Soluble Toll-like Receptor 4: A New Player in Subclinical Inflammation and Malnutrition in Hemodialysis Patients

Pasquale Esposito, Edoardo La Porta, Maria Antonietta Grignano, Daniela Verzola, Samantha Milanesi, Francesca Ansaldo, Marilena Gregorini, Carmelo Libetta, Giacomo Garibotto, Teresa Rampino

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Toll-like receptor 4 (TLR4) promotes inflammation in hemodialysis patients (HD). A soluble form of extracellular TLR4 (sTLR4) has been recently characterized, which showed the ability to attenuate TLR4 signalling. In this study, we describe the sTLR4 profile in regular HD patients.

SUBJECTS: In a cross-sectional study we enrolled forty prevalent HD patients (68.2 ± 16.3 years, twenty-five males) with a median dialysis vintage of 41 months. Nineteen patients were undergoing standard bicarbonate HD (BHD) and 21 patients on-line hemodiafiltration (HDF). Ten healthy sex-matched subjects constituted the controls (C).

INTERVENTION: Before and after the HD session, serum was tested for sTLR4 levels by ELISA. Moreover, clinical and biochemical data were collected, including body mass index, albumin, and C-reactive protein (CRP) levels. Body composition was expressed as a 3-compartment model, providing lean tissue index and fat tissue index (FTI).

MAIN OUTCOME MEASURE: Describe the profile of sTLR4 in HD patients, evaluating the correlations among sTLR4 levels and the main clinical characteristics, inflammatory and nutritional parameters.

RESULTS: Patients with subclinical inflammation (i.e., high CRP levels without clinical symptomatology) presented higher sTLR4 levels (0.42 ± 0.25 ng/mL) with respect to both C and not inflamed HD patients (0.23 ± 0.19 ng/mL, P < .05). There was a significant direct correlation between predialysis sTLR4 and body mass index, FTI (r = 0.55), and CRP levels (r = 0.52) and inverse correlation with lean tissue index and albumin (r = -0.4). In multivariate analysis, sTLR4 resulted directly associated with FTI (P = .038). Notably, sTLR4 levels resulted higher in bicarbonate hemodialysis versus hemodiafiltration (0.37 ± 0.18 vs. 0.19 ± 0.21 ng/mL, P < .05).

CONCLUSIONS: sTLR4 correlates with inflammatory and nutritional parameters, presenting as a new potential player in modulating subclinical inflammation in HD patients.

Original languageEnglish
Pages (from-to)259-264
Number of pages6
JournalJournal of Renal Nutrition
Volume28
Issue number4
DOIs
Publication statusPublished - Jul 2018

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Toll-Like Receptor 4
Malnutrition
Renal Dialysis
Inflammation
C-Reactive Protein
Hemodiafiltration
Fats
Bicarbonates
Albumins
Body Mass Index
Body Composition

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Soluble Toll-like Receptor 4 : A New Player in Subclinical Inflammation and Malnutrition in Hemodialysis Patients. / Esposito, Pasquale; La Porta, Edoardo; Grignano, Maria Antonietta; Verzola, Daniela; Milanesi, Samantha; Ansaldo, Francesca; Gregorini, Marilena; Libetta, Carmelo; Garibotto, Giacomo; Rampino, Teresa.

In: Journal of Renal Nutrition, Vol. 28, No. 4, 07.2018, p. 259-264.

Research output: Contribution to journalArticle

Esposito, Pasquale ; La Porta, Edoardo ; Grignano, Maria Antonietta ; Verzola, Daniela ; Milanesi, Samantha ; Ansaldo, Francesca ; Gregorini, Marilena ; Libetta, Carmelo ; Garibotto, Giacomo ; Rampino, Teresa. / Soluble Toll-like Receptor 4 : A New Player in Subclinical Inflammation and Malnutrition in Hemodialysis Patients. In: Journal of Renal Nutrition. 2018 ; Vol. 28, No. 4. pp. 259-264.
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abstract = "OBJECTIVE: Toll-like receptor 4 (TLR4) promotes inflammation in hemodialysis patients (HD). A soluble form of extracellular TLR4 (sTLR4) has been recently characterized, which showed the ability to attenuate TLR4 signalling. In this study, we describe the sTLR4 profile in regular HD patients.SUBJECTS: In a cross-sectional study we enrolled forty prevalent HD patients (68.2 ± 16.3 years, twenty-five males) with a median dialysis vintage of 41 months. Nineteen patients were undergoing standard bicarbonate HD (BHD) and 21 patients on-line hemodiafiltration (HDF). Ten healthy sex-matched subjects constituted the controls (C).INTERVENTION: Before and after the HD session, serum was tested for sTLR4 levels by ELISA. Moreover, clinical and biochemical data were collected, including body mass index, albumin, and C-reactive protein (CRP) levels. Body composition was expressed as a 3-compartment model, providing lean tissue index and fat tissue index (FTI).MAIN OUTCOME MEASURE: Describe the profile of sTLR4 in HD patients, evaluating the correlations among sTLR4 levels and the main clinical characteristics, inflammatory and nutritional parameters.RESULTS: Patients with subclinical inflammation (i.e., high CRP levels without clinical symptomatology) presented higher sTLR4 levels (0.42 ± 0.25 ng/mL) with respect to both C and not inflamed HD patients (0.23 ± 0.19 ng/mL, P < .05). There was a significant direct correlation between predialysis sTLR4 and body mass index, FTI (r = 0.55), and CRP levels (r = 0.52) and inverse correlation with lean tissue index and albumin (r = -0.4). In multivariate analysis, sTLR4 resulted directly associated with FTI (P = .038). Notably, sTLR4 levels resulted higher in bicarbonate hemodialysis versus hemodiafiltration (0.37 ± 0.18 vs. 0.19 ± 0.21 ng/mL, P < .05).CONCLUSIONS: sTLR4 correlates with inflammatory and nutritional parameters, presenting as a new potential player in modulating subclinical inflammation in HD patients.",
author = "Pasquale Esposito and {La Porta}, Edoardo and Grignano, {Maria Antonietta} and Daniela Verzola and Samantha Milanesi and Francesca Ansaldo and Marilena Gregorini and Carmelo Libetta and Giacomo Garibotto and Teresa Rampino",
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TY - JOUR

T1 - Soluble Toll-like Receptor 4

T2 - A New Player in Subclinical Inflammation and Malnutrition in Hemodialysis Patients

AU - Esposito, Pasquale

AU - La Porta, Edoardo

AU - Grignano, Maria Antonietta

AU - Verzola, Daniela

AU - Milanesi, Samantha

AU - Ansaldo, Francesca

AU - Gregorini, Marilena

AU - Libetta, Carmelo

AU - Garibotto, Giacomo

AU - Rampino, Teresa

N1 - Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - OBJECTIVE: Toll-like receptor 4 (TLR4) promotes inflammation in hemodialysis patients (HD). A soluble form of extracellular TLR4 (sTLR4) has been recently characterized, which showed the ability to attenuate TLR4 signalling. In this study, we describe the sTLR4 profile in regular HD patients.SUBJECTS: In a cross-sectional study we enrolled forty prevalent HD patients (68.2 ± 16.3 years, twenty-five males) with a median dialysis vintage of 41 months. Nineteen patients were undergoing standard bicarbonate HD (BHD) and 21 patients on-line hemodiafiltration (HDF). Ten healthy sex-matched subjects constituted the controls (C).INTERVENTION: Before and after the HD session, serum was tested for sTLR4 levels by ELISA. Moreover, clinical and biochemical data were collected, including body mass index, albumin, and C-reactive protein (CRP) levels. Body composition was expressed as a 3-compartment model, providing lean tissue index and fat tissue index (FTI).MAIN OUTCOME MEASURE: Describe the profile of sTLR4 in HD patients, evaluating the correlations among sTLR4 levels and the main clinical characteristics, inflammatory and nutritional parameters.RESULTS: Patients with subclinical inflammation (i.e., high CRP levels without clinical symptomatology) presented higher sTLR4 levels (0.42 ± 0.25 ng/mL) with respect to both C and not inflamed HD patients (0.23 ± 0.19 ng/mL, P < .05). There was a significant direct correlation between predialysis sTLR4 and body mass index, FTI (r = 0.55), and CRP levels (r = 0.52) and inverse correlation with lean tissue index and albumin (r = -0.4). In multivariate analysis, sTLR4 resulted directly associated with FTI (P = .038). Notably, sTLR4 levels resulted higher in bicarbonate hemodialysis versus hemodiafiltration (0.37 ± 0.18 vs. 0.19 ± 0.21 ng/mL, P < .05).CONCLUSIONS: sTLR4 correlates with inflammatory and nutritional parameters, presenting as a new potential player in modulating subclinical inflammation in HD patients.

AB - OBJECTIVE: Toll-like receptor 4 (TLR4) promotes inflammation in hemodialysis patients (HD). A soluble form of extracellular TLR4 (sTLR4) has been recently characterized, which showed the ability to attenuate TLR4 signalling. In this study, we describe the sTLR4 profile in regular HD patients.SUBJECTS: In a cross-sectional study we enrolled forty prevalent HD patients (68.2 ± 16.3 years, twenty-five males) with a median dialysis vintage of 41 months. Nineteen patients were undergoing standard bicarbonate HD (BHD) and 21 patients on-line hemodiafiltration (HDF). Ten healthy sex-matched subjects constituted the controls (C).INTERVENTION: Before and after the HD session, serum was tested for sTLR4 levels by ELISA. Moreover, clinical and biochemical data were collected, including body mass index, albumin, and C-reactive protein (CRP) levels. Body composition was expressed as a 3-compartment model, providing lean tissue index and fat tissue index (FTI).MAIN OUTCOME MEASURE: Describe the profile of sTLR4 in HD patients, evaluating the correlations among sTLR4 levels and the main clinical characteristics, inflammatory and nutritional parameters.RESULTS: Patients with subclinical inflammation (i.e., high CRP levels without clinical symptomatology) presented higher sTLR4 levels (0.42 ± 0.25 ng/mL) with respect to both C and not inflamed HD patients (0.23 ± 0.19 ng/mL, P < .05). There was a significant direct correlation between predialysis sTLR4 and body mass index, FTI (r = 0.55), and CRP levels (r = 0.52) and inverse correlation with lean tissue index and albumin (r = -0.4). In multivariate analysis, sTLR4 resulted directly associated with FTI (P = .038). Notably, sTLR4 levels resulted higher in bicarbonate hemodialysis versus hemodiafiltration (0.37 ± 0.18 vs. 0.19 ± 0.21 ng/mL, P < .05).CONCLUSIONS: sTLR4 correlates with inflammatory and nutritional parameters, presenting as a new potential player in modulating subclinical inflammation in HD patients.

U2 - 10.1053/j.jrn.2017.11.006

DO - 10.1053/j.jrn.2017.11.006

M3 - Article

C2 - 29429793

VL - 28

SP - 259

EP - 264

JO - Journal of Renal Nutrition

JF - Journal of Renal Nutrition

SN - 1051-2276

IS - 4

ER -