Estimated glomerular filtration rate is a poor predictor of the concentration of middle molecular weight uremic solutes in chronic kidney disease

Background: Uremic solute concentration increases as Glomerular Filtration Rate (GFR) declines. Weak associations were demonstrated between estimated GFR (eGFR) and the concentrations of several small water-soluble and protein-bound uremic solutes (MW500Da). Materials and Methods: In 95 CKD-patients (CKD-stage 2-5 not on dialysis), associations between different eGFR-formulae (creatinine, CystatinC-based or both) and the natural logarithm of the concentration of several LMWP's were analyzed: i.e. parathyroid hormone (PTH), Cystatin C (CystC), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), leptin, retinol binding protein (RbP), immunoglobin light chains kappa and lambda (Ig-kappa and Ig-lambda), beta-2-microglobulin (beta M-2), myoglobin and fibroblast growth factor-23 (FGF-23)). Results: The regression coefficients (R-2) between eGFR, based on the CKD-EPI-Crea-CystC-formula as reference, and the examined LMWP's could be divided into three groups. Most of the LMWP's associated weakly (R-2 0.7). Almost identical R-2-values were found per LMWP for all eGFR-formulae, with exception of CystC and beta M-2 which showed weaker associations with creatinine-based than with CystC-based eGFR. Conclusion: The association between eGFR and the concentration of several LMWP's is inconsistent, with in general low R-2-values. Thus, the use of eGFR to evaluate kidney function does not reflect the concentration of several LMWP's with proven toxic impact in CKD

M & L Jaargang 2/3

RedactioneelM. Strobbe Het landschap van de Zwinstreek. [The Zwin landscape north of Bruges.]Guido Ostyn De Zwinbosjes te Knokke-Heist. [The Zwinbosjes in Knokke-Heist.]M. Goossens en D. Mostaert (architectenbureau Dugardijn)/M. Goossens De restauratie van de Grooten Vos in Bugge en het Wyckhuuse in Alveringem. [The restoration of the Grooten Vos in Bruges and the Wyckhuuse in Alveringem.]Luc Devliegher De restauratie van het stadhuis te Damme. [The restoration of the town hall of Damme.]Mimy Neirynck-de Schaepdryver Enkele elementaire maatregelen voor een goede bewaring van boeken en grafische documenten. [Elementary measures for the preservation of books and graphic documents.]SummaryM&L Binnenkran

Soluble tumor necrosis factor receptor 1 and 2 predict outcomes in advanced chronic kidney disease : a prospective cohort study

Background : Soluble tumor necrosis factor receptors 1 (sTNFR1) and 2 (sTNFR2) have been associated to progression of renal failure, end stage renal disease and mortality in early stages of chronic kidney disease (CKD), mostly in the context of diabetic nephropathy. The predictive value of these markers in advanced stages of CKD irrespective of the specific causes of kidney disease has not yet been defined. In this study, the relationship between sTNFR1 and sTNFR2 and the risk for adverse cardiovascular events (CVE) and all-cause mortality was investigated in a population with CKD stage 4-5, not yet on dialysis, to minimize the confounding by renal function. Patients and methods : In 131 patients, CKD stage 4-5, sTNFR1, sTNFR2 were analysed for their association to a composite endpoint of all-cause mortality or first non-fatal CVE by univariate and multivariate Cox proportional hazards models. In the multivariate models, age, gender, CRP, eGFR and significant comorbidities were included as covariates. Results : During a median follow-up of 33 months, 40 events (30.5%) occurred of which 29 deaths (22.1%) and 11 (8.4%) first non-fatal CVE. In univariate analysis, the hazard ratios (HR) of sTNFR1 and sTNFR2 for negative outcome were 1.49 (95% confidence interval (CI): 1.28-1.75) and 1.13 (95% CI: 1.06-1.20) respectively. After adjustment for clinical covariables (age, CRP, diabetes and a history of cardiovascular disease) both sTNFRs remained independently associated to outcomes (HR: sTNFR1: 1.51, 95% CI: 1.30-1.77; sTNFR2: 1.13, 95% CI: 1.06-1.20). A subanalysis of the non-diabetic patients in the study population confirmed these findings, especially for sTNFR1. Conclusion : sTNFR1 and sTNFR2 are independently associated to all-cause mortality or an increased risk for cardiovascular events in advanced CKD irrespective of the cause of kidney disease

Carbon-nitrogen interactions in European forests and semi-natural vegetation - Part 2: Untangling climatic, edaphic, management and nitrogen deposition effects on carbon sequestration potentials

The effects of atmospheric nitrogen deposition (N$_{dep}$) on carbon (C) sequestration in forests have often been assessed by relating differences in productivity to spatial variations of N$_{dep}$ across a large geographic domain. These correlations generally suffer from covariation of other confounding variables related to climate and other growth-limiting factors, as well as large uncertainties in total (dry+wet) reactive nitrogen (N$_{r}$) deposition.We propose a methodology for untangling the effects of N$_{dep}$ from those of meteorological variables, soil water retention capacity and stand age, using a mechanistic forest growth model in combination with eddy covariance CO$_{2}$ exchange fluxes from a Europe-wide network of 22 forest flux towers. Total N$_{r}$ deposition rates were estimated from local measurements as far as possible. The forest data were compared with data from natural or semi-natural, non-woody vegetation sites. The response of forest net ecosystem productivity to nitrogen deposition (dNEP= dN$_{dep}$) was estimated after accounting for the effects on gross primary productivity (GPP) of the co-correlates by means of a meta-modelling standardization procedure, which resulted in a reduction by a factor of about 2 of the uncorrected, apparent dGPP/dN$_{dep}$ value. This model-enhanced analysis of the C and N$_{dep}$ flux observations at the scale of the European network suggests a mean overall dNEP/dN$_{dep}$ response of forest lifetime C sequestration to N$_{dep}$ of the order of 40–50 g C per g N, which is slightly larger but not significantly different from the range of estimates published in the most recent reviews. Importantly, patterns of gross primary and net ecosystem productivity versus N$_{dep}$ were non-linear, with no further growth responses at high N$_{dep}$ levels (N$_{dep}$ >2.5–3 gNm$^{-2}$ yr$^{-1}$) but accompanied by increasingly large ecosystem N losses by leaching and gaseous emissions. The reduced increase in productivity per unit N deposited at high N$_{dep}$ levels implies that the forecast increased N$_{r}$ emissions and increased Ndep levels in large areas of Asia may not positively impact the continent’s forest CO$_{2}$ sink. The large level of unexplained variability in observed carbon sequestration efficiency (CSE) across sites further adds to the uncertainty in the dC/dN response

Soy protein–gum karaya conjugate: emulsifying activity and rheological behavior in aqueous system and oil in water emulsion

The main objective of this study is to investigate the effects of mixing and conjugation of soy protein isolate (SPI) with gum karaya on the characteristics of the hybrid polymer (protein–gum) in both aqueous systems and oil-in-water (O/W) emulsions. It was hypothesized that the covalent linkage of gum karaya with SPI would improve the emulsifying activity and rheological properties of both polymers. Conjugation occurred under controlled conditions (i.e., 60 °C and 75 % relative humidity, 3 days). The conjugated hybrid polymer produced smaller droplet with better uniformity, higher viscosity and stronger emulsifying activity than native gum karaya, suggesting the conjugated polymer provided a bulkier secondary layer with more efficient coverage around oil droplets, thereby inducing stronger resistance against droplet aggregation and flocculation. Emulsions containing the native gum karaya produced the largest droplet size among all prepared emulsions (D 3,2 = 8.6 μm; D 4,3 = 22.4 μm); while the emulsion containing protein–gum conjugate (1:1 g/g) had the smallest droplet size (D 3,2 = 0.2 μm; D 4,3 = 0.7 μm) with lower polydispersity. The protein–gum conjugate (1:1 g/g) also showed the highest elastic and viscous modulus, the lowest polydispersity (span) and the highest emulsifying activity among all native, mixed and conjugated polymers. Therefore, the percentage of gum karaya used for production of O/W emulsion can be decreased by partially replacing it with the conjugated gum

Cold-Adapted Influenza and Recombinant Adenovirus Vaccines Induce Cross-Protective Immunity against pH1N1 Challenge in Mice

The rapid spread of the 2009 H1N1 pandemic influenza virus (pH1N1) highlighted problems associated with relying on strain-matched vaccines. A lengthy process of strain identification, manufacture, and testing is required for current strain-matched vaccines and delays vaccine availability. Vaccines inducing immunity to conserved viral proteins could be manufactured and tested in advance and provide cross-protection against novel influenza viruses until strain-matched vaccines became available. Here we test two prototype vaccines for cross-protection against the recent pandemic virus.BALB/c and C57BL/6 mice were intranasally immunized with a single dose of cold-adapted (ca) influenza viruses from 1977 or recombinant adenoviruses (rAd) expressing 1934 nucleoprotein (NP) and consensus matrix 2 (M2) (NP+M2-rAd). Antibodies against the M2 ectodomain (M2e) were seen in NP+M2-rAd immunized BALB/c but not C57BL/6 mice, and cross-reacted with pH1N1 M2e. The ca-immunized mice did not develop antibodies against M2e. Despite sequence differences between vaccine and challenge virus NP and M2e epitopes, extensive cross-reactivity of lung T cells with pH1N1 peptides was detected following immunization. Both ca and NP+M2-rAd immunization protected BALB/c and C57BL/6 mice against challenge with a mouse-adapted pH1N1 virus.Cross-protective vaccines such as NP+M2-rAd and ca virus are effective against pH1N1 challenge within 3 weeks of immunization. Protection was not dependent on recognition of the highly variable external viral proteins and could be achieved with a single vaccine dose. The rAd vaccine was superior to the ca vaccine by certain measures, justifying continued investigation of this experimental vaccine even though ca vaccine is already available. This study highlights the potential for cross-protective vaccines as a public health option early in an influenza pandemic

Antigenic Fingerprinting of H5N1 Avian Influenza Using Convalescent Sera and Monoclonal Antibodies Reveals Potential Vaccine and Diagnostic Targets

Using whole-genome-fragment phage display libraries, Hana Golding and colleagues identify the viral epitopes recognized by serum antibodies in humans who have recovered from infection with H5N1 avian influenza