The relationship of uremic toxin indoxyl sulfate and intestinal elimination mechanisms in hemodialysis patients.

INTRODUCTION: High indoxyl sulfate (IS) concentration is a serious problem for patients with CKD increasing the risk of cardiovascular diseases and CKD progression. Thus, the methods of decreasing the toxin concentrations are highly desired. The study aimed to discover the role of selected intestine related factors on IS concentration. METHODS: We evaluated the impact of ABCG2 and ABCC2 polymorphisms influencing activity and protein intake by normalized protein catabolic rate. Additionally, we examined the relation of IS and uric acid (UA), that can share common elimination transporters. A monocentric, prospective, open cohort pilot study was performed on 108 patients undergoing dialysis treatment. RESULTS: The positive effect of residual diuresis on the reduction of IS levels was confirmed (p = 0.005). Also, an increase in IS depending on the dietary protein intake was confirmed (p = 0.040). No significant correlation between ABC gene polymorphisms was observed either, suggesting the negligible role of ABCG2 and ABCC2 in the elimination of IS in small bowel. The significant difference was observed for UA where ABCG2 421C>A (rs72552713) gene polymorphism was higher (505.3 µmol/L) in comparison with a wild type genotype (360.5 µmol/L). Discussion/ Conclusion: No evidence of bowel elimination pathway via ABCC2 and ABCG2 transporters was found in renal replacement therapy patients.

Indoxyl Sulfate Elimination in Renal Replacement Therapy: Influence of Citrate- versus Acetate-Buffering Component during Bicarbonate Dialysis.

Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading cause in the poor survival rate of dialysis patients. A monocentric, prospective, open cohort study was performed in 43 male patients undergoing chronic renal replacement therapy in a single hemodialysis center. The aim of the study was to determine the influence of acetate- versus citrate-buffered dialysis fluids in hemodialysis (HD) and postdilution hemodiafiltration (HDF) settings on the elimination of indoxyl sulfate. Also, additional factors potentially influencing the serum concentration of indoxyl sulfate were evaluated. For this purpose, the predialysis and postdialysis concentration ratio of indoxyl sulfate and total protein was determined. The difference was of 1.15 (0.61; 2.10), 0.89 (0.53; 1.66), 0.32 (0.07; 0.63), and 0.44 (0.27; 0.77) µmol/g in acetate HD and HDF and citrate HD and HDF, respectively. Acetate HD and HDF were superior when concerning IS elimination when compared to citrate HD and HDF. Moreover, residual diuresis was determined as the only predictor of lower indoxyl sulfate concentration, suggesting that it should be preserved as long as possible. This trial is registered with EU PAS Register of Studies EUPAS23714.

Effect of clone selection, nitrogen supply, leaf damage and mycorrhizal fungi on stilbene and emodin production in knotweed.

BACKGROUND: Fallopia japonica and its hybrid, F. xbohemica, due to their fast spread, are famous as nature threats rather than blessings. Their fast growth rate, height, coverage, efficient nutrient translocation between tillers and organs and high phenolic production, may be perceived either as dangerous or beneficial features that bring about the elimination of native species or a life-supporting source. To the best of our knowledge, there have not been any studies aimed at increasing the targeted production of medically desired compounds by these remarkable plants. We designed a two-year pot experiment to determine the extent to which stilbene (resveratrol, piceatannol, resveratrolosid, piceid and astringins) and emodin contents of F. japonica, F. sachalinensis and two selected F. xbohemica clones are affected by soil nitrogen (N) supply, leaf damage and mycorrhizal inoculation. RESULTS: 1) Knotweeds are able to grow on substrates with extremely low nitrogen content and have a high efficiency of N translocation. The fast-spreading hybrid clones store less N in their rhizomes than the parental species. 2) The highest concentrations of stilbenes were found in the belowground biomass of F. japonica. However, because of the high belowground biomass of one clone of F. xbohemica, this hybrid produced more stilbenes per plant than F. japonica. 3) Leaf damage increased the resveratrol and emodin contents in the belowground biomass of the non-inoculated knotweed plants. 4) Although knotweed is supposed to be a non-mycorrhizal species, its roots are able to host the fungi. Inoculation with mycorrhizal fungi resulted in up to 2% root colonisation. 5) Both leaf damage and inoculation with mycorrhizal fungi elicited an increase of the piceid (resveratrol-glucoside) content in the belowground biomass of F. japonica. However, the mycorrhizal fungi only elicited this response in the absence of leaf damage. Because the leaf damage suppressed the effect of the root fungi, the effect of leaf damage prevailed over the effect of the mycorrhizal fungi on the piceid content in the belowground biomass. CONCLUSIONS: Two widely spread knotweed species, F. japonica and F. xbohemica, are promising sources of compounds that may have a positive impact on human health. The content of some of the target compounds in the plant tissues can be significantly altered by the cultivation conditions including stress imposed on the plants, inoculation with mycorrhizal fungi and selection of the appropriate plant clone.