中分子尿毒症毒素及其清除技术的研究进展

尿毒症毒素是一大组体内代谢的产物,在肾功能衰竭患者体液中水平明显升高,并与尿毒症毒素代谢紊乱或临床表现密切相关。一般认为中分子尿毒症毒素的分子量在500D-5000D之间。此类物质蓄积可促进尿毒症性心血管病变的发生发展、抑制机体免疫功能、加重患者营养不良等。研究发现,通过高通量透析、血液透析滤过和血液灌流等方法增加中分子尿毒症毒素的清除,可以为患者带来更好的生活质量和长期生存获益。     

硫酸吲哚酚在终末期肾病心血管并发症中的研究进展

心血管疾病是慢性肾脏病患者最常见的并发症之一,也是慢性肾脏病患者死亡的主要原因。尿毒症毒素是肾功能不全时导致心血管疾病发生的重要因素。在慢性肾脏病患者中,以硫酸吲哚酚为代表的蛋白结合性尿毒症毒素,是一类很难通过常规透析方式清除的物质,且毒性极大。近年来,已有研究证实慢性肾脏病诱导心血管疾病的发生与硫酸吲哚酚的蓄积密切相关。硫酸吲哚酚可通过诱导氧化应激导致内皮损伤,平滑肌细胞增殖和迁移,促进动脉粥样硬化发生,从而影响全身多个系统。本文就尿毒症毒素硫酸吲哚酚在终末期肾病心血管并发症中的研究进展作一综述。     

硫酸吲哚酚在慢性肾脏病合并肌少症中的研究进展

肌少症是慢性肾脏病(chronic kidney disease,CKD)患者常见的并发症之一，给患者带来巨大的疾病负担，甚至导致患者的死亡。肌少症的发生与CKD患者体内聚积的尿毒症毒素密切相关。硫酸吲哚酚(indoxyl sulfate,IS)是一种常见的肠源性蛋白质结合类尿毒症毒素，可能通过促进机体的炎症及氧化应激反应、破坏蛋白质合成与分解稳态、引起线粒体功能障碍、损害成肌细胞生长等机制参与CKD患者肌少症的发生发展。因此，本文综述了IS的正常代谢、引起CKD患者肌少症的机制及以IS为靶点的CKD肌少症的防治方法，以期为临床CKD肌少症患者的治疗提供新的选择，为后续研究提供参考。     

β-银环蛇神经毒素结合蛋白的分离纯化

大鼠膈肌神经突触前膜上存在β－银环蛇毒素结合蛋白。膈肌经匀浆、去垢剂抽提、离子交换层析、植物凝集素亲和层析及银环蛇毒素亲和层析,可获得纯化的β－银环蛇毒素结合蛋白。其比结合活性达１ｎｍｏｌ／ｍｇ蛋白质。整个纯化过程的总得率为３％。纯化蛋白制品的ＳＤＳ聚丙烯酰胺凝胶电泳图谱显示,有两个共纯化的多肽链,其分子量分别为６１和６９ｋＤ。     

高通量血液透析治疗慢性肾衰竭尿毒症的疗效及对尿毒症毒素、免疫球蛋白及肺功能指标的影响

目的:探讨高通量血液透析(HFHD)治疗慢性肾衰竭尿毒症的疗效及对尿毒症毒素、免疫球蛋白及肺功能指标的影响。方法:选取90例于2012年1月-2017年3月期间在喀什地区第一人民医院治疗的慢性肾衰竭尿毒症患者,依据随机数字表法将其分为对照组(n=45)和观察组(n=45),对照组给予血液透析滤过(HDF)治疗,观察组给予HFHD治疗,两组均透析治疗1个月。对比两组患者透析前后症状缓解情况及尿毒症毒素、免疫球蛋白及肺功能指标水平,记录两组相关并发症的发生情况。结果:透析治疗结束后观察组患者缓解率为91.11%(41/45),高于对照组的73.33%(33/45)(P0.05)。两组患者透析后血磷(P~-)、血钾(K~+)、甲状旁腺激素(PTH)、β2-微球蛋白(β2-MG)水平明显低于透析前,血钙(Ca~(2+))水平明显高于透析前(P0.05);观察组透析后K~+、Ca~(2+)、P~-等尿毒症毒素水平与对照组比较差异无统计学意义(P0.05),观察组透析后PTH、β2-MG水平明显低于对照组(P0.05)。透析后,两组患者的免疫球蛋白Ig M、Ig A、Ig G水平均较透析前上升,且观察组高于对照组(P0.05)。透析后,两组患者残气量(RV)均低于治疗前,最大肺活量(FVC)、肺活量(VC)、肺总量(TLC)均高于治疗前,且观察组RV低于对照组,FVC、VC、TLC均高于对照组(P0.05)。观察组并发症发生率为8.89%(4/45),低于对照组的24.44%(11/45)(P0.05)。结论:HFHD治疗慢性肾衰竭尿毒症能够安全有效地清除尿毒症毒素,缓解患者的临床症状,且能够提高患者的免疫功能和肺功能。     

Bt杀虫晶体蛋白受体分子的结构与功能

苏云金杆菌（Bacillus thuringiensis, Bt)杀虫蛋白与昆虫中肠细胞膜上受体的结合是Bt毒素作用的关键环节和决定Bt杀虫蛋白选择性的关键因素。受体与Bt杀虫蛋白结合能力的改变可能是昆虫对Bt产生抗性的主要原因,也因此成为近年来国际上的研究热点和焦点,并取得了突破性的进展。该文就昆虫体内Bt毒素的４种受体：氨肽酶N、类钙粘蛋白、碱性磷酸酶以及最近报道的糖脂类受体的结构、功能、受体与毒素的结合特性、受体基因在离体细胞中的表达特性以及受体基因的突变与害虫对Bt毒素的抗性等方面进行了综述。     

家蚕氨肽酶和类钙粘蛋白与苏云金芽孢杆菌Cry1Ac毒素相互作用

苏云金芽孢杆菌Bacillus thuringiensis生产的晶体毒素被广泛用作农林害虫的杀虫剂。鳞翅目昆虫受体蛋白是阐明其与晶体毒素相互作用的重要模式。文中纯化了苏云金芽孢杆菌的晶体毒素蛋白,质谱鉴定为Cry1Ac毒素,然后重组表达家蚕氨肽酶N (BmAPN6) 和类钙粘蛋白 (CaLP) 结合结构域。利用免疫共沉淀、Far-Western印迹和酶联免疫吸附试验,证明Cry1Ac毒素蛋白和BmAPN6之间的相互作用。在Sf9细胞中,对Cry1Ac毒素的细胞毒活性分析,表明BmAPN6参与Cry1Ac毒素诱导的细胞形态异常和裂解死亡。文中也利用相同的方法,对钙粘蛋白的3个结合位点CR7、CR11和CR12进行相互作用分析,结果表明3个重复结构域是CaLP的Cry1Ac结合位点。上述结果表明,BmAPN6和CaLP可作为Cry1Ac毒素致病的功能性受体,为进一步揭示晶体毒素的致病机制和基因编辑增强家蚕抗病性提供了研究靶标。     

家蚕氨肽酶和类钙粘蛋白与苏云金芽孢杆菌Cry1Ac毒素相互作用（英文）

苏云金芽孢杆菌Bacillusthuringiensis生产的晶体毒素被广泛用作农林害虫的杀虫剂。鳞翅目昆虫受体蛋白是阐明其与晶体毒素相互作用的重要模式。文中纯化了苏云金芽孢杆菌的晶体毒素蛋白,质谱鉴定为Cry1Ac毒素,然后重组表达家蚕氨肽酶N (BmAPN6)和类钙粘蛋白(CaLP)结合结构域。利用免疫共沉淀、Far-Western印迹和酶联免疫吸附试验,证明Cry1Ac毒素蛋白和BmAPN6之间的相互作用。在Sf9细胞中,对Cry1Ac毒素的细胞毒活性分析,表明BmAPN6参与Cry1Ac毒素诱导的细胞形态异常和裂解死亡。文中也利用相同的方法,对钙粘蛋白的3个结合位点CR7、CR11和CR12进行相互作用分析,结果表明3个重复结构域是CaLP的Cry1Ac结合位点。上述结果表明,BmAPN6和CaLP可作为Cry1Ac毒素致病的功能性受体,为进一步揭示晶体毒素的致病机制和基因编辑增强家蚕抗病性提供了研究靶标。     

炭疽毒素受体与人IgG1的Fc段融合蛋白ATR_Fc在CHO细胞中的表达

ATR_Fc是人炭疽毒素受体(ATR)的胞外区与人免疫球蛋白IgG1的铰链区、CH2区和CH3区组成的融合蛋白。表达该蛋白是为了获得结合PA的抗体样分子,通过阻断PA与细胞受体的结合,而阻止炭疽致死毒素和水肿因子进入细胞内,可作为预防和治疗炭疽感染的生物制品。将编码炭疽毒素受体N端1_227氨基酸的基因和编码Fc段的基因连接,插入到pcDNA3.1的HindⅢ和NotⅠ位点得到表达ATR_Fc融合蛋白的真核表达载体pcDNA3.1ATR_Fc,并用脂质体方法将该载体转染至CHO_K1细胞中,用G418筛选并获得ATR_Fc表达水平为10～15μg(106cells·d)的基因工程CHO细胞系ATR_Fc_1D5。采用蛋白A纯化重组蛋白,并用ELISA法鉴定ATR_Fc与PA的亲和性,表明ATR_Fc可与PA特异性结合。     

炭疽毒素受体与人IgG1的Fc段融合蛋白ATR_Fc在CHO细胞中的表达

ATR-Fc是人炭疽毒素受体（ATR）的胞外区与人免疫球蛋白IgG1的铰链区、CH2区和CH3区组成的融合蛋白。表达该蛋白是为了获得结合PA的抗体样分子,通过阻断PA与细胞受体的结合,而阻止炭疽致死毒素和水肿因子进入细胞内,可作为预防和治疗炭疽感染的生物制品。将编码炭疽毒素受体N端1-227氨基酸的基因和编码Fc段的基因连接,插入到pcDNA3-1的HindⅢ和NotⅠ位点得到表达ATR-Fc融合蛋白的真核表达载体pcDNA31/ATR9Fc,并用脂质体方法将该载体转染至CHO-K1细胞中,用G418筛选并获得ATR-Fc表达水平为10～15μg/(106cells·d)的基因工程CHO细胞系ATR-Fc-1D5。采用蛋白A纯化重组蛋白,并用ELISA法鉴定ATR-Fc与PA的亲和性,表明ATR-Fc可与PA特异性结合。     

Generation and characterization of monoclonal antibody against Advanced Glycation End Products in chronic kidney disease

Advanced Glycation End Products (AGEs) are toxins that are involved in structural and functional alterations of several organs and tissues, resulting in various pathologies. Several types of AGEs have been described but carboxymethyllysine (CML) is the major antigenic AGE compound. In this study, three different immunogenic carrier proteins (KLH, keyhole limpet hemocyanin; BSA, bovine serum albumin; and HSA, human serum albumin) were modified by glycation. The glycated molecules were used to produce epitope-specific monoclonal antibodies able to recognize the CML domain and to detect uremic toxins in the serum of patients with chronic kidney disease (CKD). A competitive ELISA was standardized in order to quantify CML in the sera of CKD patients. An increase in uremic toxins can compromise the clinical condition of these patients, thus, the detection and quantification of these toxins should contribute to a better management and understanding of this disease.     

Does P-Cresylglucuronide Have the Same Impact on Mortality as Other Protein-Bound Uremic Toxins?

Background

Uremic toxins are emerging as important, non-traditional cardiovascular risk factors in chronic kidney disease (CKD). P-cresol has been defined as a prototype protein-bound uremic toxin. Conjugation of p-cresol creates p-cresylsulfate (PCS) as the main metabolite and p-cresylglucuronide (PCG), at a markedly lower concentration. The objective of the present study was to evaluate serum PCG levels, determine the latter’s association with mortality and establish whether the various protein-bound uremic toxins (i.e. PCS, PCG and indoxylsulfate (IS)) differed in their ability to predict mortality.

Methodology/Principal Findings

We studied 139 patients (mean ± SD age: 67±12; males: 60%) at different CKD stages (34.5% at CKD stages 2–3, 33.5% at stage 4–5 and 32% at stage 5D). A recently developed high-performance liquid chromatography method was used to assay PCG concentrations. Total and free PCG levels increased with the severity of CKD. During the study period (mean duration: 779±185 days), 38 patients died. High free and total PCG levels were correlated with overall and cardiovascular mortality independently of well-known predictors of survival, such as age, vascular calcification, anemia, inflammation and (in predialysis patients) the estimated glomerular filtration rate. In the same cohort, free PCS levels and free IS levels were both correlated with mortality. Furthermore, the respective predictive powers of three Cox multivariate models (free PCS+other risk factors, free IS+other risk factors and free PCS+other risk factors) were quite similar - suggesting that an elevated PCG concentration has much the same impact on mortality as other uremic toxins (such as PCS or IS) do.

Conclusions

Although PCG is the minor metabolite of p-cresol, our study is the first to reveal its association with mortality. Furthermore, the free fraction of PCG appears to have much the same predictive power for mortality as PCS and IS do.     

Adsorption of the uremic toxin p-cresol onto hemodialysis membranes and microporous adsorbent zeolite silicalite

Para-cresol CH3C6H4OH is a protein-bound solute which is not eliminated efficiently by hemodialysis systems. In this study, we present adsorption of p-cresol as a complementary process to hemodialysis. The kinetics and isotherms of adsorption onto cellulose-based membranes (cellulose diacetate and triacetate), synthetic membranes (polyamide, polysulfone, polyacrylonitrile and polymethylmethacrylate) and microporous zeolite silicalite (MFI), have been evaluated in static conditions. The results indicate that p-cresol has a low affinity to all membranes but polysulfone and polyamide and that the times to reach equilibrium conditions are slow. In contrast, equilibration time on silicalite is fast (2 min to eliminate 90%) while adsorption levels are high (maximum adsorption about 106 mg g(-1)). Adsorption onto microporous adsorbents could be a novel way to eliminate uremic toxins from blood.     

Oxidatively-modified and glycated proteins as candidate pro-inflammatory toxins in uremia and dialysis patients

End stage renal disease (ESRD) patients accumulate blood hallmarks of protein glycation and oxidation. It is now well established that these protein damage products may represent a heterogeneous class of uremic toxins with pro-inflammatory and pro-oxidant properties. These toxins could be directly involved in the pathogenesis of the inflammatory syndrome and vascular complications, which are mainly sustained by the uremic state and bioincompatibility of dialysis therapy. A key underlying event in the toxicity of these proteinaceous solutes has been identified in scavenger receptor-dependent recognition and elimination by inflammatory and endothelial cells, which once activated generate further and even more pronounced protein injuries by a self-feeding mechanism based on inflammation and oxidative stress-derived events. This review examines the literature and provides original information on the techniques for investigating proteinaceous pro-inflammatory toxins. We have also evaluated therapeutic - either pharmacological or dialytic - strategies proposed to alleviate the accumulation of these toxins and to constrain the inflammatory and oxidative burden of ESRD.     

Involvement of organic anion transporters in the efflux of uremic toxins across the blood-brain barrier

Renal failure causes multiple physiological changes involving CNS dysfunction. In cases of uremia, there is close correlation between plasma levels of uremic toxins [e.g. 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), hippurate (HA) and indoleacetate (IA)] and the degree of uremic encephalopathy, suggesting that uremic toxins are involved in uremic encephalopathy. In order to evaluate the relevance of uremic toxins to CNS dysfunction, we investigated directional transport of uremic toxins across the blood-brain barrier (BBB) using in vivo integration plot analysis and the brain efflux index method. We observed saturable efflux transport of [(3)H]CMPF, [(14)C]HA and [(3)H]IA, which was inhibited by probenecid. For all uremic toxins evaluated, apparent efflux clearance across the BBB was greater than apparent influx clearance, suggesting that these toxins are predominantly transported from the brain to blood across the BBB. Saturable efflux transport of [(3)H]CMPF, [(14)C]HA and [(3)H]IA was completely inhibited by benzylpenicillin, which is a substrate of rat organic anion transporter 3 (rOat3). Taurocholate and digoxin, which are common substrates of rat organic anion transporting polypeptide (rOatp), partially inhibited the efflux of [(3)H]CMPF. Transport experiments using a Xenopus laevis oocyte expression system revealed that CMPF, HA and IA are substrates of rOat3, and that CMPF (but not HA or IA) is a substrate of rOap2. These results suggest that rOat3 mediates brain-to-blood transport of uremic toxins, and that rOatp2 is involved in efflux of CMPF. Thus, conditions typical of uremia can cause inhibition of brain-to-blood transport involving rOat3 and/or rOatp2, leading to accumulation of endogenous metabolites and drugs in the brain.     

The Association of Uremic Toxins and Inflammation in Hemodialysis Patients

Background

Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear.

Methods

We conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients.

Results

The uremic toxins were not associated with inflammatory markers- including high sensitivity C-reactive protein, IL(Interleukin) -1β, IL-6, tumor necrosis factor-α. In multiple linear regression, serum levels of total p-cresol sulfate (PCS) were independently significantly associated with serum total indoxyl sulfate (IS) (standardized coefficient: 0.274, p<0.001), and co-morbidity of diabetes mellitus (DM) (standardized coefficient: 0.342, p<0.001) and coronary artery disease (CAD) (standardized coefficient: 0.128, p = 0.043). The serum total PCS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, p<0.001). Serum levels of total IS was independently significantly associated with serum creatinine (standardized coefficient: 0.285, p<0.001), total PCS (standardized coefficient: 0.239, p = 0.001), and synthetic membrane dialysis (standardized coefficient: 0.139, p = 0.046).

Conclusion

The study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total PCS were independently positively significantly associated with co-morbidity of CAD and DM.     

The uremic toxin indoxyl sulfate exacerbates reactive oxygen species production and inflammation in 3T3-L1 adipose cells

Inflammation and oxidative stress are common features of patients with chronic kidney disease (CKD) and many uremic solutes retained in these patients could be involved in these processes, among which protein-bound solutes such as indoxyl sulfate (IS). White adipose tissue recently gained attention as an important source of inflammation and oxidative stress. To examine the effect of IS on adipocytes, 3T3-L1 adipose cells were incubated with IS to mimic the conditions encountered in uremic patients. Incubation of adipose cells with IS increased reactive oxygen species production generated mainly through activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase since it was prevented by the NADPH oxidase inhibitor apocynin. Exposure to IS furthermore exacerbated the secretion of tumor necrosis factor-α and interleukin-6 by adipose cells. This inflammatory response was prevented by NADPH oxidase inhibition pinpointing the pivotal role of intracellular oxidative stress. IS induces adipocyte perturbation and promotes inflammatory state mainly through induction of oxidative stress. IS, a uremic toxin, accumulates in CKD patients could, therefore, be an important mediator of adipocyte dysfunction in these patients.     

Erythrocyte glutathione transferase: a new biomarker for hemodialysis adequacy,overcoming the Kt/Vurea dogma?

Kt/V_urea ratio is commonly used to assess the delivered dose of dialysis in maintenance hemodialysis (MHD) patients. This parameter only reflects the efficacy of dialytic treatments in removing small toxins, but not middle and protein-bound toxins. Erythrocyte glutathione transferase (e-GST), an enzyme devoted to cell depuration against a lot of large and small toxins, is overexpressed in uremic patients. Aim of the present study is to verify whether e-GST may represent a novel biomarker to assess the adequacy of different dialytic techniques complementary to Kt/V_urea parameter. Furthermore, it will be investigated whether e-GST could reflect the ‘average'' adequacy of multiple dialytic sessions and not of a single one treatment as it occurs for Kt/V_urea. One hundred and three MHD patients and 82 healthy subjects were tested. Fourty four patients were treated with standard bicarbonate hemodialysis (HD) and 59 patients were on online hemodiafiltration (HDF). In all MHD patients e-GST activity was 60% higher than in healthy controls. In HDF, e-GST activity was lower than in HD subgroup (8.2±0.4 versus 10.0±0.4 U/g_Hb, respectively). Single-pool Kt/V_urea and total weekly Kt/V_urea were higher in HDF than in HD, but no correlation was found between e-GST activity and Kt/V_urea data. e-GST, whose level is stable during the erythrocyte life-span, provides information on the long-term depurative efficacy of dialysis treatments.