Endotoxin, Neutrophil Function and Albumin in Renal Insufficiency (ENARI)
Chronic kidney disease is widespread in the western world with bacterial infection and sepsis as common complication. It has been shown that innate immune defence, represented by dysfunction of neutrophil granulocytes, is impaired in chronic kidney disease. Another impact of chronic kidney disease on innate immunity is the chronic activation of neutrophils leading to high levels of inflammatory cytokines, thus contributing to protein oxidation. Oxidation of human serum albumin (HSA), the major plasma protein, occurs in chronic kidney disease and leads to further activation of neutrophils. Another important impact of HSA oxidation is the decrease of its binding capacity leading to impaired detoxification ability of albumin. This includes reduced clearance of endotoxin, a major component of the gram negative bacterial cell wall. Circulating endotoxin is recognized by complex formation with lipopolysaccharide binding protein (LBP) followed by binding to CD14 and toll-like receptor (TLR) 4. High systemic endotoxin levels occur in chronic kidney disease and may be the result of decreased clearance ability of HSA and increased gut permeability in combination with intestinal bacterial overgrowth. High systemic endotoxin is associated with worse outcome in several diseases and could be used as predictor for mortality in chronic kidney disease patients.
Endotoxemia in renal insufficiency leads to impaired neutrophil function and to increased albumin oxidation. Oxidized albumin is not able to bind endotoxin adequately any more, which leads to a further increase in oxidative stress and neutrophil dysfunction, resulting in a vicious cycle.
195 patients with renal dysfunction will be enrolled and divided into 5 groups. Additionally, samples of 25 age and sex-matched healthy controls will be collected.
This concept will change the understanding of several aspects of chronic kidney disease and will potentially help to stratify patients into different groups at risk according to their endotoxin status, and their immune and albumin dysfunction. The results of this study will have important implications into the development of novel therapeutic strategies
Chronic Renal Insufficiency
Acute Renal Failure
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Endotoxin, Neutrophil Function and Albumin in Renal Insufficiency|
- Endotoxin levels (EU/ml and qualitative positive/negative) [ Time Frame: Day 0 ] [ Designated as safety issue: No ]Percentage of patients with measurable endotoxin serum levels in each group.
- albumin oxidation (%), albumin binding capacity (ratio), neutrophil function (%), [ Time Frame: Day 0 ] [ Designated as safety issue: No ]
We want to investigate the following in patients with different stages of chronic renal insufficiency.
Albumin oxidation and function in correlation with the endotoxin status Endotoxin binding to albumin Neutrophil function, energy status and NO metabolism in correlation with the endotoxin status
Biospecimen Retention: Samples Without DNA
Serum, Plasma, Urine
|Study Start Date:||July 2011|
|Estimated Study Completion Date:||October 2015|
|Estimated Primary Completion Date:||October 2014 (Final data collection date for primary outcome measure)|
|predialytic renal insufficiency|
|peritoneal dialysis patients|
|acute renal failure|
|post renal transplantation|
Laboratory methods Endotoxin will be detected by an adapted limulus amoebocyte lysate assay. LBP and sCD14 will be determined by means of ELISA. HPLC will be used to determine nitrate, nitrite, albumin fractions, albumin binding capacity, iNOS expression and energy status of neutrophils. For investigation of oxidation driven by leukocyte derived myeloperoxidase, mass spectrometry analysis will be used. Carbonyl contents of proteins will be detected by ELISA. Neutrophil function and TLR2, 4 and 9 expression will be studied by flow cytometrical analysis. For cell culture tests, freshly isolated neutrophils or differentiated HL60 cells will be used and incubated with albumin and/or endotoxin.
|Department of Internal Medicine|
|Graz, Austria, 8036|
|Principal Investigator:||Vanessa Stadlbauer, MD||Medical Univeristy of Graz|