HDL Proteome in Hemodialysis Patients: A Quantitative Nanoflow Liquid Chromatography-Tandem Mass Spectrometry Approach

Aside from a decrease in the high-density lipoprotein (HDL) cholesterol levels, qualitative abnormalities of HDL can contribute to an increase in cardiovascular (CV) risk in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD). Dysfunctional HDL leads to an alteration of reverse cholesterol transport and the antioxidant and anti-inflammatory properties of HDL. In this study, a quantitative proteomics approach, based on iTRAQ labeling and nanoflow liquid chromatography mass spectrometry analysis, was used to generate detailed data on HDL-associated proteins. The HDL composition was compared between seven chronic HD patients and a pool of seven healthy controls. To confirm the proteomics results, specific biochemical assays were then performed in triplicate in the 14 samples as well as 46 sex-matched independent chronic HD patients and healthy volunteers. Of the 122 proteins identified in the HDL fraction, 40 were differentially expressed between the healthy volunteers and the HD patients. These proteins are involved in many HDL functions, including lipid metabolism, the acute inflammatory response, complement activation, the regulation of lipoprotein oxidation, and metal cation homeostasis. Among the identified proteins, apolipoprotein C-II and apolipoprotein C-III were significantly increased in the HDL fraction of HD patients whereas serotransferrin was decreased. In this study, we identified new markers of potential relevance to the pathways linked to HDL dysfunction in HD. Proteomic analysis of the HDL fraction provides an efficient method to identify new and uncharacterized candidate biomarkers of CV risk in HD patients

Stratification of cardio-vascular risk : Place of innovate biomarkers

L'insuffisance rénale chronique (IRC) demeure un problème de santé publique du fait de l'augmentation de sa prévalence. Malgré l'amélioration de la prise en charge, le taux de mortalité reste plus élevé comparé à la population générale. Parmi les causes de décès, les maladies cardiovasculaires, d'origine multifactorielle (élargissement et hypertrophie des artères, athérosclérose, calcifications vasculaires et valvulaires) sont au premier plan. A côté des facteurs de risque classiques, des facteurs non traditionnels, liés aux perturbations métaboliques de l'IRC, ont été mis en évidence, comme l'inflammation, la malnutrition, le stress oxydant, les anomalies du métabolisme minéralo-osseux. La meilleure connaissance de la physiopathologie de la vasculopathie de l'IRC permet d'émerger de nouveaux biomarqueurs pour stratifier le risque cardiovasculaire chez l'IRC.OBJECTIFS-METHODOLOGIE GENERALE : Nous avons réalisé une approche biochimique pour explorer trois composantes du risque cardiovasculaire chez l'IRC : stress oxydant, perturbations qualitatives des HDL (high-density lipoprotein) et métabolisme minéralo-osseux.RESULTATS : Dans une première publication la production d'anion superoxyde a été évaluée, via une méthode de chemoluminescence, en fonction du stade de l'IRC. Alors que la surproduction de formes réactives de l'oxygène est bien connue au stade 5d et peut être liée à la procédure dialytique, il existe peu de données aux stades précoces. Notre étude a porté sur 136 patients IRC non dialysés des stades 1à 5. Les résultats montrent que la production de FRO est assurée aux stades 4 et 5. Un bas débit de filtration glomérulaire (MDRD3.7g/l) et des taux anormaux d' HDL (1.75mM) apparaissent comme les principaux déterminants du stress oxydant chez l'IRC non dialysé.Alors que dans la population générale, un taux bas de HDL est reconnu comme un facteur de risque important, nous avons montré (publication 1) que des taux anormaux de HDL, bas comme hauts, étaient indépendamment associés au stress oxydant chez les sujets IRC. Dans une deuxième publication, nous avons précisé la composition des HDL en se basant sur d'éventuelles modifications qualitatives des protéines associées à la structure des lipoprotéines. Une étude protéomique a été réalisée chez 7 patients hémodialysés versus 7 sujets sains. Nous avons retrouvé 40 protéines exprimées différemment sur les 122 identifiées, dont l'apoCII, l'apoCIII qui sont significativement augmentées et la transferrine abaissée. Ces protéines interviennent dans de nombreuses fonctions comme la réponse inflammatoire, l'activation du complément, la régulation de l'oxydation des lipoprotéines, l'homéostasie des cations.Dans une troisième publication, l'épuration du FGF23, phosphatonine impliquée dans les anomalies du métabolisme minéralo-osseux, été étudiée chez l'hémodialysé chronique en fonction de la techniques de dialyse (hémodialyse (HD) high flux versus hémodiafiltration on line (OL-HDF)). Notre étude a porté sur 53 patients dans le groupe HD et 32 patients dans le groupe OL-HDF. Dans les deux groupes le taux de FGF23 en post-dialyse est significativement plus bas qu'en pré-dialyse. Cependant, le taux de réduction, la clairance et le KT/V du FGF23 sont significativement plus bas dans le groupe OL-HDF.CONCLUSION-PERSPECTIVES : Chez l'IRC, avec l'appariation de facteurs de risque non traditionnels, de nouveaux biomarqueurs ont émergés dans la stratification du risque cardio-vasculaire. Ces biomarqueurs peuvent devenir des bioacteurs et représenter de nouvelles cibles d'action et de prévention de l'atteinte cardio-vasculaire chez l'IRC. La complexité des mécanismes physiopathologiques impliqués, nous incite à proposer des approches multimarqueurs. Actuellement des études biocliniques se poursuivent en mettant en place des cohortes régionales de patients aux stades 1 à 5 et de patients incidents en dialyse.BACKGROUND: Chronic kidney disease (CKD) is a public health problem because of its increasing prevalence. Despite care improvements, the mortality rate remains higher compared to general population. Among causes of death, cardiovascular diseases with multifactorial origins (enlargement and hypertrophy of arteries, atherosclerosis, vascular and valvular calcifications) are in the foreground. Besides the traditional risk factors, non-traditional factors associated with metabolic disorders in CKD were bring out, such as inflammation, malnutrition, oxidative stress, mineral and bone disorder. A better knowledge of vasculopathy physiopathology in CKD allows the emergence of new biomarkers to stratify cardiovascular risk in CKD.AIMS-METHODOLOGY: We performed a biochemical approach to explore three components of cardiovascular risk in CKD: oxidative stress, qualitative alterations of HDL (high-density lipoprotein) and mineral and bone disorder.RESULTS: In a first publication, the superoxide anion production, according to the stage of CKD, was assessed using a chemiluminescence method. While the overproduction of reactive oxygen species is well known at the 5d stage of CKD and may be related to the dialysis procedure, there are few data in the early stages. Our study included 136 non-dialysis patients at stages 1 to 5 of CKD. Results showed an enhanced superoxide production at the pre-dialysis phase, stages 4 and 5 of CKD. Reduced glomerular filtration rate (MDRD <30 ml / min / 1.73m2), inflammation (fibrinogène≥3.7g / l) and abnormal levels of HDL (<1.42mM and ≥1.75mM) appears as main determinants of oxidative stress in non-dialysis CKD patients.While in general population, a low HDL rate is recognized as an important risk factor, we showed (publication 1) that abnormal levels of HDL, low as high, were independently associated with oxidative stress in CKD subjects. In a second publication, we have defined the HDL composition based on qualitative changes in the structure of proteins associated with lipoproteins. A proteomic study was performed in 7 patients on hemodialysis versus 7 healthy subjects. We found 40 proteins differently expressed on the 122 identified, including apoCII, apoCIII which are significantly increased and transferrin lowered. These proteins are involved in many functions such as inflammatory response, complement activation, regulation of lipoprotein oxidation and homeostasis cations. In a third publication, the removal of FGF23, phosphatonin involved in mineral and bone metabolism, was studied in chronic hemodialysis according to the dialysis techniques (high flux hemodialysis (HD) versus on line hemodiafiltration (OL- HDF)). Our study included 53 patients in the HD group and 32 patients in the OL-HDF group. In both groups the rate of FGF23 in post-dialysis was significantly lower than in pre-dialysis. However, rate of reduction, clearance and KT / V of FGF23 were significantly lower in the OL-HDF group.CONCLUSION-PROSPECTS: In the IRC, with the appearance of non traditional risk-factors, new biomarkers have emerged in the stratification of cardiovascular risk. These biomarkers can become bioactors and represent novel targets of action and prevention in the cardiovascular disease in CKD. The complexity of the involved physiopatholological mechanisms, leads us to propose multimarkers approaches. Currently bioclinical studies continue with the constitution of regional cohorts of patients at stages 1 to 5 of CKD and incident dialysis

Déterminants du stress oxydant chez le patient insuffisant rénal chronique (stade I à V n'ayant pas débuté l'épuration extra-rénale)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Hémodiafiltration en ligne : modalités pratiques, sécurité et efficacité de la méthode

International audienc

Cardioprotective Effect of Acute Intradialytic Exercise: A Comprehensive Speckle-Tracking Echocardiography Analysis

Significance Statement Hemodialysis (HD) can lead to acute left ventricular (LV) myocardial wall motion abnormalities (myocardial stunning) due to segmental hypoperfusion. Exercise during dialysis is associated with favorable effects on central hemodynamics and BP stability, factors considered in the etiology of HD-induced myocardial stunning. In a speckle-tracking echocardiography analysis, the authors explored effects of acute intradialytic exercise (IDE) on LV regional myocardial function in 60 patients undergoing HD. They found beneficial effects of IDE on LV longitudinal and circumferential function and on torsional mechanics, not accounted for by cardiac loading conditions or central hemodynamics. These findings support the implementation of IDE in people with ESKD, given that LV transient dysfunction imposed by repetitive HD may contribute to heart failure and increased risk of cardiac events in such patients. Background Hemodialysis (HD) induces left ventricular (LV) transient myocardial dysfunction. A complex interplay between linear deformations and torsional mechanics underlies LV myocardial performance. Although intradialytic exercise (IDE) induces favorable effects on central hemodynamics, its effect on myocardial mechanics has never been comprehensively documented. Methods To evaluate the effects of IDE on LV myocardial mechanics, assessed by speckle-tracking echocardiography, we conducted a prospective, open-label, two-center randomized crossover trial. We enrolled 60 individuals with ESKD receiving HD, who were assigned to participate in two sessions performed in a randomized order: standard HD and HD incorporating 30 minutes of aerobic exercise (HDEX). We measured global longitudinal strain (GLS) at baseline (T0), 90 minutes after HD onset (T1), and 30 minutes before ending HD (T2). At T0 and T2, we also measured circumferential strain and twist, calculated as the net difference between apical and basal rotations. Central hemodynamic data (BP, cardiac output) also were collected. Results The decline in GLS observed during the HD procedure was attenuated in the HDEX sessions (estimated difference, −1.16%; 95% confidence interval [95% CI], −0.31 to −2.02; P = 0.008). Compared with HD, HDEX also demonstrated greater improvements from T0 to T2 in twist, an important component of LV myocardial function (estimated difference, 2.48°; 95% CI, 0.30 to 4.65; P = 0.02). Differences in changes from T0 to T2 for cardiac loading and intradialytic hemodynamics did not account for the beneficial effects of IDE on LV myocardial mechanics kinetics. Conclusions IDE applied acutely during HD improves regional myocardial mechanics and might warrant consideration in the therapeutic approach for patients on HD

The expression analysis of apoC-II, apoC-III, serotransferrin and haptoglobin in the HDL fractions of the healthy volunteers and the HD patients.

<p>The concentration of the proteins in the 14 samples of the discovery set (A) and in the 46 samples of the validation set (B) were determined using biochemical analyses. The mean is indicated by the horizontal line.</p

Comparison of the iTRAQ ion ratios and the biochemical quantification ratios.

<p>Comparison of the iTRAQ ion ratios and the biochemical quantification ratios.</p

iTRAQ ratios for the healthy and HD samples: HD patient samples (HD1-7) <i>vs.</i> pooled healthy subject samples.

<p>Ratios of at least 1.3-fold relative to the control samples, and a <i>p</i>-value<0.05 are indicated in bold.</p

Clinical characteristics of the study population.

*<p>Mann-Whitney test.</p

Cardiovascular risk stratification in hemodialysis patients in the era of highly sensitive troponins: should we choose between hs-troponin I and hs-troponin T?

International audienceNew highly sensitive (hs) assays have challenged the interpretation of cardiac troponins (cTn). The present study was designed to evaluate simultaneously conventional cTnT and cTnI together with their corresponding highly sensitive determinations in stable hemodialysis (HD) patients. Ability of cTn to stratify HD patient risk was assessed