308258 DOI: 10.3390/toxins9010026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 12/31/2022] Open
Abstract
Lanthionine is a nonproteinogenic amino acid, composed of two alanine residues that are crosslinked on their β-carbon atoms by a thioether linkage. It is biosynthesized from the condensation of two cysteine molecules, while the related compound homolanthionine is formed from the condensation of two homocysteine molecules. The reactions can be carried out by either cystathionine-β-synthase (CBS) or cystathionine-γ-lyase (CSE) independently, in the alternate reactions of the transsulfuration pathway devoted to hydrogen sulfide biosynthesis. Low plasma total hydrogen sulfide levels, probably due to reduced CSE expression, are present in uremia, while homolanthionine and lanthionine accumulate in blood, the latter several fold. Uremic patients display a derangement of sulfur amino acid metabolism with a high prevalence of hyperhomocysteinemia. Uremia is associated with a high cardiovascular mortality, the causes of which are still not completely explained, but are related to uremic toxicity, due to the accumulation of retention products. Lanthionine inhibits hydrogen sulfide production in hepatoma cells, possibly through CBS inhibition, thus providing some basis for the biochemical mechanism, which may significantly contribute to alterations of metabolism sulfur compounds in these subjects (e.g., high homocysteine and low hydrogen sulfide). We therefore suggest that lanthionine is a novel uremic toxin.
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The Molecular and Cellular Effect of Homocysteine Metabolism Imbalance on Human Health. Int J Mol Sci 2016; 17:ijms17101733. [PMID: 27775595 PMCID: PMC5085763 DOI: 10.3390/ijms17101733] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/12/2016] [Accepted: 10/08/2016] [Indexed: 12/13/2022] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing non-proteinogenic amino acid derived in methionine metabolism. The increased level of Hcy in plasma, hyperhomocysteinemia, is considered to be an independent risk factor for cardio and cerebrovascular diseases. However, it is still not clear if Hcy is a marker or a causative agent of diseases. More and more research data suggest that Hcy is an important indicator for overall health status. This review represents the current understanding of molecular mechanism of Hcy metabolism and its link to hyperhomocysteinemia-related pathologies in humans. The aberrant Hcy metabolism could lead to the redox imbalance and oxidative stress resulting in elevated protein, nucleic acid and carbohydrate oxidation and lipoperoxidation, products known to be involved in cytotoxicity. Additionally, we examine the role of Hcy in thiolation of proteins, which results in their molecular and functional modifications. We also highlight the relationship between the imbalance in Hcy metabolism and pathogenesis of diseases, such as cardiovascular diseases, neurological and psychiatric disorders, chronic kidney disease, bone tissue damages, gastrointestinal disorders, cancer, and congenital defects.
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Perna AF, Ingrosso D. Atherosclerosis determinants in renal disease: how much is homocysteine involved? Nephrol Dial Transplant 2015; 31:860-3. [PMID: 26687901 DOI: 10.1093/ndt/gfv409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/05/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alessandra F Perna
- First Division of Nephrology, Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - Diego Ingrosso
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
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The C677T MTHFR genotypes influence the efficacy of B9 and B12 vitamins supplementation to lowering plasma total homocysteine in hemodialysis. J Nephrol 2015; 29:691-8. [DOI: 10.1007/s40620-015-0235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
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Gao XH, Zhang GY, Wang Y, Zhang HY. Correlations of MTHFR 677C>T polymorphism with cardiovascular disease in patients with end-stage renal disease: a meta-analysis. PLoS One 2014; 9:e102323. [PMID: 25050994 PMCID: PMC4106822 DOI: 10.1371/journal.pone.0102323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/17/2014] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE This meta-analysis was conducted to evaluate the correlations of a common polymorphism (677C>T) in the methylenetetrahydrofolate reductase (MTHFR) gene with risk of cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). METHOD The following electronic databases were searched without language restrictions: Web of Science (1945∼2013), the Cochrane Library Database (Issue 12, 2013), MEDLINE (1966∼2013), EMBASE (1980∼2013), CINAHL (1982∼2013) and the Chinese Biomedical Database (CBM) (1982∼2013). Meta-analysis was performed using STATA statistical software. Odds ratios (ORs) with their 95% confidence intervals (95%CIs) were calculated. RESULTS Eight cohort studies met all inclusion criteria and were included in this meta-analysis. A total of 2,292 ESRD patients with CVD were involved in this meta-analysis. Our meta-analysis results revealed that the MTHFR 677C>T polymorphism might increase the risk of CVD in ESRD patients (TT vs. CC: OR = 2.75, 95%CI = 1.35∼5.59, P = 0.005; CT+TT vs. CC: OR = 1.39, 95%CI = 1.09∼1.78, P = 0.008; TT vs. CC+CT: OR = 2.52, 95%CI = 1.25∼5.09, P = 0.010; respectively). Further subgroup analysis by ethnicity suggested that the MTHFR 677C>T polymorphism was associated with an elevated risk for CVD in ESRD patients among Asians (TT vs. CC: OR = 3.38, 95%CI = 1.11∼10.28, P = 0.032; CT+TT vs. CC: OR = 1.44, 95%CI = 1.05∼1.97, P = 0.022; TT vs. CC+CT: OR = 3.15, 95%CI = 1.02∼9.72, P = 0.046; respectively), but not among Africans or Caucasians (all P>0.05). CONCLUSION Our findings indicate that the MTHFR 677C>T polymorphism may be associated with an elevated risk for CVD in ESRD patients, especially among Asians.
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Affiliation(s)
- Xian-Hui Gao
- Laboratory of Preventive Medicine, School of Public Health, Liaoning Medical University, Jinzhou, China
- * E-mail:
| | - Guo-Yi Zhang
- Laboratory of Preventive Medicine, School of Public Health, Liaoning Medical University, Jinzhou, China
| | - Ying Wang
- Department of Toxicology, School of Public Health, Liaoning Medical University, Jinzhou, China
| | - Hui-Ying Zhang
- Sleep Monitoring Center, First Affiliated Hospital of Liaoning Medical University, Jinzhou, China
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Conzo G, Perna AF, Savica V, Palazzo A, Pietra CD, Ingrosso D, Satta E, Capasso G, Santini L, Docimo G. Impact of parathyroidectomy on cardiovascular outcomes and survival in chronic hemodialysis patients with secondary hyperparathyroidism. A retrospective study of 50 cases prior to the calcimimetics era. BMC Surg 2013; 13 Suppl 2:S4. [PMID: 24268127 PMCID: PMC3851167 DOI: 10.1186/1471-2482-13-s2-s4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In chronic hemodialysis patients with secondary hyperparathyroidism, pathological modifications of bone and mineral metabolism increase the risk of cardiovascular morbidity and mortality. Parathyroidectomy, reducing the incidence of cardiovascular events, may improve outcomes; however, its effects on long-term survival are still subject of active research. METHODS From January 2004 to December 2006, 30 hemodialysis patients, affected by severe and unresponsive secondary hyperparathyroidism, underwent parathyroidectomy - 15 total parathyroidectomy and 15 total parathyroidectomy + subcutaneous autoimplantation. During a 5-year follow-up, patients did not receive a renal transplantation and were evaluated for biochemical modifications and major cardiovascular events - death, cardiovascular accidents, myocardial infarction and peripheral vascular disease. Results were compared with those obtained in a control group of 20 hemodialysis patients, affected by secondary hyperparathyroidism, and refusing surgical treatment, and following medical treatment only. RESULTS The groups were comparable in terms of age, gender, dialysis vintage, and comorbidities. Postoperative cardiovascular events were observed in 18/30 - 54% - surgical patients and in 4/20 - 20%- medical patients, with a mortality rate respectively of 23.3% in the surgical group vs. 15% in the control group. Parathyroidectomy was not associated with a reduced risk of cardiovascular morbidity and survival rate was unaffected by surgical treatment. CONCLUSIONS In secondary hyperparathyroidism hemodialysis patients affected by severe cardiovascular disease, surgery did not modify cardiovascular morbidity and mortality rates. Therefore, in secondary hyperparathyroidism hemodialysis patients, resistant to medical treatment, only an early indication to calcimimetics, or surgery, in the initial stage of chronic kidney disease - mineral bone disorders, may offer a higher long-term survival. Further studies will be useful to clarify the role of secondary hyperparathyroidism in determining unfavorable cardiovascular outcomes and mortality in hemodialysis population.
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Affiliation(s)
- Giovanni Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences - VII Division of General and Endocrine Surgery-Second University of Naples - Italy
| | - Alessandra F Perna
- Department of Cardio-thoracic and Respiratory Sciences - First Division of Nephrology - Second University of Naples - Italy
| | | | - Antonietta Palazzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences - VII Division of General and Endocrine Surgery-Second University of Naples - Italy
| | - Cristina Della Pietra
- Department of Anaesthesiologic, Surgical and Emergency Sciences - VII Division of General and Endocrine Surgery-Second University of Naples - Italy
| | - Diego Ingrosso
- Department of Biochemistry and Biophysics “F. Cedrangolo” - Second University of Naples - Italy
| | - Ersilia Satta
- Department of Cardio-thoracic and Respiratory Sciences - First Division of Nephrology - Second University of Naples - Italy
| | - Giovambattista Capasso
- Department of Cardio-thoracic and Respiratory Sciences - First Division of Nephrology - Second University of Naples - Italy
| | - Luigi Santini
- Department of Anaesthesiologic, Surgical and Emergency Sciences - VII Division of General and Endocrine Surgery-Second University of Naples - Italy
| | - Giovanni Docimo
- Department of Anaesthesiologic, Surgical and Emergency Sciences - VII Division of General and Endocrine Surgery-Second University of Naples - Italy
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