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Oh J, Riek AE, Bauerle KT, Dusso A, McNerney KP, Barve RA, Darwech I, Sprague JE, Moynihan C, Zhang RM, Kutz G, Wang T, Xing X, Li D, Mrad M, Wigge NM, Castelblanco E, Collin A, Bambouskova M, Head RD, Sands MS, Bernal-Mizrachi C. Embryonic vitamin D deficiency programs hematopoietic stem cells to induce type 2 diabetes. Nat Commun 2023; 14:3278. [PMID: 37311757 PMCID: PMC10264405 DOI: 10.1038/s41467-023-38849-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
Environmental factors may alter the fetal genome to cause metabolic diseases. It is unknown whether embryonic immune cell programming impacts the risk of type 2 diabetes in later life. We demonstrate that transplantation of fetal hematopoietic stem cells (HSCs) made vitamin D deficient in utero induce diabetes in vitamin D-sufficient mice. Vitamin D deficiency epigenetically suppresses Jarid2 expression and activates the Mef2/PGC1a pathway in HSCs, which persists in recipient bone marrow, resulting in adipose macrophage infiltration. These macrophages secrete miR106-5p, which promotes adipose insulin resistance by repressing PIK3 catalytic and regulatory subunits and down-regulating AKT signaling. Vitamin D-deficient monocytes from human cord blood have comparable Jarid2/Mef2/PGC1a expression changes and secrete miR-106b-5p, causing adipocyte insulin resistance. These findings suggest that vitamin D deficiency during development has epigenetic consequences impacting the systemic metabolic milieu.
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Affiliation(s)
- Jisu Oh
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy E Riek
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin T Bauerle
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine, VA Medical Center, St. Louis, MO, USA
| | - Adriana Dusso
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kyle P McNerney
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Ruteja A Barve
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Isra Darwech
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Clare Moynihan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rong M Zhang
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Greta Kutz
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ting Wang
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Xiaoyun Xing
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Daofeng Li
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Marguerite Mrad
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas M Wigge
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Alejandro Collin
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Monika Bambouskova
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard D Head
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark S Sands
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carlos Bernal-Mizrachi
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Medicine, VA Medical Center, St. Louis, MO, USA.
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA.
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Ulloa-Clavijo C, Martín-Vírgala J, Gómez-Alonso C, Fernández-Mariño B, Rodríguez-Carrio J, Carrillo-López N, Sobrino-Díaz L, Rodríguez C, Rodríguez-García M, Suarez A, Dusso A. Granulocitos de baja densidad: un nuevo marcador de deterioro óseo en pacientes en diálisis peritoneal. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000400003] [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: 03/29/2023] Open
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Bover J, Trinidad P, Jara A, Soler-Majoral J, Martín-Malo A, Torres A, Frazão J, Ureña P, Dusso A, Arana C, Graterol F, Romero-González G, Troya M, Samaniego D, D'Marco L, Valdivielso JM, Fernández E, Arenas MD, Torregrosa V, Navarro-González JF, Lloret MJ, Ballarín JA, Bosch RJ, Górriz JL, de Francisco A, Gutiérrez O, Ara J, Felsenfeld A, Canalejo A, Almadén Y. Silver jubilee: 25 years of the first demonstration of the direct effect of phosphate on the parathyroid cell. Nefrologia 2022; 42:645-655. [PMID: 36925324 DOI: 10.1016/j.nefroe.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 06/18/2023] Open
Abstract
Although phosphorus is an essential element for life, it is not found in nature in its native state but rather combined in the form of inorganic phosphates (PO43-), with tightly regulated plasma levels that are associated with deleterious effects and mortality when these are out of bounds. The growing interest in the accumulation of PO43- in human pathophysiology originated in its attributed role in the pathogenesis of secondary hyperparathyroidism (SHPT) in chronic kidney disease. In this article, we review the mechanisms by which this effect was justified and we commemorate the important contribution of a Spanish group led by Dr. M. Rodríguez, just 25 years ago, when they first demonstrated the direct effect of PO43- on the regulation of the synthesis and secretion of parathyroid hormone by maintaining the structural integrity of the parathyroid glands in their original experimental model. In addition to demonstrating the importance of arachidonic acid (AA) and the phospholipase A2-AA pathway as a mediator of parathyroid gland response, these findings were predecessors of the recent description of the important role of PO43- on the activity of the calcium sensor-receptor, and also fueled various lines of research on the importance of PO43- overload not only for the pathophysiology of SHPT but also in its systemic pathogenic role.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain.
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, México
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jordi Soler-Majoral
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Alejandro Martín-Malo
- Unidad de Gestión Clinica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, España. Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Spain
| | - Armando Torres
- Servicio de Nefrología, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Tenerife, Spain
| | - João Frazão
- Department of Nephrology, Centro Hospitalar Universitário São João, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | - Pablo Ureña
- AURA Nord Saint Ouen Dialysis Service. Saint Ouen, France and Service d'Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, Paris, France
| | - Adriana Dusso
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, MO, USA
| | - Carolt Arana
- Departamento de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Fredzzia Graterol
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Gregorio Romero-González
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Maribel Troya
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Diana Samaniego
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Luis D'Marco
- CEU Cardenal Herrera University, Valencia, Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, Biomedical Research Institute, IRBLLEIDA, Lleida, España. Red Nacional de Investigación en Nefrología (REDinREN, RETIC), Instituto de Salud Carlos III, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, Biomedical Research Institute, IRBLLEIDA, Lleida, España. Red Nacional de Investigación en Nefrología (REDinREN, RETIC), Instituto de Salud Carlos III, Spain; Grupo de Investigación Traslacional Vascular y Renal, Fundación Renal Jaume Arnó, Lleida, Spain
| | | | - Vicente Torregrosa
- Departamento de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de la Candelaria, Instituto Universitario de Tecnologías Biomédicas, Universidad de la Laguna, Santa Cruz de Tenerife, España. Red Nacional de Investigación en Nefrología (REDinREN, RICORS), Instituto de Salud Carlos III, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain
| | - J A Ballarín
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain
| | - Ricardo J Bosch
- Unidad de Fisiología, Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José L Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine, Universidad de Alabama en Birmingham, Birmingham USA
| | - Jordi Ara
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Arnold Felsenfeld
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Antonio Canalejo
- Departamento de Ciencias Integradas/Centro de Investigación RENSMA, Facultad de Ciencias Experimentales, Universidad de Huelva. Huelva, Spain
| | - Yolanda Almadén
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Castro-Grattoni AL, Oh J, Zhang RM, Dusso A, Riek AE, Bauerle KT, Bambouskova M, Stone P, Arbelaez AM, Bernal-Mizrachi C. Hyperglycemia-Induced Metabolic Reprogramming Mediates a Proatherogenic Phenotype in Healthy Human Monocytes. J Endocr Soc 2021. [PMCID: PMC8089500 DOI: 10.1210/jendso/bvab048.655] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Poor glycemic control is considered an important contributor to cardiovascular disease in patients with diabetes. Episodic hyperglycemia as a surrogate for glycemic variability promotes monocyte adhesion and increases the prevalence of proinflammatory monocytes within atherosclerotic plaques of patients with diabetes. We previously found that acute hyperglycemia-induced a pro-inflammatory phenotype and promoted the development of foamy monocytes by increasing total cholesterol deposition, cholesterol ester, and free cholesterol content by enhancing oxidized LDL uptake. However, the mechanism by which acute hyperglycemia induces monocyte cholesterol deposition and inflammation remains unknown. Methods: Monocytes isolated from healthy individuals (age range 20–40; n=5) were cultured in low (5mM) or high (16.7mM) glucose conditions with or without a glycolysis inhibitor (2-deoxyglucose, 2DG, 5 mM) or an endoplasmic reticulum stress inhibitor (4-phenylbutyric acid, PBA; 20mM) for 6 hrs. After treatment, cytokine release, oxidized LDL uptake, and metabolic assays using Seahorse Technology were performed. Results: Healthy human monocytes exposed under high glucose conditions showed a pro-atherosclerotic phenotype with higher levels of the pro-inflammatory cytokines, TNFα(median of differences 6.34 pg/ml, p=0.002) and IL1β(12.04 pg/ml, p=0.003), and increased oxidized LDL uptake (5062ug Dil-Ox LDL/mg, p=0.001). Furthermore, hyperglycemia resulted in higher levels of glycolysis (basal glycolysis 12.94 pmol/min, p=0.01; basal proton efflux rate 15.5 pmol/min, p=0.03) and mitochondrial respiration (percentage of respiratory capacity 16pmol/min p=0.04), suggesting a significant alteration in the metabolic programming of these monocytes. Treatment with 2-DG or PBA attenuated the pro-atherosclerotic phenotype induced by hyperglycemia, promoting a reduction of cytokine release, a reduction of oxidized LDL uptake, and near normalization of the glycolic rate and mitochondrial respiration, stabilizing cellular bioenergetics. Conclusions: Altogether, our results suggest that monocyte ER stress in response to acute hyperglycemia promotes a hypermetabolic state characterized by a proinflammatory and proatherogenic monocyte phenotype. Therefore, acute hyperglycemia is a potential mechanism promoting atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
| | - Jisu Oh
- Washington University in St Louis School Medicine, St Louis, MO, USA
| | - Rong Mei Zhang
- Washington University in St Louis School Medicine, St Louis, MO, USA
| | - Adriana Dusso
- Washington University in St Louis School Medicine, St Louis, MO, USA
| | | | - Kevin Thomas Bauerle
- Washington University in St Louis School Medicine, VA Medical Center, St Louis, MO, USA
| | | | - Pamela Stone
- Washington University in St Louis School Medicine, St Louis, MO, USA
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Bauerle KT, Oh J, Riek AE, Dusso A, Castro-Grattoni AL, Gomez RA, Sequeira-Lopez ML, Bernal-Mizrachi C. Vitamin D Deficiency Induces Macrophage Pro-Inflammatory Phenotype via ER Stress-Mediated Activation of Renin-Angiotensin System. J Endocr Soc 2021. [PMCID: PMC8090451 DOI: 10.1210/jendso/bvab048.620] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic inflammation and local activation of the renin-angiotensin-aldosterone system (RAAS) play a pivotal role in the pathogenesis and progression of diabetic complications. In patients with type 2 diabetes (T2DM), the prevalence of vitamin D deficiency is almost twice that of non-diabetics, and vitamin d deficiency nearly doubles the risk of developing hypertension and cardiovascular complications compared to diabetics with normal vitamin D levels. Interestingly, mice lacking the vitamin D receptor (VDR) in macrophages (KODMAC) develop renin-dependent hypertension, insulin resistance, and inflammation via up-regulation of macrophage ER stress. Macrophages also express all major components of the RAAS system. However, little is known about the regulation of macrophage-generated renin and its role in modulating the sequelae of VDR signaling in macrophage function and cytokine production. This study found that KODMAC macrophages and vitamin D-deficient macrophages have increased expression and secretion of renin, angiotensin II, ACE, and AT1 receptor and that adhesion, migration, and cytokine release were also increased. Inhibition of ER stress in KODMAC macrophages and vitamin D-deficient macrophages with 4-Phenylbutyric acid (PBA) reduced RAS gene expression and macrophage pro-inflammatory phenotype. Renin 1c gene deletion decreased macrophage adhesion, migration, and cytokine release compared to macrophages with disrupted VDR signaling. Notably, disruption of VDR signaling induced peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) expression in macrophages, and upregulation of renin expression in response to vitamin D deficiency was blunted in PCG1α-deficient macrophages. In conclusion, our findings delineate a mechanism by which impaired VDR signaling induces ER stress to drive PGC1α-dependent expression of renin and RAAS hyperactivation, thereby altering macrophage function and cytokine production. These data implicate RAAS as an essential mediator of VDR-mediated macrophage function and support ongoing investigations of VDR and RAAS modulation as therapeutic approaches in the management of T2DM and its complications.
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Affiliation(s)
- Kevin Thomas Bauerle
- Washington University in St Louis School of Medicine, VA Medical Center, St Louis, MO, USA
| | - Jisu Oh
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | | | - Adriana Dusso
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | | | - R Ariel Gomez
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Carlos Bernal-Mizrachi
- Washington University in St Louis School of Medicine, VA Medical Center, St Louis, MO, USA
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Carrillo-López N, Martínez-Arias L, Fernández-Villabrille S, Ruiz-Torres MP, Dusso A, Cannata-Andía JB, Naves-Díaz M, Panizo S. Role of the RANK/RANKL/OPG and Wnt/β-Catenin Systems in CKD Bone and Cardiovascular Disorders. Calcif Tissue Int 2021; 108:439-451. [PMID: 33586001 DOI: 10.1007/s00223-020-00803-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 11/16/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
In the course of chronic kidney disease (CKD), alterations in the bone-vascular axis augment the risk of bone loss, fractures, vascular and soft tissue calcification, left ventricular hypertrophy, renal and myocardial fibrosis, which markedly increase morbidity and mortality rates. A major challenge to improve skeletal and cardiovascular outcomes in CKD patients requires a better understanding of the increasing complex interactions among the main modulators of the bone-vascular axis. Serum parathyroid hormone (PTH), phosphorus (P), calcium (Ca), fibroblast growth factor 23 (FGF23), calcidiol, calcitriol and Klotho are involved in this axis interact with RANK/RANKL/OPG system and the Wnt/β-catenin pathway. The RANK/RANKL/OPG system controls bone remodeling by inducing osteoblast synthesis of RANKL and downregulating OPG production and it is also implicated in vascular calcification. The complexity of this system has recently increased due the discovery of LGR4, a novel RANKL receptor involved in bone formation, but possibly also in vascular calcification. The Wnt/β-catenin pathway plays a key role in bone formation: when this pathway is activated, bone is formed, but when it is inhibited, bone formation is stopped. In the progression of CKD, a downregulation of the Wnt/β-catenin pathway has been described which occurs mainly through the not coincident elevations of sclerostin, Dickkopf1 (Dkk1) and the secreted Frizzled Related Proteins (sFRPs). This review analyzes the interactions of PTH, P, Ca, FGF23, calcidiol, calcitriol and Klotho with the RANKL/RANKL/OPG system and the Wnt/β-catenin, pathway and their implications in bone and cardiovascular disorders in CKD.
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Affiliation(s)
- Natalia Carrillo-López
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Laura Martínez-Arias
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Sara Fernández-Villabrille
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - María Piedad Ruiz-Torres
- Department of System Biology, Universidad de Alcalá, Retic REDinREN-ISCIII, Alcalá de Henares, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain.
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Sara Panizo
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain.
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Rodríguez-Carrio J, Carrillo-López N, Ulloa C, Martín-Carro B, Rodríguez-Suárez C, Arcidiacono M, Fernández-Mariño B, Cannata-Andía J, Suárez A, Dusso A. Angiogenic T cells as predictive markers of early vascular dysfunction and atherosclerosis in chronic kidney disease. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.228] [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: 10/22/2022]
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Fernández-Martín JL, Dusso A, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, Locatelli F, Górriz JL, Rutkowski B, Bos WJ, Tielemans C, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Rodríguez-Puyol D, Carrero JJ, Zoccali C, Cannata-Andía JB. Serum phosphate optimal timing and range associated with patients survival in haemodialysis: the COSMOS study. Nephrol Dial Transplant 2020; 34:673-681. [PMID: 29741651 DOI: 10.1093/ndt/gfy093] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/24/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. METHODS The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. RESULTS There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). CONCLUSION Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.
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Affiliation(s)
- José L Fernández-Martín
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Martínez-Camblor
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.,Facultad de Ciencias de la Educación, Universidad Autónoma de Chile, Santiago, Chile
| | - Maria P Dionisi
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | | | | | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - José L Górriz
- Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain.,Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Boleslaw Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Willem-Jan Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Miha Benedik
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
| | - Diego Rodríguez-Puyol
- Department of Medicine, Universidad de Alcalá Nephrology Section and Research Unit Foundation, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain IRSIN REDinREN (Instituto de Salud Carlos III), Madrid, Spain
| | - Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Italy
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
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Hill E, Sapa H, Negrea L, Bame K, Hostetter T, Barkoukis H, Dusso A, Dobre M. Effect of Oat β-Glucan Supplementation on Chronic Kidney Disease: A Feasibility Study. J Ren Nutr 2019; 30:208-215. [PMID: 31668649 DOI: 10.1053/j.jrn.2019.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/20/2019] [Accepted: 06/29/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Dietary supplementation with grains containing high β-glucan fiber has been shown to attenuate the progression of chronic kidney disease (CKD) and vascular calcification in animal models. The aim of this study was to investigate the feasibility of consuming an oat β-glucan supplement and to assess its effects on certain uremic toxins and markers of mineral metabolism in patients with CKD. DESIGN This is a 20-week, nonrandomized, single-center, pretest-posttest study. Twenty-eight subjects with CKD stages 3-4 were enrolled. The mean age was 67.6 ± 8.9 years, and the mean estimated glomerular filtration rate was 35 ± 14 mL/min/1.73 m2. Subjects received a dietary supplement containing 3 g of oat β-glucan per day for 12 weeks. The 4-week period before the start of the intervention was used as a baseline comparison for each subject. The primary outcome was pre-post supplement changes in plasma levels of two uremic toxins: trimethylamine N-oxide (TMAO) and asymmetric dimethylarginine. Secondary outcomes were pre-post supplement changes in serum calcium, phosphorus, and Klotho levels. Repeated-measures analysis of variance was used to test the differences in outcomes over the three-month-long intervention. RESULTS Serum levels of TMAO decreased by a median of -17% (interquartile range: -46%, 7%) at the end of the intervention. A nonstatistically significant change was observed for asymmetric dimethylarginine (median -0.6% [-12%, 20%]) and serum Klotho (median -3% [-8%, 7%]). There were no changes in serum levels of calcium and phosphorus. One month after discontinuation of β-glucan therapy, TMAO levels increased by a median of 16% (-12%, 36%) but remained slightly below the pretreatment levels. Eight subjects experienced side effects and discontinued the treatment. CONCLUSION A diet supplemented with β-glucan is safe and potentially efficacious in lowering serum concentrations of TMAO in patients with CKD. Larger trials with longer follow-up times are needed to determine whether such reductions translate into clinical benefits.
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Affiliation(s)
- Eddie Hill
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Hima Sapa
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Lavinia Negrea
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kristin Bame
- Clinical Nutrition Services Department, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thomas Hostetter
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hope Barkoukis
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Mirela Dobre
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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10
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Rodríguez-Carrio J, Alperi-López M, Naves-Díaz M, Dusso A, López P, Ballina-García FJ, Cannata-Andía JB, Suárez A. Vitamin D Receptor Polymorphism and DHCR7 Contribute to the Abnormal Interplay Between Vitamin D and Lipid Profile in Rheumatoid Arthritis. Sci Rep 2019; 9:2546. [PMID: 30796319 PMCID: PMC6385268 DOI: 10.1038/s41598-019-38756-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
Emerging evidence suggests a role for 7-dehydrocholesterol reductase (DHCR7) in the crosstalk between cholesterol and vitamin D. Our aim was to evaluate the impact of vitamin D-related polymorphisms and DHCR7 levels in the association between vitamin D deficiency and altered lipid profile in rheumatoid arthritis (RA). Serum 25(OH)-vitamin D, DHCR7 levels and vitamin D-related polymorphisms (VDR-rs2228570, CYP27A1-rs933994, CYP2R1-rs10741657 and DHCR7-rs12785878) were analyzed in 211 RA patients,94 controls and in a prospective cohort of 13 RA patients undergoing TNFα-blockade. Vitamin D was decreased in RA (p < 0.001), correlated to HDL-cholesterol (r = 0.217, p < 0.001) and total-/HDL-cholesterol ratio (r = -0.227, p = 0.004). These correlations were restricted to the VDR-rs2228570 status. Vitamin D deficiency was associated with lower HDL-cholesterol (p = 0.028), higher tender (p = 0.005) and swollen (p = 0.002) joint counts, higher DAS28 (p = 0.018) and HAQ (p = 0.024) in AG/AA-patients but not in their GG-counterparts. The associations among DHCR7, vitamin D and lipid profile followed a seasonal pattern, decreased DHCR7 (p = 0.008) and vitamin D (p < 0.001) and increased total-cholesterol (p = 0.025) being found in winter/spring. Increasing vitamin D upon TNFα-blockade paralleled RA clinical improvement (r = -0.610, p = 0.027) and DHCR7 elevation (r = 0.766, p = 0.002). In conclusion, vitamin D-related polymorphisms and DHCR7 are pivotal to understand the complex, seasonal associations between vitamin D and lipid profile in RA.
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Affiliation(s)
- Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Mercedes Alperi-López
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Patricia López
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Francisco Javier Ballina-García
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Ana Suárez
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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11
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Dusso A, Colombo MI, Shanahan CM. Not all vascular smooth muscle cell exosomes calcify equally in chronic kidney disease. Kidney Int 2018; 93:298-301. [PMID: 29389393 DOI: 10.1016/j.kint.2017.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022]
Abstract
Prevention of medial calcification in patients with chronic kidney disease requires the maintenance of vascular smooth muscle cell fitness. To preserve viability under chronic kidney disease-induced stress, vascular smooth muscle cells increase exosome formation and release, but the result is aggravated pathological calcification. Now Chen et al. report that microvesicles from calcifying vascular smooth muscle cells may propagate procalcifying signals to normal vascular smooth muscle cells. To help design effective strategies to impair procalcifying cell-to-cell communication, this commentary updates the current understanding of the main regulators of microvesicle/exosome biogenesis and secretion.
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Affiliation(s)
- Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
| | - Maria Isabel Colombo
- Laboratorio de Biología Celular y Molecular, Instituto de Histología y Embriología (IHEM), Universidad Nacional de Cuyo-CONICET, Facultad de Ciencias Médicas, Mendoza, Argentina
| | - Catherine M Shanahan
- BHF Centre of Research Excellence, Cardiovascular Division, King's College London, London, UK
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12
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Panizo S, Carrillo-López N, Naves-Díaz M, Solache-Berrocal G, Martínez-Arias L, Rodrigues-Díez RR, Fernández-Vázquez A, Martínez-Salgado C, Ruiz-Ortega M, Dusso A, Cannata-Andía JB, Rodríguez I. Regulation of miR-29b and miR-30c by vitamin D receptor activators contributes to attenuate uraemia-induced cardiac fibrosis. Nephrol Dial Transplant 2018; 32:1831-1840. [PMID: 28460073 DOI: 10.1093/ndt/gfx060] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 12/05/2016] [Accepted: 03/04/2017] [Indexed: 12/20/2022] Open
Abstract
Background Uraemic cardiomyopathy, a process mainly associated with increased myocardial fibrosis, is the leading cause of death in chronic kidney disease patients and can be prevented by vitamin D receptor activators (VDRAs). Since some microRNAs (miRNAs) have emerged as regulators of the fibrotic process, we aimed to analyse the role of specific miRNAs in VDRA prevention of myocardial fibrosis as well as their potential use as biomarkers. Methods Wistar rats were nephrectomized and treated intraperitoneally with equivalent doses of two VDRAs: calcitriol and paricalcitol. Biochemical parameters, cardiac fibrosis, miRNA (miR-29b, miR-30c and miR-133b) levels in the heart and serum and expression of their target genes collagen I (COL1A1), matrix metalloproteinase 2 (MMP-2) and connective tissue growth factor (CTGF) in the heart were evaluated. Results Both VDRAs attenuated cardiac fibrosis, achieving a statistically significant difference in the paricalcitol-treated group. Increases in RNA and protein levels of COL1A1, MMP-2 and CTGF and reduced expression of miR-29b and miR-30c, known regulators of these pro-fibrotic genes, were observed in the heart of chronic renal failure (CRF) rats and were attenuated by both VDRAs. In serum, significant increases in miR-29b, miR-30c and miR-133b levels were observed in CRF rats, which were prevented by VDRA use. Moreover, vitamin D response elements were identified in the three miRNA promoters. Conclusions VDRAs, particularly paricalcitol, attenuated cardiac fibrosis acting on COL1A1, MMP-2 and CTGF expression, partly through regulation of miR-29b and miR-30c. These miRNAs and miR-133b could be useful serum biomarkers for cardiac fibrosis and also potential new therapeutic targets.
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Affiliation(s)
- Sara Panizo
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Natalia Carrillo-López
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Guillermo Solache-Berrocal
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Laura Martínez-Arias
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Raúl R Rodrigues-Díez
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Amalia Fernández-Vázquez
- Servicio de Anatomía Patológica, Centro Médico de Asturias, Oviedo, Spain.,Hospital Carmen y Severo Ochoa, Cangas del Narcea, Spain
| | - Carlos Martínez-Salgado
- Department of Physiology and Pharmacology, Renal and Cardiovascular Pathophysiology Unit, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Marta Ruiz-Ortega
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Isabel Rodríguez
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
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13
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Kreienkamp R, Croke M, Neumann MA, Bedia-Diaz G, Graziano S, Dusso A, Dorsett D, Carlberg C, Gonzalo S. Vitamin D receptor signaling improves Hutchinson-Gilford progeria syndrome cellular phenotypes. Oncotarget 2017; 7:30018-31. [PMID: 27145372 PMCID: PMC5058660 DOI: 10.18632/oncotarget.9065] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 01/26/2016] [Accepted: 04/16/2016] [Indexed: 11/25/2022] Open
Abstract
Hutchinson-Gilford Progeria Syndrome (HGPS) is a devastating incurable premature aging disease caused by accumulation of progerin, a toxic lamin A mutant protein. HGPS patient-derived cells exhibit nuclear morphological abnormalities, altered signaling pathways, genomic instability, and premature senescence. Here we uncover new molecular mechanisms contributing to cellular decline in progeria. We demonstrate that HGPS cells reduce expression of vitamin D receptor (VDR) and DNA repair factors BRCA1 and 53BP1 with progerin accumulation, and that reconstituting VDR signaling via 1α,25-dihydroxyvitamin D3 (1,25D) treatment improves HGPS phenotypes, including nuclear morphological abnormalities, DNA repair defects, and premature senescence. Importantly, we discovered that the 1,25D/VDR axis regulates LMNA gene expression, as well as expression of DNA repair factors. 1,25D dramatically reduces progerin production in HGPS cells, while stabilizing BRCA1 and 53BP1, two key factors for genome integrity. Vitamin D/VDR axis emerges as a new target for treatment of HGPS and potentially other lamin-related diseases exhibiting VDR deficiency and genomic instability. Because progerin expression increases with age, maintaining vitamin D/VDR signaling could keep the levels of progerin in check during physiological aging.
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Affiliation(s)
- Ray Kreienkamp
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Monica Croke
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Martin A Neumann
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Gonzalo Bedia-Diaz
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Simona Graziano
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Dale Dorsett
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Carsten Carlberg
- School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Susana Gonzalo
- Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University School of Medicine, St. Louis, MO, USA
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14
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Bedia Díaz G, Carrillo López N, Solache Berrocal G, Dusso A, Rodríguez I, Naves Díaz M, Cannata Andía JB, Román García P. Hipometilación del gen de la PTH por elevado fósforo de la dieta: un posible agravante epigenético de la severidad del hiperparatiroidismo secundario en la enfermedad renal crónica. Rev Osteoporos Metab Miner 2017. [DOI: 10.4321/s1889-836x2017000400003] [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: 03/29/2023] Open
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15
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Abstract
The recent identification of αKlotho protein (Klotho) in osteocytes led to the generation of an experimental mouse model with osteocyte-specific Klotho ablation. This enabled Komaba et al. to assess the contribution to bone structure and function of osteocyte Klotho per se as compared with that of the systemic fibroblast growth factor 23-Klotho axis. Surprisingly, unlike the osteopenia and low bone turnover of systemic Klotho deletion, osteocyte-specific Klotho ablation resulted in increased osteoblastic activity and bone formation rate.
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Affiliation(s)
- Rosa M A Moysés
- Medicine master's degree program, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil; Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
| | - Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
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16
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Carrillo-López N, Panizo S, Arcidiacono MV, de la Fuente S, Castro-Grattoni A, Naves M, Rodríguez I, Cannata-Andía J, Dusso A. MO053REDUCTIONS IN MICRO RNA-145 NOT ONLY AGGRAVATE HIGH-PHOSPHORUS-DRIVEN CALCIFICATION IN ADVANCED CKD STAGES BUT ALSO COMPROMISE VASCULAR HEALTH IN EARLY UREMIA. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx123] [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: 11/12/2022] Open
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17
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Dusso A, Fernández-Martín JL, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, Locatelli F, Gorriz JL, Rutkowski B, Bos WJ, Tielemans C, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Rodríguez-Puyol D, Carrero JJ, Zoccali C, Cannata-Andía JB. MP344THE INTERDIALYTIC PERIOD FOR BLOOD COLLECTION INFLUENCES SERUM PHOSPHORUS AND THE RISK OF MORTALITY IN THE COSMOS STUDY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw190.01] [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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18
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Martínez-Alonso M, Dusso A, Ariza G, Nabal M. Vitamin D deficiency and its association with fatigue and quality of life in advanced cancer patients under palliative care: A cross-sectional study. Palliat Med 2016; 30:89-96. [PMID: 26315460 DOI: 10.1177/0269216315601954] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/24/2022]
Abstract
BACKGROUND A normal vitamin D status is required for bones and muscles to maintain their function and structure, but it also contributes to the functional integrity of other multiple physiologic systems in the body. AIM To assess the relationship of Vitamin D deficiency with health-related quality-of-life issues, fatigue, and physical functioning in advanced cancer patients. DESIGN This is a cross-sectional study. PATIENTS/SETTINGS Adults under palliative care, having a locally advanced or metastatic or inoperable solid cancer. RESULTS Among 30 patients in palliative care with advanced solid cancer, 90% were vitamin D deficient. Serum Vitamin D concentration was positively correlated with patient-reported absence of fatigue (s = 0.49), and physical and functional well-being (s = 0.44 and s = 0.41, respectively, p < 0.01). Fatigue was the symptom with the highest median impact on their lives and was the only one associated with serum vitamin D (p = 0.031), with lower fatigue in patients with vitamin D concentrations in the third tertile. There was no evidence of a direct association between health-related quality of life and vitamin D status. CONCLUSION The 90% frequency of advanced cancer patients with vitamin D deficiency, together with the positive correlation of vitamin D status with the absence of fatigue and improved physical and functional well-being, points to vitamin D supplementation as a potential therapy to enhance the patient's quality of life.
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Affiliation(s)
| | - Adriana Dusso
- Division of Experimental Nephrology, IRBLLEIDA, Lleida, Spain Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gemma Ariza
- Rehabilitation Unit, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Maria Nabal
- Palliative Care Supportive Team, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
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Fusaro M, Dalle Carbonare L, Dusso A, Arcidiacono MV, Valenti MT, Aghi A, Pasho S, Gallieni M. Differential Effects of Dabigatran and Warfarin on Bone Volume and Structure in Rats with Normal Renal Function. PLoS One 2015; 10:e0133847. [PMID: 26241483 PMCID: PMC4524674 DOI: 10.1371/journal.pone.0133847] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/03/2015] [Indexed: 01/03/2023] Open
Abstract
Background Warfarin, a widely used anticoagulant, is a vitamin K antagonist impairing the activity of vitamin K-dependent Bone Gla Protein (BGP or Osteocalcin) and Matrix Gla Protein (MGP). Because dabigatran, a new anticoagulant, has no effect on vitamin K metabolism, the aim of this study was to compare the impact of warfarin and dabigatran administration on bone structure and vascular calcification. Methods Rats with normal renal function received for 6 weeks warfarin, dabigatran or placebo. Bone was evaluated immuno-histochemically and hystomorphometrically after double labelling with declomycin and calcein. Aorta and iliac arteries were examined histologically. Results Histomorphometric analysis of femur and vertebrae showed significantly decreased bone volume and increased trabecular separation in rats treated with warfarin. Vertebra analysis showed that the trabecular number was higher in dabigatran treated rats. Osteoblast activity and resorption parameters were similar among groups, except for maximum erosion depth, which was higher in warfarin treated rats, suggesting a higher osteoclastic activity. Therefore, warfarin treatment was also associated with higher bone formation rate/bone surface and activation frequency. Warfarin treatment may cause an increased bone turnover characterized by increased remodelling cycles, with stronger osteoclast activity compared to the other groups. There were no differences among experimental groups in calcium deposition either in aortic or iliac arteries. Conclusions These findings suggest for the first time that dabigatran has a better bone safety profile than warfarin, as warfarin treatment affects bone by reducing trabecular size and structure, increasing turnover and reducing mineralization. These differences could potentially result in a lower incidence of fractures in dabigatran treated patients.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR)–Neuroscience Institute, Padova, Italy
- * E-mail:
| | - Luca Dalle Carbonare
- Department of Medicine, Section of Internal Medicine D, University of Verona, Verona, Italy
| | - Adriana Dusso
- Division of Experimental Nephrology, IRB Lleida (Lleida Institute for Biomedical Research), Lleida, Spain
| | - Maria Vittoria Arcidiacono
- Division of Experimental Nephrology, IRB Lleida (Lleida Institute for Biomedical Research), Lleida, Spain
| | - Maria Teresa Valenti
- Department of Medicine, Section of Internal Medicine D, University of Verona, Verona, Italy
| | - Andrea Aghi
- Nephrology Unit, University of Padua, Padua, Italy
| | - Sabina Pasho
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo and Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo and Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy
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Slatopolsky E, Lopez-Hilker S, Dusso A, Morrissey JJ, Martin KJ. Parathyroid hormone secretion: perturbations in chronic renal failure. Contrib Nephrol 2015; 64:16-24. [PMID: 3053034 DOI: 10.1159/000415723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- E Slatopolsky
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
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Slatopolsky E, Lopez-Hilker S, Dusso A, Brown A, Delmez J, Martin K. Renal osteodystrophy: past and future. Contrib Nephrol 2015; 78:38-45; discussion 45-6. [PMID: 2225842 DOI: 10.1159/000418268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- E Slatopolsky
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
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Martinez-Alonso M, Dusso A, Ariza G, Nabal M. The effect on quality of life of vitamin D administration for advanced cancer treatment (VIDAFACT study): protocol of a randomised controlled trial. BMJ Open 2014; 4:e006128. [PMID: 25552610 PMCID: PMC4281528 DOI: 10.1136/bmjopen-2014-006128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Vitamin D is related to resistance to chronic diseases, physiological parameters and functional measures. All of these relationships underscore the potential benefits of cholecalciferol or D3 (nutritional vitamin D) in cancer. This is the first study designed to obtain conclusive evidence on the effect of cholecalciferol in advanced patients with cancer. The main goal is to assess its effects on the patient's perceived quality of life. Cholecalciferol's impact on fatigue and physical performance, as well as its cost utility, will also be assessed. METHODS AND ANALYSIS A randomised triple-blind phase II/III placebo-controlled multicentre trial has been designed. Patients satisfying the inclusion and exclusion criteria will be randomly assigned to receive cholecalciferol or placebo. Eligible patients will be adults with a locally advanced or metastatic or inoperable solid cancer in palliative care, who have given signed informed consent and have matched inclusion and exclusion criteria. The randomisation will be based on a computer-generated procedure and centralised by the pharmacy service of the coordinating centre. The assigned treatment will be administered by the hospital's pharmacy to conceal group allocation for patients and healthcare providers. Cholecalciferol (4000 IU/day) or placebo, starting at day 15 and continuing up to day 42, will be added to palliative care treatment. Outpatient visits will be scheduled every 14 days. ETHICS AND DISSEMINATION Ethical approval was received from the Medical Ethical Commitee of the HUAV (CEIC-1169). Participants and their families will receive the research findings which will also be disseminated on local and national media, presented at national and international meetings of the specialty, and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER EudraCT: 2013-003478-29.
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Affiliation(s)
- Montserrat Martinez-Alonso
- Ciències Mèdiques Bàsiques, Universitat de Lleida, Lleida, Spain
- Biostatistics and Methodological Support, IRBLLEIDA, Lleida, Spain
| | | | - Gemma Ariza
- Rehabilitation Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Maria Nabal
- Palliative Care Supportive Team, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Arcidiacono MV, Yang J, Fernandez E, Dusso A. Parathyroid-specific epidermal growth factor-receptor inactivation prevents uremia-induced parathyroid hyperplasia in mice. Nephrol Dial Transplant 2014; 30:434-40. [PMID: 25324357 DOI: 10.1093/ndt/gfu318] [Citation(s) in RCA: 18] [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] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In chronic kidney disease (CKD), parathyroid hyperplasia contributes to high serum parathyroid hormone (PTH) and also to an impaired suppression of secondary hyperparathyroidism by calcium, vitamin D and fibroblast growth factor 23 (FGF23). In rats, systemic inhibition of epidermal growth factor receptor (EGFR) activation markedly attenuated uremia-induced parathyroid hyperplasia and vitamin D receptor (VDR) loss, hence restoring the response to vitamin D. Therefore, we propose that parathyroid-specific EGFR inactivation should prevent CKD-induced parathyroid hyperplasia. METHODS A dominant-negative human EGFR mutant, which forms non-functional heterodimers with full-length endogenous EGFR, was successfully targeted to the parathyroid glands (PTGs) of FVB/N mice, using the 5' regulatory sequence of the PTH promoter. The parathyroid phenotype and serum chemistries of wild-type (WT) and transgenic mice were examined after 14 weeks of either sham operation or 75% renal mass reduction (NX). RESULTS Both genotypes had similar morphology and body weight, and NX-induction enhanced similarly serum blood urea nitrogen compared with sham-operated controls. However, despite similar serum calcium, phosphate and FGF23 levels in NX mice of both genotypes, parathyroid EGFR inactivation sufficed to completely prevent the marked increases in PTG enlargement, serum PTH and in parathyroid levels of transforming growth factor-α, a powerful EGFR-activator, and the VDR reductions observed in WT mice. CONCLUSION In CKD, parathyroid EGFR activation is essential for parathyroid hyperplasia and VDR loss, rendering this transgenic mouse a unique tool to scrutinize the pathogenesis of parathyroid and multiple organ dysfunction of CKD progression unrelated to parathyroid hyperplasia.
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Affiliation(s)
- Maria Vittoria Arcidiacono
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA Division of Experimental Nephrology, IRB Lleida, Lleida, Spain Renal Division, Hospital Universitari Arnau de Vilanova, Universidad de Lleida, Lleida, Spain
| | - Jing Yang
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Elvira Fernandez
- Division of Experimental Nephrology, IRB Lleida, Lleida, Spain Renal Division, Hospital Universitari Arnau de Vilanova, Universidad de Lleida, Lleida, Spain
| | - Adriana Dusso
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA Division of Experimental Nephrology, IRB Lleida, Lleida, Spain Renal Division, Hospital Universitari Arnau de Vilanova, Universidad de Lleida, Lleida, Spain
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Arcidiacono MV, Yang J, Fernandez E, Dusso A. The induction of C/EBPβ contributes to vitamin D inhibition of ADAM17 expression and parathyroid hyperplasia in kidney disease. Nephrol Dial Transplant 2014; 30:423-33. [PMID: 25294851 DOI: 10.1093/ndt/gfu311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In secondary hyperparathyroidism (SHPT), enhanced parathyroid levels of transforming growth factor-α (TGFα) increase EGF receptor (EGFR) activation causing parathyroid hyperplasia, high parathyroid hormone (PTH) and also reductions in vitamin D receptor (VDR) that limit vitamin D suppression of SHPT. Since anti-EGFR therapy is not an option in human SHPT, we evaluated ADAM17 as a therapeutic target to suppress parathyroid hyperplasia because ADAM17 is required to release mature TGFα, the most potent EGFR-activating ligand. METHODS Computer analysis of the ADAM17 promoter identified TGFα and C/EBPβ as potential regulators of the ADAM17 gene. Their regulation of ADAM17 expression, TGFα/EGFR-driven growth and parathyroid gland (PTG) enlargement were assessed in promoter-reporter assays in A431 cells and corroborated in rat and human SHPT, using erlotinib as anti-EGFR therapy to suppress TGFα signals, active vitamin D to induce C/EBPβ or the combination. RESULTS While TGFα induced ADAM17-promoter activity by 2.2-fold exacerbating TGFα/EGFR-driven growth, ectopic C/EBPβ expression completely prevented this vicious synergy. Accordingly, in advanced human SHPT, parathyroid ADAM17 levels correlated directly with TGFα and inversely with C/EBPβ. Furthermore, combined erlotinib + calcitriol treatment suppressed TGFα/EGFR-cell growth and PTG enlargement more potently than erlotinib in part through calcitriol induction of C/EBPβ to inhibit ADAM17-promoter activity, mRNA and protein. Importantly, in rat SHPT, the correction of vitamin D deficiency effectively reversed the resistance to paricalcitol induction of C/EBPβ to suppress ADAM17 expression and PTG enlargement, reducing PTH by 50%. CONCLUSION In SHPT, correction of vitamin D and calcitriol deficiency induces parathyroid C/EBPβ to efficaciously attenuate the severe ADAM17/TGFα synergy, which drives PTG enlargement and high PTH.
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Affiliation(s)
- Maria Vittoria Arcidiacono
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA Division of Experimental Nephrology, IRB Lleida, Lleida, Spain
| | - Jing Yang
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Elvira Fernandez
- Division of Experimental Nephrology, IRB Lleida, Lleida, Spain Renal Division, Hospital Universitari Arnau de Vilanova, Universidad de Lleida, Lleida, Spain
| | - Adriana Dusso
- Renal Division, Washington University School of Medicine, St. Louis, MO, USA Division of Experimental Nephrology, IRB Lleida, Lleida, Spain
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El-Shahawy MA, Rasmussen HS, Lavin PT, Yang A, Packham DK, Singh B, Rasmussen HS, Lavin PT, Yang A, Roger SD, Fusaro M, Dalle Carbonare L, Dusso A, Arcidiacono MV, Pasho S, Gallieni M, Ormanji MS, Korkes F, Meca R, Baia LC, Ferraz RR, Heilberg IP, Roger SD, Rasmussen HS, Lavin PT, Yang A, El-Shahawy MA, Nistor I, Bararu I, Apavaloaie MC, Voroneanu L, Donciu MD, Nagler EV, Covic A, Gil HW, Park SH, Hong SY, Ponte B, Alwan H, Pruijm M, Ackermann D, Guessous I, Ehret G, Paccaud F, Mohaupt M, Pechere-Bertschi A, Burnier M, Martin PY, Bochud M, Filiopoulos V, Biblaki D, Manolios N, Karatzas I, Arvanitis D, Vlassopoulos D, Altuntas A, Kidir V, Inal S, Diker S, Cil N, Orhan H, Sezer MT, Verdelho M, Rodrigues N, Ribeiro F, Roger SD, Rasmussen HS, Lavin PT, Yang A, Qunibi WY, Azar H, Ossman R, Flamant M, Chelala D, Ria P, Fabris A, Branco C, Gambaro G, Lupo A, Hao J, Qiu L, Li Y, Li R, Li X, Chen L, Verdesca S, Cucchiari D, Podesta M, Badalamenti S, Veldhuijzen NMH, Gerritsen KGF, Boer WH, Abrahams AC, Packham DK, Rasmussen HS, Lavin PT, Yang A, Qunibi WY, Mangione F, Albrizio P, Sepe V, Esposito P, Manini A, Muciaccia S, Dal Canton A. ACID BASE, ION DISORDERS, LITHISASIS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Valcheva P, Cardus A, Panizo S, Parisi E, Bozic M, Lopez Novoa JM, Dusso A, Fernández E, Valdivielso JM. Lack of vitamin D receptor causes stress-induced premature senescence in vascular smooth muscle cells through enhanced local angiotensin-II signals. Atherosclerosis 2014; 235:247-55. [PMID: 24880896 DOI: 10.1016/j.atherosclerosis.2014.05.911] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 02/17/2014] [Revised: 04/09/2014] [Accepted: 05/01/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The inhibition of the renal renin-angiotensin system by the active form of vitamin D contributes to the cardiovascular health benefits of a normal vitamin D status. Local production of angiotensin-II in the vascular wall is a potent mediator of oxidative stress, prompting premature senescence. Herein, our objective was to examine the impact of defective vitamin D signalling on local angiotensin-II levels and arterial health. METHODS Primary cultures of aortic vascular smooth muscle cells (VSMC) from wild-type and vitamin D receptor-knockout (VDRKO) mice were used for the assessment of cell growth, angiotensin-II and superoxide anion production and expression levels of cathepsin D, angiotensin-II type 1 receptor and p57(Kip2). The in vitro findings were confirmed histologically in aortas from wild-type and VDRKO mice. RESULTS VSMC from VDRKO mice produced more angiotensin-II in culture, and elicited higher levels of cathepsin D, an enzyme with renin-like activity, and angiotensin-II type 1 receptor, than wild-type mice. Accordingly, VDRKO VSMC showed higher intracellular superoxide anion production, which could be suppressed by cathepsin D, angiotensin-II type 1 receptor or NADPH oxidase antagonists. VDRKO cells presented higher levels of p57(Kip2), impaired proliferation and premature senescence, all of them blunted upon inhibition of angiotensin-II signalling. In vivo studies confirmed higher levels of cathepsin D, angiotensin-II type 1 receptor and p57(Kip2) in aortas from VDRKO mice. CONCLUSION The beneficial effects of active vitamin D in vascular health could be a result of the attenuation of local production of angiotensin-II and downstream free radicals, thus preventing the premature senescence of VSMC.
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Affiliation(s)
- Petya Valcheva
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Anna Cardus
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Sara Panizo
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Eva Parisi
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Milica Bozic
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Jose M Lopez Novoa
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
| | - Adriana Dusso
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Elvira Fernández
- Nephrology Service and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jose M Valdivielso
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain.
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Dusso A. Update on the Biologic Role of the Vitamin D Endocrine System. Curr Vasc Pharmacol 2014; 12:272-7. [DOI: 10.2174/15701611113119990026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/03/2013] [Accepted: 03/10/2013] [Indexed: 11/22/2022]
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Vijayan A, Li T, Dusso A, Jain S, Coyne DW. Relationship of 1,25 dihydroxy Vitamin D Levels to Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury. ACTA ACUST UNITED AC 2014; 5. [PMID: 26295008 DOI: 10.4172/2161-0959.1000190] [Citation(s) in RCA: 6] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Calcitriol [1,25(OH)2D] plays a central role in endocrine regulation of bone and mineral metabolism. Low 1,25(OH)2D levels in chronic kidney disease (CKD) are associated with increased cardiovascular morbidity and mortality. However, the role of 1,25(OH)2D in acute kidney injury (AKI) is unclear, with very limited data. This pilot study examined the relationship between 1,25(OH)2D levels in critically ill patients with AKI and clinical outcomes. METHODS Plasma 1,25(OH)2D, intact parathyroid hormone (iPTH), 25-OH Vitamin D (VitD), calcium and phosphorus were measured in 34 patients with AKI without pre-existing chronic kidney disease and 12 healthy controls. RESULTS The mean 1,25(OH)2D levels were significantly lower in patients with AKI compared to controls, (42±5.6 pg/mL vs. 76.1±5.3 pg/mL, P <0.0001). The mortality in patients with AKI was 30%. 1,25(OH)2D levels were higher in non-survivors than survivors (62±41.4 pg/mL vs. 33.7±24.2 pg/mL respectively, P = 0.046) and serum phosphorus was also higher in non-survivors (6.2±2.1 mg/dL vs. 4.6±1.6 mg/dL, P = 0.019). However, on multivariate regression analysis, accounting for age and APACHE II score, higher levels of 1,25(OH)2D was not associated with mortality in critically ill patients with AKI. CONCLUSION Mineral metabolism is dysregulated within days of acute renal injury in critically ill patients. On univariate analysis, high levels of calcitriol were associated with adverse clinical outcome in AKI. This association was not apparent after adjusting for age and APACHE II. Large controlled studies are needed to confirm these results, and determine if higher 1,25(OH)2D mediates worse outcomes in AKI.
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Affiliation(s)
- Anitha Vijayan
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Tingting Li
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Adriana Dusso
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Sanjay Jain
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Daniel W Coyne
- Renal Division, Washington University in St. Louis, St. Louis, MO
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Craver L, Dusso A, Martinez-Alonso M, Sarro F, Valdivielso JM, Fernández E. A low fractional excretion of Phosphate/Fgf23 ratio is associated with severe abdominal Aortic calcification in stage 3 and 4 kidney disease patients. BMC Nephrol 2013; 14:221. [PMID: 24119158 PMCID: PMC3852798 DOI: 10.1186/1471-2369-14-221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/09/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular calcification (VC) contributes to high mortality rates in chronic kidney disease (CKD). High serum phosphate and FGF23 levels and impaired phosphaturic response to FGF23 may affect VC. Therefore, their relative contribution to abdominal aortic calcification (AAC) was examined in patients CKD stages 3-4. METHODS Potential risk factors for AAC, measured by the Kauppila Index (KI), were studied in 178 patients. RESULTS In multivariate linear analysis, AAC associated positively with age, male gender, CKD-stage, presence of carotid plaques (CP) and also with FGF23, but negatively with fractional excretion of phosphate (FEP). Intriguingly, FEP increased with similar slopes with elevations in PTH, with reductions in GFR, and also with elevations in FGF23 but the latter only in patients with none (KI = 0) or mild (KI = 1-5) AAC. Lack of a FEP-FGF23 correlation in patients with severe AAC (KI > 5) suggested a role for an impaired phosphaturic response to FGF23 but not to PTH in AAC. Logistic and zero-inflated analysis confirmed the independent association of age, CKD stage, male gender and CP with AAC, and also identified a threshold FEP/FGF23 ratio of 1/3.9, below which the chances for a patient of presenting severe AAC increased by 3-fold. Accordingly, KI remained unchanged as FEP/FGF23 ratios decreased from 1/1 to 1/3.9 but markedly increased in parallel with further reductions in FEP/FGF23 < 1/3.9. CONCLUSIONS In CKD 3-4, an impaired phosphaturic response to FGF23 with FEP/FGF23 < 1/3.9 associates with severe AAC independently of age, gender or CP.
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Affiliation(s)
- Lourdes Craver
- Nephrology Service and Unit for the Detection and Treatment of Atherothrombotic diseases (UDETMA), Hospital Universitari Arnau de Vilanova, Av Rovira Roure, 25198 Lleida, Spain.
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Kanlaya R, Sintiprungrat K, Thongboonkerd V, Torremade N, Bindels R, Hoenderop J, Fernandez E, Dusso A, Valdivielso JM, Krueger T, Boor P, Schafer C, Westenfeld R, Brandenburg V, Schlieper G, Jahnen-Dechent W, Ketteler M, Jee W, Li X, Richards B, Floege J, Goncalves JG, Canale D, de Braganca AC, Shimizu MHM, Moyses RMA, Andrade L, Seguro AC, Volpini RA, Romoli S, Migliorini A, Anders HJ, Eskova O, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Simic I, Tabatabaeifar M, Wlodkowski T, Denc H, Mollet G, Antignac C, Schaefer F, Ekaterina IA, Giardino L, Rastaldi MP, Van den Heuvel L, Levtchenko E, Okina C, Okamoto T, Kamata M, Murano J, Kobayashi K, Takeuchi K, Kamata F, Sakai T, Naito S, Aoyama T, Sano T, Takeuchi Y, Kamata K, Thomasova D, Bruns HA, Liapis H, Anders HJ, Iwashita T, Hasegawa H, Takayanagi K, Shimizu T, Asakura J, Okazaki S, Kogure Y, Hatano M, Hara H, Inamura M, Iwanaga M, Mitani T, Mitarai T, Savin VJ, Sharma M, Wei C, Reiser J, McCarthy ET, Sharma R, Gauchat JF, Eneman B, Freson K, Van den Heuvel L, Van Geet C, Levtchenko E, Choi DE, Jeong JY, Chang YK, Na KR, Lee KW, Shin YT, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Lee KW, Jeong JY, Choi DE, Chang YK, Kim SS, Na KR, Shin YT, Suzuki T, Iyoda M, Matsumoto K, Shindo-Hirai Y, Kuno Y, Wada Y, Yamamoto Y, Shibata T, Akizawa T, Munoz-Felix JM, Lopez-Novoa JM, Martinez-Salgado C, Ehling J, Babickova J, Gremse F, Kiessling F, Floege J, Lammers T, Boor P, Lech M, Gunthner R, Lorenz G, Ryu M, Grobmayr R, Susanti H, Kobayashi KS, Flavell RA, Anders HJ, Rayego-Mateos S, Morgado J, Sanz AB, Eguchi S, Pato J, Keri G, Egido J, Ortiz A, Ruiz-Ortega M, Leduc M, Geerts L, Grouix B, Sarra-Bournet F, Felton A, Gervais L, Abbott S, Duceppe JS, Zacharie B, Penney C, Laurin P, Gagnon L, Detsika MG, Duann P, Lianos EA, Leong KI, Chiang CK, Yang CC, Wu CT, Chen LP, Hung KY, Liu SH, Carvalho FF, Teixeira VP, Almeida WS, Schor N, Small DM, Bennett NC, Coombes J, Johnson DW, Gobe GC, Montero N, Prada A, Riera M, Orfila M, Pascual J, Rodriguez E, Barrios C, Kokeny G, Fazekas K, Rosivall L, Mozes MM, Munoz-Felix JM, Lopez-Novoa JM, Martinez-Salgado C, Hornigold N, Hughes J, Mooney A, Benardeau A, Riboulet W, Vandjour A, Jacobsen B, Apfel C, Conde-Knape K, Grouix B, Felton A, Sarra-Bournet F, Leduc M, Geerts L, Gervais L, Abbott S, Bienvenu JF, Duceppe JS, Zacharie B, Penney C, Laurin P, Gagnon L, Tanaka T, Yamaguchi J, Nangaku M, Niwa T, Bolati D, Shimizu H, Yisireyili M, Nishijima F, Brocca A, Virzi G, de Cal M, Ronco C, Priante G, Musacchio E, Valvason C, Sartori L, Piccoli A, Baggio B, Boor P, Perkuhn M, Weibrecht M, Zok S, Martin IV, Schoth F, Ostendorf T, Kuhl C, Floege J, Karabaeva A, Essaian A, Beresneva O, Parastaeva M, Kayukov I, Smirnov A, Audzeyenka I, Kasztan M, Piwkowska A, Rogacka D, Angielski S, Jankowski M, Bockmeyer CL, Kokowicz K, Agustian PA, Zell S, Wittig J, Becker JU, Nishizono R, Venkatareddy MP, Chowdhury MA, Wang SQ, Fukuda A, Wickman LT, Yang Y, Wiggins RC, Fazio MR, Donato V, Lucisano S, Cernaro V, Lupica R, Trimboli D, Montalto G, Aloisi C, Mazzeo AT, Buemi M, Gawrys O, Olszynski KH, Kuczeriszka M, Gawarecka K, Swiezewska E, Chmielewski M, Masnyk M, Rafalowska J, Kompanowska-Jezierska E, Lee WC, Chau YY, Lee LC, Chiu CH, Lee CT, Chen JB, Kim WK, Shin SJ. Experimental models of CKD. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft114] [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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Grotsky DA, Gonzalez-Suarez I, Novell A, Neumann MA, Yaddanapudi SC, Croke M, Martinez-Alonso M, Redwood AB, Ortega-Martinez S, Feng Z, Lerma E, Ramon y Cajal T, Zhang J, Matias-Guiu X, Dusso A, Gonzalo S. BRCA1 loss activates cathepsin L-mediated degradation of 53BP1 in breast cancer cells. ACTA ACUST UNITED AC 2013; 200:187-202. [PMID: 23337117 PMCID: PMC3549967 DOI: 10.1083/jcb.201204053] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cathepsin L degrades 53BP1 to overcome genomic instability and growth arrest in BRCA1-deficient and triple-negative breast cancers. Loss of 53BP1 rescues BRCA1 deficiency and is associated with BRCA1-deficient and triple-negative breast cancers (TNBC) and with resistance to genotoxic drugs. The mechanisms responsible for decreased 53BP1 transcript and protein levels in tumors remain unknown. Here, we demonstrate that BRCA1 loss activates cathepsin L (CTSL)–mediated degradation of 53BP1. Activation of this pathway rescued homologous recombination repair and allowed BRCA1-deficient cells to bypass growth arrest. Importantly, depletion or inhibition of CTSL with vitamin D or specific inhibitors stabilized 53BP1 and increased genomic instability in response to radiation and poly(adenosine diphosphate–ribose) polymerase inhibitors, compromising proliferation. Analysis of human breast tumors identified nuclear CTSL as a positive biomarker for TNBC, which correlated inversely with 53BP1. Importantly, nuclear levels of CTSL, vitamin D receptor, and 53BP1 emerged as a novel triple biomarker signature for stratification of patients with BRCA1-mutated tumors and TNBC, with potential predictive value for drug response. We identify here a novel pathway with prospective relevance for diagnosis and customization of breast cancer therapy.
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Affiliation(s)
- David A Grotsky
- Department of Biochemistry and Molecular Biology, St. Louis University School of Medicine, St. Louis, MO 63104, USA
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Rogers SA, Droege D, Dusso A, Hammerman MR. Incubation of metanephroi with vitamin d(3) increases numbers of glomeruli. Organogenesis 2012; 1:52-4. [PMID: 19521561 DOI: 10.4161/org.1.2.1292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 08/20/2004] [Accepted: 10/11/2004] [Indexed: 11/19/2022] Open
Abstract
To characterize actions of vitamin D3 on metanephroi transplanted from rat embryos to adult recipients, we incubated metanephroi with or without 0.01, 0.1 or 1 ug/ml vitamin D3, 25-hydroxyvitamin D(3) [25(OH)D(3)] or 1, 25-hydroxyvitamin D(3) [1,25(OH)2D(3)] prior to implantation. The number of glomeruli in developed metanephroi three weeks post-transplantation that had been incubated with 1.0 ug/ml vitamin D(3) was increased relative to the number in metanephroi that were not incubated with vitamin D(3) (control), an effect that was not recapitulated by administration of vitamin D(3) directly to hosts at the time of transplantation. Incubation of metanephroi with 1.0 ug/ml vitamin D(3) also enhanced inulin clearances of metanephroi measured at 12 weeks post-transplantation. The hydroxylated derivative of vitamin D(3), 25(OH)D(3), increased glomerulus number when applied at 0.01 ug/ml but not at higher concentrations, while the twice-hydroxylated derivative 1,25(OH)(2)D(3), failed to increase glomerulus number at any concentration tested. We conclude that incubation with vitamin D(3) prior to implantation enhances inulin clearance possibly by increasing the number of glomeruli that develop post-transplantation.Our findings suggest the vitamin D(3) effect is mediated locally.
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Affiliation(s)
- Sharon A Rogers
- Renal Division; Department of Medicine; Washington University School of Medicine; St. Louis, Missouri USA
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Agnes H, Kalman P, Jozsef A, Henrik B, Mucsi I, Kamata K, Sano T, Naito S, Okamoto T, Okina C, Kamata M, Murano J, Kobayashi K, Uchida M, Aoyama T, Takeuchi Y, Nagaba Y, Sakamoto H, Torino C, Torino C, Panuccio V, Clementi A, Garozzo M, Bonanno G, Boito R, Natale G, Cicchetti T, Chippari A, Logozzo D, Alati G, Cassani S, Sellaro A, D'arrigo G, Tripepi G, Roberta A, Postorino M, Mallamaci F, Zoccali C, Buonanno E, Brancaccio S, Fimiani V, Napolitano P, Spadola R, Morrone L, DI Iorio B, Russo D, Betriu A, Martinez-Alonso M, Vidal T, Valdivielso J, Fernandez E, Bernadette F, Jean-Baptiste B, Frimat L, Madala ND, Thusi GP, Sibisi N, Mazibuko BG, Assounga AGH, Tsai NC, Wang HH, Chen YC, Hung CC, Hwang SJ, Chen HC, Branco P, Adragao T, Birne R, Martins AR, Vizinho R, Gaspar A, Grilo MJ, Barata JD, Bonhorst D, Adragao P, Kim JS, Yang JW, Kim MK, Choi SO, Han BG, Nathalie N, Sunny E, Glorieux G, Daniela B, Fellype B, Sophie L, Horst D L, Ziad M, Raymond V, Yanai M, Okada K, Takeuchi K, Nitta K, Takahashi S, Morena M, Jaussent I, Halkovich A, Dupuy AM, Bargnoux AS, Chenine L, Leray-Moragues H, Klouche K, Vernhet H, Canaud B, Cristol JP, Shutov A, Serov V, Kuznetsova J, Menzorov M, Serova D, Petrescu L, Zugravu A, Capusa C, Stancu S, Cinca S, Anghel C, Timofte D, Medrihan L, Ionescu D, Mircescu G, Hsu TW, Kuo KL, Hung SC, Tarng DC, Lee S, Kim I, Lee D, Rhee H, Song S, Seong E, Kwak I, Holzmann M, Gardell C, Jeppsson A, Sartipy U, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Sonmez A, Unal HU, Gok M, Gaipov A, Kayrak M, Eyileten T, Turk S, Vural A, DI Lullo L, Floccari F, Rivera R, Granata A, D'amelio A, Logias F, Otranto G, Malaguti M, Santoboni A, Fiorini F, Connor T, Oygar D, Nitsch D, Gale D, Steenkamp R, Neild GH, Maxwell P, Louise Hogsbro I, Redal-Baigorri B, Sautenet B, Halimi JM, Caille A, Goupille P, Giraudeau B, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Unal HU, Gok M, Oguz Y, Gaipov A, Yenicesu M, Cetinkaya H, Eyileten T, Turk S, Vural A, Chen YC, Wang HH, Tsai NC, Hung CC, Hwang SJ, Chen HC, Ishimoto Y, Ohki T, Sugahara M, Kanemitsu T, Kobayashi M, Uchida L, Kotera N, Tanaka S, Sugimoto T, Mise N, Miyazaki N, Matsumoto J, Murata I, Yoshida G, Morishita K, Ushikoshi H, Nishigaki K, Ogura S, Minatoguchi S, Harvey R, Harvey R, Ala A, Banerjee D, Farmer C, Irving J, Hobbs H, Wheeler T, Klebe B, Stevens P, Selim G, Selim G, Stojceva-Taneva O, Tozija L, Stojcev N, Gelev S, Dzekova-Vidimliski P, Pavleska S, Sikole A, Qureshi AR, Evans M, Stendahl M, Prutz KG, Elinder CG, Tamagaki K, Kado H, Nakata M, Kitani T, Ota N, Ishida R, Matsuoka E, Shiotsu Y, Ishida M, Mori Y, Christelle M, Rognant N, Evelyne D, Sophie F, Laurent J, Maurice L, Silverwood R, Pierce M, Kuh D, Savage C, Ferro C, Nitsch D, Moniek DG, De Goeij M, Nynke H, Gurbey O, Joris R, Friedo D, Clayton P, Grace B, Cass A, Mcdonald S, Lorenzo V, Martin Conde M, Betriu A, Dusso A, Valdivielso JM, Fernandez E, Roggeri DP, Cannella G, Cozzolino M, Mazzaferro S, Messa P, Brancaccio D, De Souza Faria R, Fernandes N, Lovisi J, Moura Marta M, Reboredo M, Do Vale Pinheiro B, Bastos M, Hundt F, Hundt F, Pabst S, Hammerstingl C, Gerhardt T, Skowasch D, Woitas R, Lopes AA, Silva LF, Matos CM, Martins MS, Silva FA, Lopes GB, Pizzarelli F, Dattolo P, Tripepi G, Michelassi S, Rossi C, Bandinelli S, Mieth M, Mass R, Ferrucci L, Zoccali C, Parisi S, Arduino S, Attini R, Fassio F, Biolcati M, Pagano A, Bossotti C, Ferraresi M, Gaglioti P, Todros T, Piccoli GB, Salgado TM, Arguello B, Benrimoj SI, Fernandez-Llimos F, Bailey P, Tomson C, Ben-Shlomo Y, Santoro A, Rucci P, Mandreoli M, Caruso F, Corradini M, Flachi M, Gibertoni D, Rigotti A, Russo G, Fantini M, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Janusz O, Mikolaj M, Jacek M, Boleslaw R, Prakash S, Coffin R, Schold J, Einstadter D, Stark S, Rodgers D, Howard M, Sehgal A, Stevens P, Irving J, Wheeler T, Klebe B, Farmer C, Palmer S, Tong A, Manns B, Craig J, Ruospo M, Gargano L, Strippoli G, Ruospo M, Palmer S, Vecchio M, Gargano L, Petruzzi M, De Benedictis M, Pellegrini F, Strippoli G, Ohno Y, Ishimura E, Naganuma T, Kondo K, Fukushima W, Mui K, Inaba M, Hirota Y, Sun X, Sun X, Jiang S, Gu H, Chen Y, XI C, Qiao X, Chen X, Daher E, Junior GS, Jacinto CN, Pimentel RS, Aguiar GBR, Lima CB, Borges RC, Mota LPC, Melo JVL, Melo SA, Canamary VT, Alves M, Araujo SMHA, Chen YC, Hung CC, Huang YK, Tsai NC, Wang HH, Hung CC, Hwang SJ, Chen HC, Rogacev K, Cremers B, Zawada A, Seiler S, Binder N, Ege P, Grosse-Dunker G, Heisel I, Hornof F, Jeken J, Rebling N, Ulrich C, Scheller B, Bohm M, Fliser D, Heine GH, Robinson B, Wang M, Bieber B, Fluck R, Kerr PG, Wikstrom B, Krishnan M, Nissenson A, Pisoni RL, Mykleset S, Osthus TB, Waldum B, Os I, Buttigieg J, Buttigieg J, Cassar A, Farrugia Agius J, Redal-Baigorri B, Hara M, Ando M, Tsuchiya K, Nitta K, Yamato M, Yasuda K, Sasaki K. Clinical Nephrology - Epidemiology II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs236] [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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Abstract
In chronic kidney disease (CKD), abnormalities in vitamin D metabolism contribute to the development of mineral and skeletal disorders, elevations in parathyroid hormone (PTH), hypertension, systemic inflammation, renal and cardiovascular damage. CKD induces a progressive loss of the capacity of the kidney not only to convert 25-hydroxyvitamin D [25(OH)D] to circulating calcitriol, the vitamin D hormone, but also to maintain serum 25(OH)D levels for non-renal calcitriol synthesis. The resulting calcitriol and 25(OH)D deficiency associates directly with accelerated disease progression and death. This chapter presents our understanding of the pathophysiology behind 25(OH)D and calcitriol deficiency in CKD, of the adequacy of current recommendations for vitamin D supplementation and PTH suppression, and of potential markers of renal and cardiovascular lesions unrelated to PTH suppression, a knowledge required for the design of trials to obtain evidence-based recommendations for vitamin D and calcitriol replacement that improve outcomes at all stages of CKD.
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Affiliation(s)
- Adriana Dusso
- Division of Experimental Nephrology, IRBLleida (Lleida Institute for Biomedical Research), Avda Rovira Roure 80, Lleida, Spain.
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Gonzalez-Suarez I, Redwood AB, Grotsky DA, Neumann MA, Cheng EHY, Stewart CL, Dusso A, Gonzalo S. A new pathway that regulates 53BP1 stability implicates cathepsin L and vitamin D in DNA repair. EMBO J 2011; 30:3383-96. [PMID: 21750527 DOI: 10.1038/emboj.2011.225] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 06/16/2011] [Indexed: 12/17/2022] Open
Abstract
Genomic instability due to telomere dysfunction and defective repair of DNA double-strand breaks (DSBs) is an underlying cause of ageing-related diseases. 53BP1 is a key factor in DNA DSBs repair and its deficiency is associated with genomic instability and cancer progression. Here, we uncover a novel pathway regulating the stability of 53BP1. We demonstrate an unprecedented role for the cysteine protease Cathepsin L (CTSL) in the degradation of 53BP1. Overexpression of CTSL in wild-type fibroblasts leads to decreased 53BP1 protein levels and changes in its cellular distribution, resulting in defective repair of DNA DSBs. Importantly, we show that the defects in DNA repair associated with 53BP1 deficiency upon loss of A-type lamins are due to upregulation of CTSL. Furthermore, we demonstrate that treatment with vitamin D stabilizes 53BP1 and promotes DNA DSBs repair via inhibition of CTSL, providing an as yet unsuspected link between vitamin D action and DNA repair. Given that CTSL upregulation is a hallmark of cancer and progeria, regulation of this pathway could be of great therapeutic significance for these diseases.
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Affiliation(s)
- Ignacio Gonzalez-Suarez
- Radiation and Cancer Biology Division, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
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Dusso A, Arcidiacono MV, Yang J, Tokumoto M. Vitamin D inhibition of TACE and prevention of renal osteodystrophy and cardiovascular mortality. J Steroid Biochem Mol Biol 2010; 121:193-8. [PMID: 20359533 PMCID: PMC2906659 DOI: 10.1016/j.jsbmb.2010.03.064] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [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: 11/12/2009] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 11/28/2022]
Abstract
In the course of kidney disease, the progressive loss of renal capacity to maintain normal serum levels of 1,25-dihydroxyvitamin D (1,25(OH)2D) is a main contributor to parathyroid hyperplasia and high serum PTH. High PTH causes mineral and skeletal abnormalities predisposing to ectopic calcifications and increased mortality. Intriguingly, replacement therapy with 1,25(OH)2D or its less calcemic analogs was recently shown to improve survival in kidney disease patients through renal and cardiovascular protective actions that are independent of PTH suppression. This work presents preliminary evidence that 1,25(OH)2D inhibition of TACE (Tumor necrosis factor Alpha Converting Enzyme) is a potential common mechanism underlying the efficacy of therapy with 1,25(OH)2D or its analogs to improve outcomes in chronic kidney disease. 1,25(OH)2D prevents/moderates not only the onset and progression of parathyroid TACE/TGFalpha-driven secondary hyperparathyroidism, but, more significantly, renal TACE/TGFalpha-driven fibrotic and inflammatory lesions to the renal parenchyma, and TACE/TNFalpha-driven systemic inflammation, which is known to aggravate renal and cardiovascular lesions and enhance the risk of vascular calcification and cardiovascular mortality.
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Affiliation(s)
- Adriana Dusso
- Renal Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Cozzolino M, Brancaccio D, Gallieni M, Galassi A, Slatopolsky E, Dusso A. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol 2005; 18:5-8. [PMID: 15772917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In chronic kidney disease, secondary hyperparathyroidism (HPTH) is characterized by parathyroid hyperplasia and enhanced synthesis and secretion of parathyroid hormone (PTH). Elevated PTH levels cause renal osteodistrophy and cardiovascular complications, with significantly increased morbidity and mortality in renal failure. The three main direct causes of renal HPTH are hypocalcemia, hyperphosphatemia and vitamin D deficiency. A link between the mechanisms controlling proliferation and hormonal production also exists in normal parathyroid cells which respond to the stimulus of chronic hypocalcemia, not only by an increase in PTH release but also with a consequent parathyroid cell proliferation. The mechanisms responsible for this link, however, remain poorly understood. In this review, we analyze the current understanding concerning the new insights into the molecular mechanisms of parathyroid hyperplasia and PTH secretion in renal failure regulated by calcium, phosphate and vitamin D.
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Abstract
BACKGROUND Alterations in calcium, phosphate (P) and vitamin D metabolism play a critical role in the development of secondary hyperparathyroidism (SH), parathyroid hyperplasia and soft tissue and vascular calcification. METHODOLOGY Studies were performed in uremic dogs and rats fed a low and high P diet over a period of 1-4 months. In addition, in vitro studies were performed in normal parathyroid glands incubated in culture media containing 0.2 mM P (low) or 2.0 mM P (high). RESULTS Uremic rats maintained on a low P diet did not develop SH or parathyroid hyperplasia. There was an enhancement of p21, the suppressor of the cell cycle, in these parathyroid glands. Opposite results were obtained using a high P diet. There was an enhancement of transforming growth factor-alpha and epidermal growth factor receptor, known enhancers of cell proliferation. In vitro studies demonstrated the direct effect of P on parathyroid hormone secretion. CONCLUSIONS Early dietary P restriction prevents the development of SH and parathyroid hyperplasia. If dietary P restriction is applied to rats with established SH, there is a significant amelioration of SH and parathyroid hyperplasia. In addition, control of serum P in uremic patients is crucial in the prevention of vascular calcification.
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Affiliation(s)
- Eduardo Slatopolsky
- Washington University School of Medicine, Department of Medicine, Renal Division, St. Louis, Mo., USA
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Dusso A, Cozzolino M, Lu Y, Sato T, Slatopolsky E. 1,25-Dihydroxyvitamin D downregulation of TGFalpha/EGFR expression and growth signaling: a mechanism for the antiproliferative actions of the sterol in parathyroid hyperplasia of renal failure. J Steroid Biochem Mol Biol 2004; 89-90:507-11. [PMID: 15225829 DOI: 10.1016/j.jsbmb.2004.03.061] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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] [Indexed: 11/18/2022]
Abstract
Elevated serum levels of parathyroid hormone (PTH) contribute to the increased morbidity and mortality in renal failure patients. Parathyroid gland hyperplasia is a major cause of high serum PTH. The present studies used the rat model of renal failure to address the mechanisms underlying uremia-induced parathyroid hyperplasia and the antiproliferative properties of vitamin D therapy (1,25-dihydroxyvitamin D (1,25(OH)(2)D(3)) or its less calcemic analogs). Enhanced TGFalpha/EGFR co-expression is the major mitogenic signal in uremic parathyroid glands. At early stages of renal failure, vitamin D therapy efficiently counteracts uremia- and high phosphorus-induced hyperplasia by inhibiting the increases in parathyroid-TGFalpha/EGFR co-expression. In established hyperparathyroidism, characterized by highly enhanced-TGFalpha/EGFR co-expression, vitamin D therapy arrests growth by suppressing EGFR-growth signals from the plasma membrane and nuclear EGFR actions as a transactivator of the cyclin D1 gene, an important contributor to parathyroid hyperplasia in humans. In advanced renal failure, reduced-parathyroid vitamin D receptor levels limits the antiproliferative efficacy of vitamin D therapy. However, non-antiproliferative doses of 1,25-dihydroxyvitamin D enhance the anti-EGFR actions of EGFR-tyrosine kinase inhibitors (TKI). In fact, combined 1,25-dihydroxyvitamin D/TKI therapy inhibits parathyroid hyperplasia more efficiently than phosphorus restriction, the most powerful promoter of parathyroid growth arrest available at present.
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Affiliation(s)
- Adriana Dusso
- Renal Division, Washington University School of Medicine, Campus Box 8126, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
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Esteban L, Vidal M, Dusso A. 1alpha-Hydroxylase transactivation by gamma-interferon in murine macrophages requires enhanced C/EBPbeta expression and activation. J Steroid Biochem Mol Biol 2004; 89-90:131-7. [PMID: 15225760 DOI: 10.1016/j.jsbmb.2004.03.092] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
gamma-Interferon [gamma-IFN] induction of macrophage 1alpha-hydroxylase mRNA and activity causes severe hypercalcemia in granulomatous disorders. These studies demonstrate transcriptional regulation. gamma-IFN induces the activity of the murine 1alpha-hydroxylase [-1651; +22] promoter in the murine macrophage cell line Raw 264.7 only after a 24h exposure. This slow kinetics is incompatible with classical gamma-IFN-mediated transactivation. In fact, gamma-IFN response mapped to the minimal [-85; +11] promoter, which lacks GAS or ISRE sites but contains a putative C/EBPbeta site. C/EBPbeta is a gamma-IFN inducible gene and a novel mediator of gamma-IFN-regulated transcription. As expected for a C/EBPbeta-driven transcription, ectopic C/EBPbeta expression was sufficient to increase 1alpha-hydroxylase activity, enhance minimal promoter activity and potentiate the induction of this promoter by gamma-IFN. Importantly, the dominant negative C/EBPbeta isoform antagonized C/EBPbeta-transcriptional activity. gamma-IFN induction of C/EBPbeta expression is not sufficient for gamma-IFN induction of minimal promoter activity. There is also a cell-specific induction of C/EBPbeta-transcriptional activity by gamma-IFN. In Raw cells, specific inhibition of gamma-IFN induction of endogenous-C/EBPbeta phosphorylation by MEKK1 markedly reduced basal promoter activity and the response to gamma-IFN. We conclude that gamma-IFN-induction of C/EBPbeta expression and activation by phosphorylation contributes to gamma-IFN-transcriptional control of 1alpha-hydroxylase expression in murine macrophages.
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Affiliation(s)
- L Esteban
- Department of Internal Medicine, Washington University School of Medicine, Campus Box 8126, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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Cordero JB, Cozzolino M, Lu Y, Vidal M, Slatopolsky E, Stahl PD, Barbieri MA, Dusso A. 1,25-Dihydroxyvitamin D down-regulates cell membrane growth- and nuclear growth-promoting signals by the epidermal growth factor receptor. J Biol Chem 2002; 277:38965-71. [PMID: 12181310 DOI: 10.1074/jbc.m203736200] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
1,25(OH)(2)D(3) antiproliferative properties are widely known. However, the molecular bases of these properties are only partially elucidated. Since 1,25(OH)(2)D(3) effectively arrests growth in many tumors and hyperplastic tissues whose growth is driven by co-expression of EGFR and its ligand TGF-alpha, it was hypothesized that 1,25(OH)(2)D(3) could affect the TGF-alpha/EGFR-autocrine growth loop. This study examined 1,25(OH)(2)D(3) regulation of EGFR-growth signals, using human epidermoid A431 cells, in which the overexpression of EGFR and TGF-alpha constitute the major autocrine mitogenic signal. 1,25(OH)(2)D(3) inhibited autocrine and EGF-induced A431 cell proliferation. Furthermore, 1,25(OH)(2)D(3) changed the cellular localization of both TGF-alpha and EGFR and inhibited ligand-dependent phosphorylation of EGFR and ERK1/2. In addition, 1,25(OH)(2)D(3) impaired autocrine and EGF-induced nuclear translocation of activated EGFR and, consequently, its binding to AT-rich DNA sequences and transcriptional activation of the cyclin D1 promoter. These results demonstrate that 1,25(OH)(2)D(3) alters EGFR membrane trafficking and down-regulates EGFR growth signaling.
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Affiliation(s)
- Julia B Cordero
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Affiliation(s)
- Eduardo Slatopolsky
- Washington University School of Medicine, Renal Division, St. Louis, Missouri, USA.
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Abstract
Secondary hyperparathyroidism (SH) and hyperplasia of the parathyroid glands (PTG) are universal complications in patients with CRF. In early renal failure, reduction in serum calcitriol and moderate decreases in ionized calcium contribute to greater synthesis and secretion of PTH. As renal disease progresses, a reduction in parathyroid expression of vitamin D receptor and calcium receptor renders the PTG more resistant to both calcitriol and calcium. High dietary phosphorus (P), independent of calcium and calcitriol, further enhances uremia-induced PTG hyperplasia and PTH synthesis and secretion, the latter by posttranscriptional mechanisms. Once SH develops, dietary P restriction can return the high serum PTH levels toward normal, however, parathyroid hyperplasia persists. Studies in our laboratory identified 2 of the mechanisms involved in the opposing effects of high and low dietary P content on PTG growth. Whereas high dietary P increases parathyroid expression of transforming growth factor alpha (TGFalpha), a growth promoter, P restriction induces the cyclin-dependent kinase inhibitor p21, an inducer of growth arrest. Both effects of P are specific for the PTG. No increase in either protein was observed in liver or intestine. TGFalpha induction of hyperplasia involves binding to the epidermal growth factor receptor and activation of mitogen activated protein (MAP) kinases cascades. p21 blocks progression through the cycle and cell division by inactivating cyclin/cyclin-dependent kinase complexes. Preventing hyperphosphatemia and elevated Ca x P product in renal failure not only ameliorates the progression of SH and bone disease but also the morbidity and mortality resulting from vascular calcification.
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Affiliation(s)
- E Slatopolsky
- Renal Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA.
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Slatopolsky E, Finch J, Clay P, Martin D, Sicard G, Singer G, Gao P, Cantor T, Dusso A. A novel mechanism for skeletal resistance in uremia. Kidney Int 2000. [DOI: 10.1016/s0085-2538(15)47156-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND In treating secondary hyperparathyroidism, the target level of serum intact parathyroid hormone (I-PTH) should be three to five times normal to prevent adynamic bone disease. In circulation, there is a non-(1-84) PTH-truncated fragment, likely 7-84, which, in addition to PTH 1-84, is measured by most I-PTH immunoradiometric (IRMA) assays, giving erroneously high I-PTH values. We have developed a new IRMA assay in which the labeled antibody recognizes only the first six amino acids of the PTH molecule. Thus, this new IRMA assay (Whole PTH) measures only the biologically active 1-84 PTH molecule. METHODS Using this new IRMA assay (Whole PTH) and the Nichols "intact" PTH assay, we compared the ability of each assay to recognize human PTH (hPTH) 1-84 and hPTH 7-84 and examined the percentage of non-1-84 PTH in circulation and in parathyroid glands. Possible antagonistic effects of the 7-84 PTH fragment on the biological activity of 1-84 PTH in rats were also tested. RESULTS In 28 uremic patients, PTH values measured with the Nichols assay, representing a combined measurement of both hPTH 1-84 and hPTH 7-84, were 34% higher than with the Whole assay (hPTH 1-84 only); the median PTH was 523 versus 318 pg/mL (P < 0.001). Similar results were found in 14 renal transplant patients. In osteoblast-like cells, ROS 17.2, 1-84 PTH (10-8 mol/L) increased cAMP from 18.1 +/- 1.25 to 738 +/- 4.13 mmol/well. Conversely, the same concentration of 7-84 PTH had no effect. In parathyroidectomized rats fed a calcium-deficient diet, 7-84 PTH was not only biologically inactive, but had antagonistic effects on 1-84 PTH in bone. Plasma calcium was increased (0.65 mg/dL) two hours after 1-84 PTH treatment, while 7-84 PTH had no effect. When 1-84 PTH and 7-84 PTH were given simultaneously in a 1:1 molar ratio, the calcemic response to 1-84 PTH was decreased by 94%. In normal rats, the administration of 1-84 PTH increased renal fractional excretion of phosphate (11.9 to 27.7%, P < 0.001). However, when 1-84 PTH and 7-84 PTH were given simultaneously, the 7-84 PTH decreased the phosphaturic response by 50.2% (P < 0.005). Finally, in surgically excised parathyroid glands from six uremic patients, we found that 44.1% of the total intracellular PTH was the non-PTH (1-84), most likely PTH 7-84. CONCLUSION In patients with chronic renal failure, the presence of high circulating levels of non-1-84 PTH fragments (most likely 7-84 PTH) detected by the "intact" assay and the antagonistic effects of 7-84 PTH on the biological activity of 1-84 PTH explain the need of higher levels of "intact" PTH to prevent adynamic bone disease.
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Affiliation(s)
- E Slatopolsky
- Renal Division, Washington University Medical School, St. Louis, MO 63110, USA
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Abstract
Secondary hyperparathyroidism is a universal complication in patients with chronic renal failure. Hyperplasia of the parathyroid glands is typically seen in these patients. In early renal failure, alteration in vitamin metabolism, decreased levels of calcitriol and moderate decreases in ionized calcium may allow greater synthesis and secretion of PTH. As the disease progresses, there is a decrease in the number of vitamin D receptors (VDR) and calcium receptors (CaR). The decreased number of VDR and CaR makes the parathyroid glands more resistant to calcitriol and calcium. Phosphorus induces hyperplasia of the parathyroid glands independent of calcium and calcitriol, and by a post-transcriptional mechanism increases PTH synthesis and secretion. Experimental work in uremic rats demonstrated that if the animals are fed a high-phosphorus diet, they not only developed secondary hyperparathyroidism but parathyroid cell hyperplasia. If the diet is then reduced in phosphorus, the levels of PTH return to normal. However, the parathyroid cell hyperplasia persists and no apoptosis is seen. Thus, the control of the three most important factors, calcium, calcitriol and phosphorus, is critical to prevent the development of secondary hyperparathyroidism and hyperplasia of the parathyroid glands.
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Affiliation(s)
- E Slatopolsky
- Renal Division, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
Calcitriol, the most active metabolite of vitamin D, controls parathyroid gland growth and suppresses the synthesis and secretion of parathyroid hormone (PTH). However, because of its potent effects on intestinal calcium absorption and bone mobilization, calcitriol treatment can induce hypercalcemia, often precluding its use at therapeutic doses. Hyperphosphatemia is also a persistent problem among patients undergoing chronic hemodialysis and can be aggravated by therapeutic doses of calcitriol. Several pharmaceutical companies were able to modify the side-chain of the 1,25(OH)2D3, allowing some of these new analogs to retain the action on the parathyroid glands while decreasing their hypercalcemic and hyperphosphatemic effects. The structure-activity relationship for ligand-mediated transcriptional regulation has been studied in detail. In some analogs the serum binding protein (DBP) plays a key role in determining the pharmacokinetics of the vitamin D compound. The affinity to DBP for 22-oxacalcitriol (OCT), an analog of calcitriol for the treatment of secondary hyperparathryoidism, is approximately 300-400 times lower than that of calcitriol and the analog is rapidly cleared from the circulation. The mechanisms for the selectivity of 19-nor-1,25(OH)2D2 (paricalcitol) (Zemplar) another analog of calcitriol, is clearly different from OCT. Although the mechanisms of action is not completely known, it does appear that paricalcitol down-regulates the VDR in the intestine. It is likely that the unique biological profiles of vitamin D analogs in vivo are due to multiple mechanisms. Understanding the molecular basis of the analog selectivity will not only provide an explanation for their unique actions but allow intelligent design of more effective analogs in the future.
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Affiliation(s)
- E Slatopolsky
- Renal Division, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
The vitamin D endocrine systems plays a critical role in calcium and phosphate homeostasis. The active form of vitamin D, 1, 25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], binds with high affinity to a specific cellular receptor that acts as a ligand-activated transcription factor. The activated vitamin D receptor (VDR) dimerizes with another nuclear receptor, the retinoid X receptor (RXR), and the heterodimer binds to specific DNA motifs (vitamin D response elements, VDREs) in the promoter region of target genes. This heterodimer recruits nuclear coactivators and components of the transcriptional preinitiation complex to alter the rate of gene transcription. 1,25(OH)(2)D(3) also binds to a cell-surface receptor that mediates the activation of second messenger pathways, some of which may modulate the activity of the VDR. Recent studies with VDR-ablated mice confirm that the most critical role of 1, 25(OH)(2)D(3) is the activation of genes that control intestinal calcium transport. However, 1,25(OH)(2)D(3) can control the expression of many genes involved in a plethora of biological actions. Many of these nonclassic responses have suggested a number of therapeutic applications for 1,25(OH)(2)D(3) and its analogs.
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Affiliation(s)
- A J Brown
- Renal Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Slatopolsky E, Dusso A, Brown AJ. The role of phosphorus in the development of secondary hyperparathyroidism and parathyroid cell proliferation in chronic renal failure. Am J Med Sci 1999; 317:370-6. [PMID: 10372836 DOI: 10.1097/00000441-199906000-00004] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hyperplasia of the parathyroid glands and high levels of parathyroid hormone (PTH) are among the most consistent findings in patients with chronic renal failure. In early renal failure, alterations in vitamin D metabolism play a key role in the development of secondary hyperparathyroidism. Low levels of calcitriol and decreased expression of the vitamin D responsive element may allow greater synthesis and secretion of PTH. Phosphorus independent of serum calcium and calcitriol increases PTH synthesis and secretion by a post-transcriptional mechanism. Studies in vivo in uremic rats demonstrated that an increase in dietary phosphorus induces parathyroid gland hyperplasia. If the rats are then fed a low-phosphorus diet, the levels of serum PTH return to normal; however, the size of the parathyroid glands remains enlarged. No apoptosis was observed in the glands. To further characterize the effects of phosphorus on PTH synthesis and secretion, intact rat parathyroid glands were metabolically labeled during a 4-hour incubation in methionine-free medium containing 1.25 mM Ca2+, [35S]methionine, and either 2.8 mM or 0.2 mM phosphorus. Total PTH secretion, as measured in the medium, was increased more than 6-fold in glands incubated in high-phosphorus medium compared with glands incubated in the low-phosphorus medium. Thus, in the past 20 years, numerous investigators have provided strong evidence for the action of phosphorus on PTH secretion. Unfortunately, the absence of a parathyroid cell line is slowing the progress in understanding the molecular mechanism(s) involved in phosphorus regulation of PTH.
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Affiliation(s)
- E Slatopolsky
- Department of Internal Medicine, Washington University, St. Louis, Missouri, USA.
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Slatopolsky E, Dusso A, Brown AJ. The Role of Phosphorus in the Development of Secondary Hyperparathyroidism and Parathyroid Cell Proliferation in Chronic Renal Failure. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40549-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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