In the COVID-19 era, let’s keep an eye on clinical trials in Africa

Due to the high contagiousness of COVID-19 and the lack of an effective medicine, governments and companies are urging their teams to develop new vaccine and therapy with the noble mission to protect us from COVID-19 and preserve our economic achievements. However, under the current pandemic circumstances, we cannot exclude the possibilities that some scientists violate clinical trials rules and guidelines to accelerate new vaccine and medicine development. Low-income countries, notably Africans, could be preferred as a basis for experimentations on human subjects due to the lack of stringent policies in comparison to their high-income counterparts

Osteocytic FGF23 and Its Kidney Function

Osteocytes, which represent up to 95% of adult skeletal cells, are deeply embedded in bone. These cells exhibit important interactive abilities with other bone cells such as osteoblasts and osteoclasts to control skeletal formation and resorption. Beyond this local role, osteocytes can also influence the function of distant organs due to the presence of their sophisticated lacunocanalicular system, which connects osteocyte dendrites directly to the vasculature. Through these networks, osteocytes sense changes in circulating metabolites and respond by producing endocrine factors to control homeostasis. One critical function of osteocytes is to respond to increased blood phosphate and 1,25(OH)2 vitamin D (1,25D) by producing fibroblast growth factor-23 (FGF23). FGF23 acts on the kidneys through partner fibroblast growth factor receptors (FGFRs) and the co-receptor Klotho to promote phosphaturia via a downregulation of phosphate transporters, as well as the control of vitamin D metabolizing enzymes to reduce blood 1,25D. In the first part of this review, we will explore the signals involved in the positive and negative regulation of FGF23 in osteocytes. In the second portion, we will bridge bone responses with the review of current knowledge on FGF23 endocrine functions in the kidneys

C-FGF23 peptide alleviates hypoferremia during acute inflammation

Hypoferremia results as an acute phase response to infection and inflammation aiming to reduce iron availability to pathogens. Activation of toll-like receptors (TLRs), the key sensors of the innate immune system, induces hypoferremia mainly through the rise of the iron hormone hepcidin. Conversely, stimulation of erythropoiesis suppresses hepcidin expression via induction of the erythropoietin-responsive hormone erythroferrone. Iron deficiency stimulates transcription of the osteocyte-secreted protein FGF23. Here we hypothesized that induction of FGF23 in response to TLR4 activation is a potent contributor to hypoferremia and, thus, impairment of its activity may alleviate hypoferremia induced by lipopolysaccharide (LPS), a TLR 4 agonist. We used the C-terminal tail of FGF23 to impair endogenous full-length FGF23 signaling in wild-type mice, and investigated its impact on hypoferremia. Our data show that FGF23 is induced as early as pro-inflammatory cytokines in response to LPS, followed by upregulation of hepcidin and downregulation of erythropoietin (Epo) expression in addition to decreased serum iron and transferrin saturation. Further, LPS-induced hepatic and circulating hepcidin were significantly reduced by FGF23 signaling disruption. Accordingly, iron sequestration in liver and spleen caused by TLR4 activation was completely abrogated by FGF23 signaling inhibition, resulting in alleviation of serum iron and transferrin saturation deficit. Taken together, our studies highlight for the first time that inhibition of FGF23 signaling alleviates LPS-induced acute hypoferremia

Erythropoietin and a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHDi) lowers FGF23 in a model of chronic kidney disease (CKD)

Iron‐deficiency anemia is a potent stimulator of the phosphaturic hormone Fibroblast growth factor‐23 (FGF23). Anemia, elevated FGF23, and elevated serum phosphate are significant mortality risk factors for patients with chronic kidney disease (CKD). However, the contribution of anemia to overall circulating FGF23 levels in CKD is not understood. Our goal was to investigate the normalization of iron handling in a CKD model using the erythropoiesis stimulating agents (ESAs) Erythropoietin (EPO) and the hypoxia‐inducible factor prolyl hydroxylase inhibitor (HIF‐PHDi) FG‐4592, on the production of, and outcomes associated with, changes in bioactive, intact FGF23 (“iFGF23”). Our hypothesis was that rescuing the prevailing anemia in a model of CKD would reduce circulating FGF23. Wild‐type mice were fed an adenine‐containing diet to induce CKD, then injected with EPO or FG‐4592. The mice with CKD were anemic, and EPO improved red blood cell indices, whereas FG‐4592 increased serum EPO and bone marrow erythroferrone (Erfe), and decreased liver ferritin, bone morphogenic protein‐6 (Bmp‐6), and hepcidin mRNAs. In the mice with CKD, iFGF23 was markedly elevated in control mice but was attenuated by >70% after delivery of either ESA, with no changes in serum phosphate. ESA treatment also reduced renal fibrosis markers, as well as increased Cyp27b1 and reduced Cyp24a1 mRNA expression. Thus, improvement of iron utilization in a CKD model using EPO and a HIF‐PHDi significantly reduced iFGF23, demonstrating that anemia is a primary driver of FGF23, and that management of iron utilization in patients with CKD may translate to modifiable outcomes in mineral metabolism

The HIF-PHI BAY 85–3934 (Molidustat) Improves Anemia and Is Associated With Reduced Levels of Circulating FGF23 in a CKD Mouse Model

Fibroblast growth factor-23 (FGF23) is a critical factor in chronic kidney disease (CKD), with elevated levels causing alterations in mineral metabolism and increased odds for mortality. Patients with CKD develop anemia as the kidneys progressively lose the ability to produce erythropoietin (EPO). Anemia is a potent driver of FGF23 secretion; therefore, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) currently in clinical trials to elevate endogenous EPO to resolve anemia was tested for effects on iron utilization and FGF23-related parameters in a CKD mouse model. Mice were fed either a casein control diet or an adenine-containing diet to induce CKD. The CKD mice had markedly elevated iFGF23 and blood urea nitrogen (BUN), hyperphosphatemia, and anemia. Cohorts of mice were then treated with a patient-equivalent dose of BAY 85-3934 (BAY; Molidustat), which elevated EPO and completely resolved aberrant complete blood counts (CBCs) in the CKD mice. iFGF23 was elevated in vehicle-treated CKD mice (120-fold), whereas circulating iFGF23 was significantly attenuated (>60%) in the BAY-treated CKD mice. The BAY-treated mice with CKD also had reduced BUN, but there was no effect on renal vitamin D metabolic enzyme expression. Consistent with increased EPO, bone marrow Erfe, Transferrin receptor (Tfrc), and EpoR mRNAs were increased in BAY-treated CKD mice, and in vitro hypoxic marrow cultures increased FGF23 with direct EPO treatment. Liver Bmp-6 and hepcidin expression were downregulated in all BAY-treated groups. Femur trabecular parameters and cortical porosity were not worsened with BAY administration. In vitro, differentiated osteocyte-like cells exposed to an iron chelator to simulate iron depletion/hypoxia increased FGF23; repletion with holo-transferrin completely suppressed FGF23 and normalized Tfrc1. Collectively, these results support that resolving anemia using a HIF-PHI during CKD was associated with lower BUN and reduced FGF23, potentially through direct restoration of iron utilization, thus providing modifiable outcomes beyond improving anemia for this patient population. © 2021 American Society for Bone and Mineral Research (ASBMR)

Single cell cortical bone transcriptomics define novel osteolineage gene sets altered in chronic kidney disease

IntroductionDue to a lack of spatial-temporal resolution at the single cell level, the etiologies of the bone dysfunction caused by diseases such as normal aging, osteoporosis, and the metabolic bone disease associated with chronic kidney disease (CKD) remain largely unknown.MethodsTo this end, flow cytometry and scRNAseq were performed on long bone cells from Sost-cre/Ai9+ mice, and pure osteolineage transcriptomes were identified, including novel osteocyte-specific gene sets.ResultsClustering analysis isolated osteoblast precursors that expressed Tnc, Mmp13, and Spp1, and a mature osteoblast population defined by Smpd3, Col1a1, and Col11a1. Osteocytes were demarcated by Cd109, Ptprz1, Ramp1, Bambi, Adamts14, Spns2, Bmp2, WasI, and Phex. We validated our in vivo scRNAseq using integrative in vitro promoter occupancy via ATACseq coupled with transcriptomic analyses of a conditional, temporally differentiated MSC cell line. Further, trajectory analyses predicted osteoblast-to-osteocyte transitions via defined pathways associated with a distinct metabolic shift as determined by single-cell flux estimation analysis (scFEA). Using the adenine mouse model of CKD, at a time point prior to major skeletal alterations, we found that gene expression within all stages of the osteolineage was disturbed.ConclusionIn sum, distinct populations of osteoblasts/osteocytes were defined at the single cell level. Using this roadmap of gene assembly, we demonstrated unrealized molecular defects across multiple bone cell populations in a mouse model of CKD, and our collective results suggest a potentially earlier and more broad bone pathology in this disease than previously recognized

In the COVID-19 era, let’s keep an eye on clinical trials in Africa

Due to the high contagiousness of COVID-19 and the lack of an effective medicine, governments and companies are urging their teams to develop new vaccine and therapy with the noble mission to protect us from COVID-19 and preserve our economic achievements. However, under the current pandemic circumstances, we cannot exclude the possibilities that some scientists violate clinical trials rules and guidelines to accelerate new vaccine and medicine development. Low-income countries, notably Africans, could be preferred as a basis for experimentations on human subjects due to the lack of stringent policies in comparison to their high-income counterparts

Iron – hepcidin - ferroportin axis and mycobacterial infection interactions

Le fer est un oligoélément indispensable pour tout organisme vivant. Le taux de fer systémique est régulé par la fixation de l’hepcidine, hormone synthétisée majoritairement par le foie mais également par les macrophages, à la ferroportine seul exporteur du fer. L’expression de ces deux protéines est régulée par le taux de fer et les processus inflammatoires. Des mécanismes d’acquisition et de séquestration du fer sont mis en place respectivement par le pathogène et l’hôte durant l’infection et régulent en parallèle l’expression de l’hepcidine et la ferroportine. Les travaux de recherche effectués dans le cadre de ma thèse ont porté d’une part sur un aspect fondamental à améliorer nos connaissances du mécanisme de régulation de l’axe hepcidine - ferroportine en condition inflammatoire et analyser l’influence du fer sur la réponse immune au niveau des macrophages; d’autre part une deuxième partie de mes recherches s’est orientée vers une étude plus appliquée du rôle du fer dans la réponse immune induite par une infection mycobactérienne. Nous montrons que l’expression de l’hepcidine et de la ferroportine est différentiellement régulée en corrélation avec la polarisation des macrophages via les voies de signalisation intracellulaires PI3K et autres kinases. Le fer influence la polarisation des macrophages et module ainsi la réponse inflammatoire, et représente aussi un signal de danger capable de stimuler une voie MyD88-dépendante. Enfin, la réponse à l’infection Mycobacterium. bovis BCG est modulée par un régime modérément enrichi en fer, réduisant la charge bactérienne et l’inflammation.Iron is an essential trace element for all organisms. In mammals, systemic iron homeostasis relies on hepcidin, a peptide hormone synthesized by liver but also macrophages with defensing properties, and its target, the cell iron exporter ferroportin. Iron content and inflammation regulate hepcidin and ferroportin expression in mammals. During infection, pathogens develop sophisticated mechanisms for iron acquisition and sequestration. In response, host regulates the bioavailability of iron through hepcidin and ferroportin expression. First, this work contributes to improve our fundamental knowledge on hepcidin and ferroportin regulation during inflammation and analyzes the influence of iron in macrophages immune response. Second, the role of iron in response to mycobacterial infection was investigated. We show that hepcidin and ferroportin expression was regulated differentially in correlation with macrophages polarization through intracellular signaling pathways involving PI3K and others kinases. In addition, iron influenced macrophages polarization leading to a decrease of inflammatory response with a potent effect on MyD88 pathway stimulation. Finally, we showed that moderate iron-rich diet modulated Mycobacterium bovis BCG response reducing the bacterial burden and inflammation

Etude des interactions de l'axe hepcidine - ferroportine - fer et infection mycobactérienne

Iron is an essential trace element for all organisms. In mammals, systemic iron homeostasis relies on hepcidin, a peptide hormone synthesized by liver but also macrophages with defensing properties, and its target, the cell iron exporter ferroportin. Iron content and inflammation regulate hepcidin and ferroportin expression in mammals. During infection, pathogens develop sophisticated mechanisms for iron acquisition and sequestration. In response, host regulates the bioavailability of iron through hepcidin and ferroportin expression. First, this work contributes to improve our fundamental knowledge on hepcidin and ferroportin regulation during inflammation and analyzes the influence of iron in macrophages immune response. Second, the role of iron in response to mycobacterial infection was investigated. We show that hepcidin and ferroportin expression was regulated differentially in correlation with macrophages polarization through intracellular signaling pathways involving PI3K and others kinases. In addition, iron influenced macrophages polarization leading to a decrease of inflammatory response with a potent effect on MyD88 pathway stimulation. Finally, we showed that moderate iron-rich diet modulated Mycobacterium bovis BCG response reducing the bacterial burden and inflammation.Le fer est un oligoélément indispensable pour tout organisme vivant. Le taux de fer systémique est régulé par la fixation de l’hepcidine, hormone synthétisée majoritairement par le foie mais également par les macrophages, à la ferroportine seul exporteur du fer. L’expression de ces deux protéines est régulée par le taux de fer et les processus inflammatoires. Des mécanismes d’acquisition et de séquestration du fer sont mis en place respectivement par le pathogène et l’hôte durant l’infection et régulent en parallèle l’expression de l’hepcidine et la ferroportine. Les travaux de recherche effectués dans le cadre de ma thèse ont porté d’une part sur un aspect fondamental à améliorer nos connaissances du mécanisme de régulation de l’axe hepcidine - ferroportine en condition inflammatoire et analyser l’influence du fer sur la réponse immune au niveau des macrophages; d’autre part une deuxième partie de mes recherches s’est orientée vers une étude plus appliquée du rôle du fer dans la réponse immune induite par une infection mycobactérienne. Nous montrons que l’expression de l’hepcidine et de la ferroportine est différentiellement régulée en corrélation avec la polarisation des macrophages via les voies de signalisation intracellulaires PI3K et autres kinases. Le fer influence la polarisation des macrophages et module ainsi la réponse inflammatoire, et représente aussi un signal de danger capable de stimuler une voie MyD88-dépendante. Enfin, la réponse à l’infection Mycobacterium. bovis BCG est modulée par un régime modérément enrichi en fer, réduisant la charge bactérienne et l’inflammation

Etude des interactions de l'axe hepcidine - ferroportine - fer et infection mycobactérienne

Iron is an essential trace element for all organisms. In mammals, systemic iron homeostasis relies on hepcidin, a peptide hormone synthesized by liver but also macrophages with defensing properties, and its target, the cell iron exporter ferroportin. Iron content and inflammation regulate hepcidin and ferroportin expression in mammals. During infection, pathogens develop sophisticated mechanisms for iron acquisition and sequestration. In response, host regulates the bioavailability of iron through hepcidin and ferroportin expression. First, this work contributes to improve our fundamental knowledge on hepcidin and ferroportin regulation during inflammation and analyzes the influence of iron in macrophages immune response. Second, the role of iron in response to mycobacterial infection was investigated. We show that hepcidin and ferroportin expression was regulated differentially in correlation with macrophages polarization through intracellular signaling pathways involving PI3K and others kinases. In addition, iron influenced macrophages polarization leading to a decrease of inflammatory response with a potent effect on MyD88 pathway stimulation. Finally, we showed that moderate iron-rich diet modulated Mycobacterium bovis BCG response reducing the bacterial burden and inflammation.Le fer est un oligoélément indispensable pour tout organisme vivant. Le taux de fer systémique est régulé par la fixation de l’hepcidine, hormone synthétisée majoritairement par le foie mais également par les macrophages, à la ferroportine seul exporteur du fer. L’expression de ces deux protéines est régulée par le taux de fer et les processus inflammatoires. Des mécanismes d’acquisition et de séquestration du fer sont mis en place respectivement par le pathogène et l’hôte durant l’infection et régulent en parallèle l’expression de l’hepcidine et la ferroportine. Les travaux de recherche effectués dans le cadre de ma thèse ont porté d’une part sur un aspect fondamental à améliorer nos connaissances du mécanisme de régulation de l’axe hepcidine - ferroportine en condition inflammatoire et analyser l’influence du fer sur la réponse immune au niveau des macrophages; d’autre part une deuxième partie de mes recherches s’est orientée vers une étude plus appliquée du rôle du fer dans la réponse immune induite par une infection mycobactérienne. Nous montrons que l’expression de l’hepcidine et de la ferroportine est différentiellement régulée en corrélation avec la polarisation des macrophages via les voies de signalisation intracellulaires PI3K et autres kinases. Le fer influence la polarisation des macrophages et module ainsi la réponse inflammatoire, et représente aussi un signal de danger capable de stimuler une voie MyD88-dépendante. Enfin, la réponse à l’infection Mycobacterium. bovis BCG est modulée par un régime modérément enrichi en fer, réduisant la charge bactérienne et l’inflammation