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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Sci+Transl+Med
2017 ; 9
(417
): ä Nephropedia Template TP
Shashar M
; Belghasem ME
; Matsuura S
; Walker J
; Richards S
; Alousi F
; Rijal K
; Kolachalama VB
; Balcells M
; Odagi M
; Nagasawa K
; Henderson JM
; Gautam A
; Rushmore R
; Francis J
; Kirchhofer D
; Kolandaivelu K
; Sherr DH
; Edelman ER
; Ravid K
; Chitalia VC
Sci Transl Med
2017[Nov]; 9
(417
): ä PMID29167396
show ga
Chronic kidney disease (CKD/uremia) remains vexing because it increases the risk
of atherothrombosis and is also associated with bleeding complications on
standard antithrombotic/antiplatelet therapies. Although the associations of
indolic uremic solutes and vascular wall proteins [such as tissue factor (TF) and
aryl hydrocarbon receptor (AHR)] are being defined, the specific mechanisms that
drive the thrombotic and bleeding risks are not fully understood. We now present
an indolic solute-specific animal model, which focuses on solute-protein
interactions and shows that indolic solutes mediate the hyperthrombotic phenotype
across all CKD stages in an AHR- and TF-dependent manner. We further demonstrate
that AHR regulates TF through STIP1 homology and U-box-containing protein 1
(STUB1). As a ubiquitin ligase, STUB1 dynamically interacts with and degrades TF
through ubiquitination in the uremic milieu. TF regulation by STUB1 is supported
in humans by an inverse relationship of STUB1 and TF expression and reduced
STUB1-TF interaction in uremic vessels. Genetic or pharmacological manipulation
of STUB1 in vascular smooth muscle cells inhibited thrombosis in flow loops.
STUB1 perturbations reverted the uremic hyperthrombotic phenotype without
prolonging the bleeding time, in contrast to heparin, the standard-of-care
antithrombotic in CKD patients. Our work refines the thrombosis axis (STUB1 is a
mediator of indolic solute-AHR-TF axis) and expands the understanding of the
interconnected relationships driving the fragile thrombotic state in CKD. It also
establishes a means of minimizing the uremic hyperthrombotic phenotype without
altering the hemostatic balance, a long-sought-after combination in CKD patients.