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2015 ; 10
(3
): e0118703
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Functional genomic analysis identifies indoxyl sulfate as a major, poorly
dialyzable uremic toxin in end-stage renal disease
#MMPMID25811877
Jhawar S
; Singh P
; Torres D
; Ramirez-Valle F
; Kassem H
; Banerjee T
; Dolgalev I
; Heguy A
; Zavadil J
; Lowenstein J
PLoS One
2015[]; 10
(3
): e0118703
PMID25811877
show ga
BACKGROUND: Chronic renal failure is characterized by progressive renal scarring
and accelerated arteriosclerotic cardiovascular disease despite what is
considered to be adequate hemodialysis or peritoneal dialysis. In rodents with
reduced renal mass, renal scarring has been attributed to poorly filtered, small
protein-bound molecules. The best studied of these is indoxyl sulfate (IS).
METHODS: We have attempted to establish whether there are uremic toxins that are
not effectively removed by hemodialysis. We examined plasma from patients
undergoing hemodialysis, employing global gene expression in normal human renal
cortical cells incubated in pre- and post- dialysis plasma as a reporter system.
Responses in cells incubated with pre- and post-dialysis uremic plasma (n = 10)
were compared with responses elicited by plasma from control subjects (n = 5).
The effects of adding IS to control plasma and of adding probenecid to uremic
plasma were examined. Plasma concentrations of IS were measured by HPLC (high
pressure liquid chromatography). RESULTS: Gene expression in our reporter system
revealed dysregulation of 1912 genes in cells incubated with pre-dialysis uremic
plasma. In cells incubated in post-dialysis plasma, the expression of 537 of
those genes returned to baseline but the majority of them (1375) remained
dysregulated. IS concentration was markedly elevated in pre- and post-dialysis
plasma. Addition of IS to control plasma simulated more than 80% of the effects
of uremic plasma on gene expression; the addition of probenecid, an organic anion
transport (OAT) inhibitor, to uremic plasma reversed the changes in gene
expression. CONCLUSION: These findings provide evidence that hemodialysis fails
to effectively clear one or more solutes that effect gene expression, in our
reporter system, from the plasma of patients with uremia. The finding that gene
dysregulation was simulated by the addition of IS to control plasma and inhibited
by addition of an OAT inhibitor to uremic plasma identifies IS as a major, poorly
dialyzable, uremic toxin. The signaling pathways initiated by IS and possibly
other solutes not effectively removed by dialysis may participate in the
pathogenesis of renal scarring and uremic vasculopathy.