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van den Born JC, Frenay ARS, Koning AM, Bachtler M, Riphagen IJ, Minovíc I, Feelisch M, Dekker MM, Bulthuis MLC, Gansevoort RT, Hillebrands JL, Pasch A, Bakker SJL, van Goor H. Urinary Excretion of Sulfur Metabolites and Risk of Cardiovascular Events and All-Cause Mortality in the General Population. Antioxid Redox Signal 2019; 30:1999-2010. [PMID: 29905081 DOI: 10.1089/ars.2017.7040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims: Thiosulfate and sulfate are metabolites of hydrogen sulfide (H2S), a gaseous signaling molecule with cardiovascular (CV) protective properties. Urinary thiosulfate excretion and sulfate excretion are associated with favorable disease outcome in high-risk patient groups. We investigated the relationship between urinary excretion of sulfur metabolites, and risk of CV events and all-cause mortality in the general population. Results: Subjects (n = 6839) of the Prevention of Renal and Vascular End-stage Disease (PREVEND) study were followed prospectively. At baseline, 24-h urinary excretion of thiosulfate and sulfate was determined. Median urinary thiosulfate and sulfate excretion values were 1.27 (interquartile range [IQR] 0.89-2.37) μmol/24 h and 15.7 (IQR 12.0-20.3) mmol/24 h, respectively. Neither thiosulfate nor sulfate excretion showed an independent association with risk of CV events. Sulfate, but not thiosulfate, was inversely associated with risk of all-cause mortality, independent of potential confounders (hazard ratio 0.73 [95% confidence interval 0.63-0.84], p < 0.001). This association appeared most pronounced for normolipidemic subjects (pinteraction = 0.019). Innovation: The strong association between sulfate excretion and mortality in the general population emphasizes the (patho)physiological importance of sulfate or its precursor H2S. Conclusion: We hypothesize that urinary sulfate excretion, which is inversely associated with all-cause mortality in the general population, holds clinical relevance as a beneficial modulator in health and disease. Antioxid. Redox Signal. 30, 1999-2010.
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Affiliation(s)
- Joost C van den Born
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Anne-Roos S Frenay
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Anne M Koning
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,2 Department of Surgery, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Matthias Bachtler
- 3 Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Ineke J Riphagen
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,5 Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Isidor Minovíc
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Martin Feelisch
- 6 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,7 NIHR Biomedical Research Centre, University of Southampton, Southampton, United Kingdom.,8 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marinda M Dekker
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Marian L C Bulthuis
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Ron T Gansevoort
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
| | - Andreas Pasch
- 3 Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Stephan J L Bakker
- 4 Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands.,5 Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Harry van Goor
- 1 Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, The Netherlands
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Affiliation(s)
- Harmen G. Booij
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anne M. Koning
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harry van Goor
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudolf A. de Boer
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - B. Daan Westenbrink
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Koning AM, Meijers WC, Minović I, Post A, Feelisch M, Pasch A, Leuvenink HGD, de Boer RA, Bakker SJL, van Goor H. The fate of sulfate in chronic heart failure. Am J Physiol Heart Circ Physiol 2016; 312:H415-H421. [PMID: 27923792 DOI: 10.1152/ajpheart.00645.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/26/2016] [Revised: 10/24/2016] [Accepted: 11/26/2016] [Indexed: 11/22/2022]
Abstract
New leads to advance our understanding of heart failure (HF) pathophysiology are urgently needed. Previous studies have linked urinary sulfate excretion to a favorable cardiovascular risk profile. Sulfate is not only the end product of hydrogen sulfide metabolism but is also directly involved in various (patho)physiological processes, provoking scientific interest in its renal handling. This study investigates sulfate clearance in chronic HF (CHF) patients and healthy individuals and considers its relationship with disease outcome. Parameters related to renal sulfate handling were determined in and compared between 96 previously characterized CHF patients and sex-matched healthy individuals. Among patients, sulfate clearance was analyzed for associations with clinical and outcome parameters. In CHF patients, plasma sulfate concentrations are significantly higher, whereas 24-h urinary excretion, fractional excretion, and clearance of sulfate are significantly lower, compared with healthy individuals. Among patients, sulfate clearance is independently associated with diuretics use, creatinine clearance and 24-h urinary sodium excretion. Sulfate clearance is associated with favorable disease outcome [hazard ratio per SD increase 0.38 (95% confidence interval 0.23-0.63), P < 0.001]. Although significance was lost after adjustment for creatinine clearance, the decrease of sulfate clearance in patients is independent of this parameter, indicating that sulfate clearance is not merely a reflection of renal function. This exploratory study reveals aberrant sulfate clearance as a potential contributor to CHF pathophysiology, with reduced levels in patients and a positive association with favorable disease outcome. Further research is needed to unravel the nature of its involvement and to determine its potential as a biomarker and target for therapy.NEW & NOTEWORTHY Sulfate clearance is decreased in chronic heart failure patients compared with healthy individuals. Among patients, sulfate clearance is positively associated with favorable disease outcome, i.e., a decreased rehospitalization rate and increased patient survival. Hence, decreased sulfate clearance may be involved in the pathophysiology of heart failure.
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Affiliation(s)
- Anne M Koning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidor Minović
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrian Post
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Biomedical Research Centre, Southampton, United Kingdom; and
| | - Andreas Pasch
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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Koning AM, Meijers WC, Pasch A, Leuvenink HGD, Frenay ARS, Dekker MM, Feelisch M, de Boer RA, van Goor H. Serum free thiols in chronic heart failure. Pharmacol Res 2016; 111:452-458. [PMID: 27378569 DOI: 10.1016/j.phrs.2016.06.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 04/18/2016] [Revised: 06/22/2016] [Accepted: 06/30/2016] [Indexed: 01/19/2023]
Abstract
Oxidative stress is a key element of the pathophysiology of heart failure (HF). As free thiols are readily oxidized by reactive oxygen and sulfur species, their circulating level may directly reflect the systemic redox status. This study addresses the role of serum free thiols in chronic HF, which is of particular interest as free thiols are amenable to therapeutic modulation and thus are a potential target for therapy. Free thiols were measured in serum of 101 previously characterized stable chronic HF patients (93% male, age 63.7±10.0y, left ventricular ejection fraction 34.6±8.2%), adjusted for total serum protein, and subsequently analysed for associations with clinical and outcome parameters. The mean serum free thiol concentration was 3.6±0.5μM/g protein. Patients with above-average levels were younger, had better renal function, lower levels of NT-proBNP and PTH, and higher levels of cholesterol. Furthermore, above-average levels were associated with favourable disease outcome, i.e. a decreased rehospitalisation rate and increased patient survival (HR 0.27 (95% CI 0.11-0.62), P=0.002) independent of associated clinical parameters, age and PTH. After adjustment for cholesterol or established prognostic factors in HF, eGFR and NT-proBNP the association was no longer significant, suggesting involvement of these variables in a common pathophysiological pathway. This exploratory study demonstrates favourable associations of serum free thiols with markers of HF severity and prognosis as well as disease outcome, which should be further investigated in larger prospective studies. Restoring redox status by therapeutic modulation of free thiols may be a promising strategy to improve disease outcome in CHF.
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Affiliation(s)
- Anne M Koning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andreas Pasch
- Department of Nephrology, Clinical Research and Calciscon AG, University Hospital Bern, Bern, Switzerland
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne-Roos S Frenay
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marinda M Dekker
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Koning AM, Frenay ARS, Leuvenink HG, van Goor H. Hydrogen sulfide in renal physiology, disease and transplantation – The smell of renal protection. Nitric Oxide 2015; 46:37-49. [DOI: 10.1016/j.niox.2015.01.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/19/2015] [Accepted: 01/22/2015] [Indexed: 01/08/2023]
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Fijlstra M, Ferdous M, Koning AM, Rings EHHM, Harmsen HJM, Tissing WJE. Substantial decreases in the number and diversity of microbiota during chemotherapy-induced gastrointestinal mucositis in a rat model. Support Care Cancer 2014; 23:1513-22. [PMID: 25376667 DOI: 10.1007/s00520-014-2487-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Earlier, we showed in acute myeloid leukemia (AML) patients that the microbiota changes dramatically during anticancer treatment, coinciding with gastrointestinal mucositis: The commensal anaerobic populations reduce in favor of potential pathogens. Therefore, interventions targeting the microbiota during mucositis might be interesting but can better be tested in animals than in vulnerable mucositis patients. Here, we aimed to study the potential microbial changes during methotrexate (MTX)-induced gastrointestinal mucositis in a well-established rat model and to study whether this model can be used for future microbial intervention studies. METHODS After injection with MTX or saline (day 0), rats were sacrificed between days 2 and 11. Plasma citrulline level, jejunal histology, and the number and diversity of intestinal bacteria in feces (using fluorescence in situ hybridization (FISH)) were determined. RESULTS Mucositis was most severe on day 4 when food intake, plasma citrulline, and villus length were the lowest, compared with controls (P < 0.0125). At the same time, MTX-treated rats showed an overall decrease (705-fold) in most bacteria (using a universal probe), compared with controls (P < 0.125). Reduced bacterial presence was related with the presence of diarrhea and a reduced villus length (rho = 0.38, P < 0.05). At day 4, there was an absolute and relative decrease of anaerobes (13-fold and -58 %, respectively) and streptococci (296-fold and -1 %, respectively) but a relative increase of Bacteroides (+49 %), compared with controls (P < 0.125). CONCLUSIONS In the mucositis rat model, we found substantial decreases in the number and diversity of microbiota, resembling earlier findings in humans. The model therefore seems well suited to study the effects of different microbial interventions on mucositis, prior to performing human studies.
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Affiliation(s)
- Margot Fijlstra
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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Snijder PM, Frenay ARS, Koning AM, Bachtler M, Pasch A, Kwakernaak AJ, van den Berg E, Bos EM, Hillebrands JL, Navis G, Leuvenink HGD, van Goor H. Sodium thiosulfate attenuates angiotensin II-induced hypertension, proteinuria and renal damage. Nitric Oxide 2014; 42:87-98. [PMID: 25459997 DOI: 10.1016/j.niox.2014.10.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/05/2014] [Accepted: 10/09/2014] [Indexed: 01/03/2023]
Abstract
Hypertension and proteinuria are important mediators of renal damage. Despite therapeutic interventions, the number of patients with end stage renal disease steadily increases. Hydrogen sulfide (H(2)S) is an endogenously produced gasotransmitter with vasodilatory, anti-inflammatory and antioxidant properties. These beneficial characteristics make H(2)S an attractive candidate for pharmacological use in hypertensive renal disease. We investigated the protective properties of H(2)S in angiotensin II (Ang II)-induced hypertensive renal disease in rats. Treatment with the H(2)S donor NaHS and major H(2)S metabolite sodium thiosulfate (STS) during three weeks of Ang II infusion reduced hypertension, proteinuria, oxidative stress and renal functional and structural deterioration. In an ex vivo isolated perfused kidney setup, NaHS, but not STS, reduced intrarenal pressure. The effect of NaHS could partially be explained by its activation of the ATP-sensitive potassium channels. In conclusion, treatment with H(2)S attenuates Ang II-associated functional and structural renal deterioration, suggesting that intervention in H(2)S production pathways has potential therapeutic benefit and might be a valuable addition to the already existing antihypertensive and renoprotective therapies.
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Affiliation(s)
- Pauline M Snijder
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne-Roos S Frenay
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M Koning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthias Bachtler
- Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Andreas Pasch
- Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Arjan J Kwakernaak
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Else van den Berg
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelke M Bos
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Koning AM, Ettema EM, Bakker MM, Leuvenink HG, Pasch A, Bakker SJ, Franssen CF, van Goor H. P29 Dialysate sulfate levels reflect nutrional status. Nitric Oxide 2014. [DOI: 10.1016/j.niox.2014.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koning AM, Leuvenink HG, Hoeksma DH, Pasch A, van Goor H. P30 NAHS and STS treatment in ischemia–reperfusion injury in rats. Nitric Oxide 2014. [DOI: 10.1016/j.niox.2014.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koning AM, Holwerda KM, Weedon-Fekjær SM, Staff AC, Nolte IM, Titia Lely A, Seelen MA, Faas MM, Leuvenink HG, van Goor H. P23 CBS gene variants are associated with conditions characterized by ischemia. Nitric Oxide 2013. [DOI: 10.1016/j.niox.2013.06.085] [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: 11/26/2022]
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Snijder PM, Frenay ARS, Koning AM, Pasch A, den Berg E, Leuvenink HG, Goor VH. P47 Hydrogen Sulfide reduces hypertension, proteinuria and renal damage. Nitric Oxide 2013. [DOI: 10.1016/j.niox.2013.06.109] [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: 11/27/2022]
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