Expression of Circulating MicroRNAs Linked to Bone Metabolism in Chronic Kidney Disease-Mineral and Bone Disorder

miR-29a-3p/Vegfa axis modulates high phosphate-induced vascular smooth muscle cell calcification

Vascular calcification (VC) is a major contributor to the progression of cardiovascular disease (CVD). The VC is characterized by arterial stiffness and impaired blood flow. This pathology is especially prevalent in chronic kidney disease (CKD), where dysregulated mineral metabolism and elevated phosphate levels accelerate calcification of vascular smooth muscle cells (VSMCs). Emerging evidence suggests that microRNAs (miRNAs) are key regulators of VC, with the miR-29 family implicated in extracellular matrix remodeling and calcification. We investigated the role of the miR-29a-3p/vascular endothelial growth factor A (Vegfa) axis in CKD-associated VC. Dual-luciferase assays and bioinformatic analysis confirmed that miR-29a-3p directly targets Vegfa, a critical regulator of vascular homeostasis. miR-29a-3p overexpression significantly attenuated VSMC calcification under high phosphate conditions, as indicated by significantly reduced Alizarin Red staining (ARS, P < 0.0001) and intracellular calcium content (ICC, P = 0.0235). Conversely, Vegfa overexpression exacerbated calcification (P = 0.0010 for ICC and P = 0.0001 for ARS). Vegfa knockdown mitigated these effects (P < 0.0001 for both ARS and ICC). Notably, miR-29a-3p counteracted calcification even in Vegfa-overexpressing cells (P < 0.0001 for ARS and P = 0.0235 for ICC), underscoring its protective role in vascular integrity. These findings highlight the therapeutic potential of targeting the miR-29a-3p/Vegfa axis for VC management in patients with CKD. miRNA-based interventions may offer a promising strategy for preventing pathological calcification and reducing the risk of CVD in affected patients.

Panel miRNAs are potential diagnostic markers for chronic kidney diseases: a systematic review and meta-analysis

BACKGROUND

Accurate detection of kidney damage is key to preventing renal failure, and identifying biomarkers is essential for this purpose. We aimed to assess the accuracy of miRNAs as diagnostic tools for chronic kidney disease (CKD).

METHODS

We thoroughly searched five databases (MEDLINE, Web of Science, Embase, Scopus, and CENTRAL) and performed a meta-analysis using R software. We assessed the overall diagnostic potential using the pooled area under the curve (pAUC), sensitivity (SEN), and specificity (SPE) values and the risk of bias by using the QUADAS-2 tool. The study protocol was registered on PROSPERO (CRD42021282785).

RESULTS

We analyzed data from 8351 CKD patients, 2989 healthy individuals, and 4331 people with chronic diseases. Among the single miRNAs, the pooled SEN was 0.82, and the SPE was 0.81 for diabetic nephropathy (DN) vs. diabetes mellitus (DM). The SEN and SPE were 0.91 and 0.89 for DN and healthy controls, respectively. miR-192 was the most frequently reported miRNA in DN patients, with a pAUC of 0.91 and SEN and SPE of 0.89 and 0.89, respectively, compared to those in healthy controls. The panel of miRNAs outperformed the single miRNAs (pAUC of 0.86 vs. 0.79, p < 0.05). The SEN and SPE of the panel miRNAs were 0.89 and 0.73, respectively, for DN vs. DM. In the lupus nephritis (LN) vs. systemic lupus erythematosus (SLE) cohorts, the SEN and SPE were 0.84 and 0.81, respectively. Urinary miRNAs tended to be more effective than blood miRNAs (p = 0.06).

CONCLUSION

MiRNAs show promise as effective diagnostic markers for CKD. The detection of miRNAs in urine and the use of a panel of miRNAs allows more accurate diagnosis.

Atherosclerosis and Epigenetic Modifications in Chronic Kidney Disease

Chronic kidney disease (CKD) is one of the most common chronic diseases worldwide, with prevalence currently projected at 10% and rising. Cardiovascular disease is the leading cause of morbidity and mortality in CKD patients and is integrally linked with atherogenesis and vascular stiffness. Estimated glomerular filtration rate and the level of proteinuria are not only markers of kidney function but of cardiovascular risk, as well. Despite the efforts, CKD patients still experience excessive cardiovascular burden. MicroRNAs (miRNAs) are small (18-24 nucleotides), single-stranded non-coding RNAs that regulate gene expression by blocking messenger RNA (mRNA) translation and initiating degradation of mRNA. Studies have confirmed the imperative role of miRNA dysregulation in the pathophysiology of several diseases, including atherosclerosis and CKD. This article summarizes what is currently known about the role of miRNAs in CKD patients.

Non-Coding RNAs in Health and Disease: Editorial

Non-coding RNAs (ncRNAs) represent the largest part of the transcriptional production of the human genome and play key roles in health and disease processes [...].

MicroRNAs: emerging biomarkers and therapeutic targets of bone fragility in chronic kidney disease

Bone fragility is highly prevalent, yet underdiagnosed in patients with chronic kidney disease. Incomplete understanding of the pathophysiology and limitations of current diagnostics contribute to therapeutic hesitation, if not nihilism. This narrative review addresses the question of whether microRNAs (miRNAs) may improve therapeutic decision making in osteoporosis and renal osteodystrophy. miRNAs are key epigenetic regulators of bone homeostasis and show promise as both therapeutic targets and as biomarkers, primarily of bone turnover. Experimental studies show that miRNAs are involved in several osteogenic pathways. Clinical studies exploring the usefulness of circulating miRNAs for fracture risk stratification and for guiding and monitoring therapy are few and, so far, provide inconclusive results. Likely, (pre)analytical heterogeneity contributes to these equivocal results. In conclusion, miRNAs are promising in metabolic bone disease, both as a diagnostic tool and as therapeutic targets, but not yet ready for clinical prime time.

The effect of pharmacological cessation and restoration of menstrual cycle on bone metabolism in premenopausal women with endometriosis

INTRODUCTION

GnRH-analogs induce bone loss. We aimed to investigate the effects of goserelin-induced menstrual cessation (MC) and subsequent menstrual restoration (MR) on bone metabolism (BM).

METHODS

In this prospective cohort study, premenopausal women (PMW) with histologically verified endometriosis (n = 21) received goserelin monthly for 6 months (6 m) resulting in MC and were followed up for another 6 m after MR (12 m). Age- and BMI-matched healthy PMW (n = 20) served as controls for bone mineral density (BMD) measurements. The primary endpoint was changes in lumbar spine (LS)-BMD at 6 m and 12 m; Secondary endpoints were changes in femoral neck (FN)-BMD, bone turnover markers (P1NP and CΤx), sclerostin, and expression of bone-related circulating microRNAs (miRNAs) at 6 m and 12 m.

RESULTS

Goserelin-induced MC reduced LS- and FN-BMD at 6 m (both p < 0.001). From 6 m to 12 m, LS-BMD increased (p < 0.001) but remained below baseline values (p = 0.012), whereas FN-BMD remained stable (p = 1.000). CTx and P1NP levels increased at 6 m (both p < 0.001) and decreased at 12 m (p < 0.001 and p = 0.013, respectively), while CTx (p = 1.000) alone and not P1NP (p = 0.020) returned to baseline. Sclerostin levels did not change. Relative expression of miRNAs targeting RUNX 2 and beta-catenin was significantly downregulated at 6 m compared to baseline (p < 0.001), while the expression of miRNAs targeting osteoblast and osteoclast function at both directions demonstrated a robust increase (up to 400fold) at 12 m (p < 0.001).

CONCLUSIONS

Six months of goserelin-induced MC lead to significant bone loss associated with increased bone turnover and changes in the expression of bone-related miRNAs, changes that are only partially reversed at 6 m after MR.

Utility of Trabecular Bone Score (TBS) in Bone Quality and Fracture Risk Assessment in Patients on Maintenance Dialysis

Maintenance dialysis is associated with almost universal changes in bone metabolism collectively known as chronic kidney disease—mineral and bone disorder (CKD-MBD). These are accompanied in various proportions by bone loss and altered bone quality that led to an increased risk of fracture. Osteoporosis, age-related or postmenopausal, a condition that often coexists with CKD, is also a leading cause of fracture. Dual-energy X-ray densitometry (DXA) is the main tool for assessing the bone quantity and bone loss and the associated fracture risk. It has been validated in both CKD-MBD and osteoporosis. Trabecular bone score (TBS) is a DXA-derived algorithm for the evaluation of bone microarchitecture, and its clinical value has been repeatedly demonstrated in large cohorts of osteoporotic patients. However, its utility in patients on maintenance dialysis has not been conclusively shown. Published studies showed a lower TBS score and implicitly an altered bone microarchitecture in patients on maintenance dialysis, even after adjusting for various variables. Moreover, FRAX-based fracture risk is higher after adjusting for TBS, showing promise on an algorithm better estimating the clinical fracture risk in dialysis patients. However, TBS has not been demonstrated to independently predict clinical fractures in prospective studies on dialysis patients. Also, aortic calcifications and altered fluid balance could significantly affect TBS score and could hamper the widespread clinical use in patients on maintenance dialysis. In this mini-review, we focus on the benefits and pitfalls of TBS in the management of CKD-MBD and fracture risk assessment in patients on maintenance dialysis.

Osteoporosis, an Inevitable Circumstance of Chronic Kidney Disease: A Systematic Review

Nowadays, chronic kidney disease (CKD) and osteoporosis have become crucial health-related issues globally. CKD-induced osteoporosis is a systemic disease characterized by the disruption of mineral, hormone, and vitamin homeostasis that elevates the likelihood of fracture. Here, we review recent studies on the association of CKD and osteoporosis. In particular, we focus on the pathogenesis of CKD-associated osteoporosis, including the homeostasis and pathways of several components such as parathyroid hormone, calcium, phosphate, vitamin D, fibroblast growth factor, and klotho, as well as abnormal bone mineralization, remodeling, and turnover. In addition, we explore the diagnostic tools and possible therapeutic approaches for the management and prevention of CKD-associated osteoporosis. Patients with CKD show higher osteoporosis prevalence, greater fracture rate, increased morbidity and mortality, and an elevated occurrence of hip fracture. We also rule out that increased severity of CKD is related to a more severe condition of osteoporosis. Furthermore, supplements such as calcium and vitamin D as well as lifestyle modifications such as exercise and cessation of smoking and alcohol help in fracture prevention. However, new approaches and advancements in treatment are needed to reduce the fracture risk in patients with CKD. Therefore, further collaborative multidisciplinary research is needed in this regard.

Research on the inhibition for aseptic loosening of artificial joints by Sr-doped calcium polyphosphate (SCPP)in vivo

Aseptic loosening of artificial joints is the most common complication after artificial joint replacement. Finding the solution to tackle aseptic loosening of artificial joints is a focus in bone and joint surgery research field.In vitrostudies of Sr-doped calcium polyphosphate (SCPP) have found by our team that it could promote osteoblast proliferation and inhibit osteoclast activity, and it has a potential inhibitory effect on aseptic loosening by suppressing the expression of receptor activator of nuclear factor-κ B ligand and improving the expression of OPG. The present study aims to confirm the conclusionin vitroby the mean of animal experiment. The Ti rod prosthesis coated with SCPP, calcium polyphosphate (CPP), and Ultra-high molecular weight polyethylene (UHMWPE were implanted in the femur (the internal surface of bone tunnel was also coated with SCPP, CPP and UHMWPE respectively). Radiography (x-rays, micro-CT), histochemistry (Hematoxylin-eosin staining (HE), methylene blue-acid fuchsin, Von Kossa histological staining), molecular biology (alkaline phosphatase and TRAP5b factors, Mir21-5p and Mir 26a-5p) were performed to analyzed the effects of SCPP within 20 weeks. The Radiography results showed that osteolysis with various severity occurred in all groups, and SCPP group had the mildest osteolysis. Histochemistry results showed that arthritis was milder in SCPP and CPP groups, while the bone formation in SCPP group was most significant. Its bone reconstruction effect was the best as well. The Molecular biology results showed that the bone reconstruction was out-sync in each group. Compared with other groups, the bone resorption occurred at the latest and the bone resorption time was the shortest in experimental animals of SCPP group. All results indicated that SCPP could promote osteoblast activity and bone reconstruction, improve the integration of bone interface between prosthesis and base bone, reduce osteoclast activity and shorten the osteoclast action time at the implantation sitein vivo. Thus, it could postpone or alleviate the occurrence and development of aseptic looseningin vivo. Therefore, SCPP could be a promising material for the construction of artificial joints with the ability to resist aseptic loosening.

Circulating microRNAs Related to Bone Metabolism in HIV-Associated Bone Loss

The pathophysiology of human immunodeficiency virus (HIV)-associated bone loss is complex and to date largely unknown. In this study, we investigated serum expression of microRNAS (miRNAs) linked to bone metabolism in HIV-associated bone loss. This was a case-control study. Thirty male individuals with HIV infection (HIV+) and osteoporosis/osteopenia (HIV+/OP+) (cases) and 30 age-matched male HIV+ individuals with normal bone mass (HIV+/OP-) (controls) were included in the analysis. Thirty male individuals matched for age without HIV infection (HIV-), were also included as second controls. The selected panel of miRNAs was as follows: hsa-miRNA-21-5p; hsa-miRNA-23a-3p; hsa-miRNA-24-2-5p; hsa-miRNA-26a-5p; hsa-miRNA-29a-3p; hsa-miRNA-124-3p; hsa-miRNA-33a-5p; and hsa-miRNA-133a-3p. Within the cohort of HIV+ individuals, relative serum expression of miRNA-21-5p and miRNA-23a-3p was significantly lower (p < 0.001) while the expression of miRNA-24-2-5p was significantly higher (p = 0.030) in HIV+/OP+ compared to HIV+/OP-. Expression of miRNA-21-5p demonstrated a sensitivity of 84.6% and a specificity of 66.7 in distinguishing HIV+/OP+ individuals. Expression of circulating miRNAs related to bone metabolism; miRNA-23a-3p, miRNA-24-2-5p, and miRNA-21-5p is significantly altered in HIV+OP+ individuals, in line with data on other causes of osteoporosis, suggesting a common pattern of circulating miRNAs independent of the underlying cause.