Role of lipotoxicity in insulin resistance in subtotally nephrectomized mouse model

Chronic kidney disease (CKD) is associated with a large range of metabolic alterations among which insulin resistance and dyslipidemia. We hypothesize that a phenomenon of lipotoxicity and ectopic fat redistribution could be responsible for the insulin-resistance associated to CKD.C57BL/6 mice underwent a 5/6 nephrectomy and were compared to pair fed sham-operated mice. Insulin sensitivity was estimated through intra-peritoneal insulin (ipITT) and glucose tolerance (ipGTT) tests. Anthropometric (body weight, lean and fad pad mass) and metabolic parameters (glycemia, insulin, cholesterol, triglycerides) were measured. The phosphorylation of a key protein of insulin signaling pathway (protein kinase B, PKB/Akt) was studied by Western blot. The intra-muscular and intra-hepatic lipids were extracted using Chloroform-Methanol (2:1, v/v).The CKD mice exhibited a marked decrease in insulin sensitivity (−76%, p<0.01) and altered glucose tolerance (+24%, p<0.001). CKD mice exhibited a profile of insulin resistance. CKD mice exhibited a significant decrease in white adipose tissue accretion (−57%, p< 0.001) associated with increased muscle (+138%, p<0.05) and liver (+38%, P<0.05) lipid contents compared to sham-operated mice. The CKD mice presented a blunted insulin-induced Akt phosphorylation (−34%, p<0.05) in gastrocnemius muscle.In subtotally nephrectomized mouse model we showed an ectopic intramuscular and intrahepatic lipid redistribution concomitant with insulin resistance. Insulin resistance and lipotoxicity may represent the missing links (beyond the classical cardiovascular risk factors) that may help explain the increased risk of cardiovascular disease in CKD

Role of the uremic toxin, p-cresyl sulfate in insulin resistance associated with chronic kidney disease

Bien que l'insulino-résistance soit une caractéristique connue de la maladie rénale chronique (MRC), les mécanismes impliqués sont encore mal compris. Le p-crésol est un produit toxique généré par la transformation de la tyrosine par la flore bactérienne intestinale. Son sulfoconjugué, le p-crésyl sulfate (PCS) a été identifié comme le principal métabolite circulant du p-crésol chez l'homme et est considéré comme une importante toxine urémique liée aux protéines. En effet, les concentrations de PCS sont corrélées de façon indépendante à la morbi-mortalité cardiovasculaire présente chez les patients ayant une MRC. Le but de cette étude est de déterminer le rôle du PCS dans l'insulino-résistance associée à la MRC. L'administration chronique de PCS (10mg/kg, deux fois par jour pendant 4 semaines) chez des souris ayant une fonction rénale normale induit une insulino-résistance ainsi qu'une perte de masse grasse et une redistribution ectopique de lipides dans le muscle et le foie (lipotoxicité), ce qui est observé chez les souris ayant une MRC. Le PCS perturbe la signalisation de l'insuline dans les muscles squelettiques des souris par l'activation des kinases ERK 1/2. L'incubation in vitro de myotubes C2C12 avec du PCS à des concentrations retrouvées (40 μg/ml) chez les patients ayant une MRC terminale induit également une insulino-résistance par le biais d'une activation directe d’ERK1/2. Le traitement de souris urémiques avec un prébiotique (arabino-xylo-oligosaccharide, AXOS) qui diminue la production intestinale de p-crésol et donc la concentration de PCS dans le sérum, améliore significativement les paramètres métaboliques. Ces données suggèrent que le PCS participe à l'insulino-résistance associée à la MRC. Du fait d’une faible élimination par les techniques conventionnelles de dialyse, des thérapeutiques alternatives tels que les prébiotiques, diminuant la production de PCS, pourraient diminuer la mortalité cardio-vasculaire associée à la MRCAlthough insulin resistance is a well-documented feature of chronic kidney disease (CKD), the underlying mechanisms remain poorly understood. p-cresol is a toxic by product generated by transformation of tyrosine by intestinal microbiota. Its conjugate p-cresyl sulfate (PCS) is identified as the main circulating metabolite of p-cresol and a major protein bound uremic toxin. PCS is independently associated with mortality and cardiovascular disease in CKD patients. The aim of this study was to determine the role of PCS in CKD-associated insulin-resistance. Chronic administration of PCS (10mg/kg, twice daily for 4 weeks) in mice with normal kidney function triggered insulin resistance, fat mass loss and ectopic lipid redistribution in muscle and liver (lipotoxicity) mimicking those associated to CKD. PCS mice revealed altered insulin signaling in skeletal muscle through ERK1/2 activation. Exposition of C2C12 myotubes to PCS at CKD-relevant concentrations (40 μg/ml) caused insulin resistance, also through a direct activation of ERK1/2. Mouse models of surgically induced renal failure displayed insulin resistance and dyslipidemia, and treatment with a prebiotic (arabino-xylo-oligosaccharide) reducing p-cresol intestinal production and thus serum PCS, prevented these metabolic defects. These data suggest that although PCS is poorly removed by the common dialysis techniques, alternative therapeutic such prebiotics ttargeting of PCS may prevent metabolic abnormalities associated to end-stage renal diseas

The impact of dietary nutrient intake on gut microbiota in the progression and complications of chronic kidney disease

International audienceLa maladie rénale chronique a été associée à des changements dans la fonction et la composition du microbiote intestinal. L'écosystème de l'intestin humain se compose de milliards de micro-organismes formant un authentique organe métaboliquement actif qui est alimenté par des nutriments pour produire des composés bioactifs. Ces métabolites dérivés du microbiote peuvent être protecteurs pour la fonction rénale (par exemple, les acides gras à chaîne courte issus de la fermentation des fibres alimentaires) ou délétères (par exemple, les toxines urémiques dérivées de l'intestin telles que le N-oxyde de triméthylamine, le sulfate de p-crésyle et le sulfate d'indoxyle de la fermentation des acides aminés). Bien que l'alimentation soit la pierre angulaire de la prise en charge du patient atteint d'insuffisance rénale chronique, elle reste une composante relativement sous-utilisée de l'arsenal thérapeutique du clinicien. Dans cette revue, nous décrivons les dernières avancées dans la compréhension de la diaphonie alimentation-microbiote dans le contexte urémique et comment cette communication pourrait contribuer à la progression et aux complications de la maladie rénale chronique. Nous discutons ensuite de la manière dont ces connaissances pourraient être exploitées pour des stratégies nutritionnelles personnalisées afin d'empêcher les patients atteints d'insuffisance rénale chronique de progresser vers l'insuffisance rénale et ses conséquences néfastes

Microbiota and prebiotics modulation of uremic toxin generation

article in PressRecent data have shown that the host-intestinal microbiota interaction is intrinsically linked with overall health. Chronic kidney disease (CKD) could influence intestinal microbiota and gut dysbiosis is also considered as a cause of progression of kidney disease. An increasing body of evidence indicates that dysbiosis is a key contributor of uremic retention solutes (URS) accumulating in patients with CKD. The discovery of the kidney-gut axis has created new therapeutic opportunities for nutritional intervention in order to prevent adverse outcomes. One of these strategies is prebiotics, which refers to nondigestible food ingredients or substances that beneficial affect growth and/or activity of limited health-promoting bacteria in the gastrointestinal tract. The influence of prebiotics on the production and concentration of URS have been investigated in various animal and human CKD studies. However, to date, there is still paucity of high-quality intervention trials. Randomized controlled trials and adequately powered intervention studies are needed before recommending prebiotics in clinical practice. This review will outline the interconnection between CKD progression, dysbiosis and URS production and will discuss mechanisms of action and efficacy of prebiotics as a new CKD management tool, with a particular emphasis on URS generation

New clinical evidence for urea toxicity

International audienc

The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

Uremic retention solutes (URS) are associated with cardiovascular complications and poor survival in chronic kidney disease. The better understanding of the origin of a certain number of these toxins enabled the development of new strategies to reduce their production. URS can be classified according to their origins (i.e., host, microbial, or exogenous). The discovery of the fundamental role that the intestinal microbiota plays in the production of many URS has reinstated nutrition at the heart of therapeutics to prevent the accumulation of URS and their deleterious effects. The intestinal microbiota is personalized and is strongly influenced by dietary habits, such as the quantity and the quality of dietary protein and fibers. Herein, this review out lines the role of intestinal microbiota on URS production and the recent discoveries on the effect of diet composition on the microbial balance in the host with a focus on the effect on URS production

Metabolic abnormalities in diabetes and kidney disease: Role of uremic toxins

International audiencePurpose of ReviewChronic kidney disease (CKD) is characterized by the accumulation of uremic retention solutes (URS) and is associated with perturbations of glucose homeostasis even in absence of diabetes. The underlying mechanisms of insulin resistance, cell failure, and increase risk of diabetes in CKD, however, remain unclear. Metabolomic studies reported that some metabolites are similar in CKD and diabetic kidney disease (DKD) and contribute to the progression to end-stage renal disease. We attempted to discuss the mechanisms involved in the disruption of carbohydrate metabolism in CKD by focusing on the specific role of URS.Recent FindingsRecent clinical data have demonstrated a defect of insulin secretion in CKD. Several studies highlighted the direct role of some URS (urea, trimethylamine N-oxide (TMAO), p-cresyl sulfate, 3-carboxylic acid 4-methyl-5-propyl-2-furan propionic (CMPF)) in glucose homeostasis abnormalities and diabetes incidence.SummaryGut dysbiosis has been identified as a potential contributor to diabetes and to the production of URS. The complex interplay between the gut microbiota, kidney, pancreas cell, and peripheral insulin target tissues has brought out new hypotheses for the pathogenesis of CKD and DKD. The characterization of intestinal microbiota and its associated metabolites are likely to fill fundamental knowledge gaps leading to innovative research, clinical trials, and new treatments for CKD and DKD