The toxicity of guanidino compounds in the red blood cell in uremia and the effects of hemodialysis

The Effect of Hemodialysis and Dialyzer Biocompatibility on Erythrocyte Glutathione-Defense System in Chronic Hemodialysis Patients

Background

Uremic patients, especially those receiving regular hemodialysis (HD) treatment, are at high risk of oxidative damage by noxious free radicals and reactive oxygen species (ROS). The erythrocyte glutathione-defense system (GSH-DS) is one of the major enzymatic means of scavenging and detoxifying ROS. This study aimed to elucidate the effect of HD and dialyzer biocompatibility on erythrocyte GSH-DS in uremic patients on maintenance HD treatment.

Methods

Twenty-five healthy volunteers and 42 HD patients were enrolled in this study. Blood samples were drawn immediately before and after HD session, and erythrocyte glutathione (GSH) level as well as the activities of the enzymes glucose-6-phosphate dehydrogenase (G6PD), glutathione peroxidase (GSH-Px), glutathione reductase (GSSG-Rd), and glutathione S-transferase (GST) were measured. To evaluate the effect of dialyzer type on the studied parameters the patients were were subdivided into two groups: those who had dialysis with cuprophane (CU) membranes (n=23) and those who received dialysis with the aid of polysulfone (PS) membranes (n=19).

Results

The activities of G6PD and GSH-Px as well as GSH level were significantly decreased in HD patients as compared with controls. On the other hand, the activities of GSSG-Rd and GST were significantly elevated among HD patients in comparison with control values. A single HD session, regardless of the type of dialyzer, did not induce any significant effect on any of the measured parameters, although G6PD activity increased significantly after dialysis. CU membrane did not result in any change in GSH or its metabolizing enzymes, while PS dialyzers exerted a minor but significant restoration in GSH-DS.

Conclusion

The antioxidant pool, as represented by GSH-DS, is significantly affected by dialyzer type in HD patients being significantly corrected with polysulfone dialyzer.

The effect of the creatine analogue beta-guanidinopropionic acid on energy metabolism: a systematic review

Background

Creatine kinase plays a key role in cellular energy transport. The enzyme transfers high-energy phosphoryl groups from mitochondria to subcellular sites of ATP hydrolysis, where it buffers ADP concentration by catalyzing the reversible transfer of the high-energy phosphate moiety (P) between creatine and ADP. Cellular creatine uptake is competitively inhibited by beta-guanidinopropionic acid. This substance is marked as safe for human use, but the effects are unclear. Therefore, we systematically reviewed the effect of beta-guanidinopropionic acid on energy metabolism and function of tissues with high energy demands.

Methods

We performed a systematic review and searched the electronic databases Pubmed, EMBASE, the Cochrane Library, and LILACS from their inception through March 2011. Furthermore, we searched the internet and explored references from textbooks and reviews.

Results

After applying the inclusion criteria, we retrieved 131 publications, mainly considering the effect of chronic oral administration of beta-guanidinopropionic acid (0.5 to 3.5%) on skeletal muscle, the cardiovascular system, and brain tissue in animals. Beta-guanidinopropionic acid decreased intracellular creatine and phosphocreatine in all tissues studied. In skeletal muscle, this effect induced a shift from glycolytic to oxidative metabolism, increased cellular glucose uptake and increased fatigue tolerance. In heart tissue this shift to mitochondrial metabolism was less pronounced. Myocardial contractility was modestly reduced, including a decreased ventricular developed pressure, albeit with unchanged cardiac output. In brain tissue adaptations in energy metabolism resulted in enhanced ATP stability and survival during hypoxia.

Conclusion

Chronic beta-guanidinopropionic acid increases fatigue tolerance of skeletal muscle and survival during ischaemia in animal studies, with modestly reduced myocardial contractility. Because it is marked as safe for human use, there is a need for human data.

Influence of green tea polyphenol in rats with arginine-induced renal failure

To determine whether green tea polyphenol ameliorates the pathological conditions induced by excessive dietary arginine, green tea polyphenol was administered to rats at a daily dose of 50 or 100 mg/kg body weight for 30 days with a 2% w/w arginine diet. In arginine-fed control rats, urinary and/or serum levels of guanidino compounds, nitric oxide (NO), urea, protein, and glucose increased significantly, while the renal activities of the oxygen species-scavenging enzymes superoxide dismutase (SOD) and catalase decreased, compared with casein-fed rats. However, rats given green tea polyphenol showed significant and dose-dependent decreases in serum levels of creatinine (Cr) and urea nitrogen and urinary excretion of Cr, and they exerted a slight reduction of nitrite plus nitrate, indicating that green tea polyphenol reduced the production of uremic toxins and NO. In addition, in arginine-fed rats the urinary urea, protein, and glucose level increases were reversed by the administration of green tea polyphenol. Moreover, in rats given green tea polyphenol the SOD and catalase activities suppressed by excessive arginine administration increased dose-dependently, implying the biological defense system was augmented as a result of free radical scavenging. These results suggest that green tea polyphenol would ameliorate renal failure induced by excessive dietary arginine by decreasing uremic toxin, and NO production and increasing radical-scavenging enzyme activity.

Erythrocyte transketolase activity and guanidino compounds in hemodialysis patients

BACKGROUND

The toxic effects of guanidino compounds on enzymatic activity in uremic patients are known. Thus, we determined the hemodialysis (HD) impact on this toxicity.

METHODS

The erythrocyte transketolase activity (ETKA), total guanidino compounds (TGCs), and guanidinosuccinic acid (GSA) levels in plasma were compared before, after 5 hours of HD, and at 12 and 24 hours from the end of HD. Thirty-seven HD patients (28 to 49 years old) with primary glomerulopathies participated in this study. Thirty healthy volunteers (HVs) served as controls.

RESULTS

At the beginning of this study, ETKA was lower in uremics (1.94 +/- 0.45) than in HVs (2.59 +/- 0.26). The TGC and GSA plasma levels were higher (26.07 +/- 5.34 and 4.5 +/- 1.22) than in HVs (10.41 +/- 1.42 and 0.76 +/- 0.09, P < 0.001), respectively. After five hours of HD, the ETKA increased to 2.49 +/- 0.62 (P < 0.001). The plasma levels TGC decreased to 12.56 +/- 2.02 (P < 0.001) and the GSA to 2.12 +/- 0.68 (P < 0.001). After 12 and 24 hours from the end of HD, the ETKA decreased to 2.25 +/- 0.56 and 2.09 +/- 0.49 (P < 0.001), respectively. The plasma levels for TGC and GSA both increased: TGC to 19.39 +/- 3.67 and 25.68 +/- 4.61 (P < 0.001), respectively; GSA to 3.49 +/- 1.11 and 4.53 +/- 1.12 (P < 0.001), respectively.

CONCLUSION

There was no significant correlation between ETKA and the plasma levels of the examined toxins. By removing the guanidino compounds, HD temporarily decreases the inhibition of ETKA, diminishing other metabolic disturbances connected with pentose phosphate cycle.

Creatine and creatinine metabolism

The goal of this review is to present a comprehensive survey of the many intriguing facets of creatine (Cr) and creatinine metabolism, encompassing the pathways and regulation of Cr biosynthesis and degradation, species and tissue distribution of the enzymes and metabolites involved, and of the inherent implications for physiology and human pathology. Very recently, a series of new discoveries have been made that are bound to have distinguished implications for bioenergetics, physiology, human pathology, and clinical diagnosis and that suggest that deregulation of the creatine kinase (CK) system is associated with a variety of diseases. Disturbances of the CK system have been observed in muscle, brain, cardiac, and renal diseases as well as in cancer. On the other hand, Cr and Cr analogs such as cyclocreatine were found to have antitumor, antiviral, and antidiabetic effects and to protect tissues from hypoxic, ischemic, neurodegenerative, or muscle damage. Oral Cr ingestion is used in sports as an ergogenic aid, and some data suggest that Cr and creatinine may be precursors of food mutagens and uremic toxins. These findings are discussed in depth, the interrelationships are outlined, and all is put into a broader context to provide a more detailed understanding of the biological functions of Cr and of the CK system.

Chromatography and electrophoresis of creatinine and other guanidino compounds

Chromatographic methods, in general, are considered as the definitive and reference procedure. The HPLC procedures reviewed all seem to provide improved and adequate specificity and sensitivity for CRN assay. The HPLC methods are relatively easy to use, have nearly complete recoveries (greater than or equal to 95%) and have good precision. The within- and between-day variations are often less than 4% [85,87,90,94-97,99]. Most of the methods developed [84,85,90,91,94,97,99] were tested for potential interference and the specificity for CRN was demonstrated. One important advantage of the HPLC method [85] is that the presence of an interfering substance in the biological sample can most likely be detected by its influence on the sharpness and resolution of the CRN peak. It is understandable that there are possibilities that other constituents in the biological sample may also be co-eluting with CRN and the investigator should carefully examine the chromatogram obtained for any sign of interference. Ginman and Colliss [107] reported that azathioprine, cyclosporin A, cefotaxime and prednisolone used in patients after renal transplant interfered with the HPLC assay: the results are 40% higher than those by Jaffe method. These interferences, however, were corrected with a slight modification of the HPLC conditions [107]. Because of the non-specificity associated with the Jaffe reaction, the results obtained from Jaffe-based assays often exceed those from HPLC methods [95,108,109]. Such overestimation would be especially significant when the serum CRN is in the normal range where small changes may be indicative of a significant change in a patient's renal function [95,111]. It appears that HPLC methods are the methods of choice for simultaneous analysis of endogenous guanidino compounds. Depending on the purpose of analysis, one would choose a particular type of method, e.g., one among those representative methods listed in Table 1. If one is interested in measuring MG and GSA levels in serum or plasma, then depending on the sensitivity requirement and available instrumentations, one could choose many method listed in Table 1. However, if one needs to measure AARG, ARG and ARA, in addition to MG and GSA, then method 4 in Table 1 would be more appropriate. If TAU is the compound of interest, then one of the methods 2,3,4,5, and 7 with an appropriate deproteinization procedure would be desirable.

Effect of Transfer of Erythrocytes to a Nonuremic Medium on Corpuscular Parameters and Red Blood Cell Deformability in Patients Treated with CAPD and Hemodialysis

We studied the effect produced on corpuscular parameters and erythrocyte deformability by transfer of red blood cells to a nontoxic isoosmotic medium. The study groups were uremic patients treated with hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Erythrocyte deformability was estimated by the erythrocyte filtration rate (EFR). Transfer resulted in a significant decrease in mean corpuscular volume (MCV) and an increase in mean corpuscular hemoglobin concentration (MCHC), in comparison with healthy controls. The principal cause for this may be an improvement in erythrotycte membrane function. The change was more marked in the CAPD than in the HD patients; CAPD patients displayed a clear tendency to microcytosis after changing media, not directly attributable to iron deficiency or aluminum intoxication. Erythrocyte deformability was decreased markedly in all the patients, but study of the EFR of washed erythrocytes suggested that there was more impairment in HD. These differences could have some effect on the response of the hemolytic component of the anemia of uremia to HD and CAPD.

Enzymatic determination of red cell creatine as an index of hemolysis

An enzymatic assay for creatine, depending on the creatine kinase reaction, has been modified for the determination of creatine in packed erythrocytes, using a centrifugal analyzer (COBAS BIO). The method is precise, sensitive and shows excellent accuracy in recovery experiments when compared to the diacetyl-alpha-naphthol method. The enzymatic red cell creatine correlates with the erythrocyte survival time determined with the radioactive chromium method. It can be used as a rapidly available parameter for the quantification of hemolytic processes.

High-performance liquid chromatographic analysis of guanidino compounds using ninhydrin reagent. II. Guanidino compounds in blood of patients on haemodialysis therapy

An automated high-performance liquid chromatographic method using alkali-ninhydrin reagent for the post-column derivatization of guanidines has been developed. This procedure was applied to measurements made before and after haemodialysis. Among the guanidino compounds found in human blood, methylguanidine showed the lowest removal rate. The removal rate of guanidinosuccinic acid correlated with the plasma alpha 1-globulin fraction. The removal rate of each guanidino compound decreased with the period of dialysis.