role of pyrophosphate in vascular calcification in chronic kidney disease

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ID: 173474
2018
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Ranked #19 of 196 articles by views in european journal of preventive cardiology

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Abstract
Vascular calcification is a pathology characterized by the deposition of calcium-phosphate in cardiovascular structures, mainly in the form of hydroxyapatite crystals, resulting in ectopic calcification. It is correlated with increased risk of cardiovascular disease and myocardial infarction in diabetic patients and in those with chronic kidney disease (CKD). Vascular smooth muscle cells are sensitive to changes in inorganic phosphate (Pi) levels. They are able to adapt and modify some of their functions and promote changes which trigger calcification. Pi is regulated by parathyroid hormone and 1,25-dihydroxyvitamin D. Changes in the transport of Pi are the primary factor responsible for the regulation of Pi homeostasis and the calcification process.Synthesis of calcification inhibitors is the main mechanism by which cells are able to prevent vascular calcification. Extracellular pyrophosphate (PPi) is a potent endogenous inhibitor of calcium-phosphate deposition both in vivo and in vitro. Patients with CKD show lower levels of PPi and increased activity of the enzyme alkaline phosphatase. Numerous enzymes implicated in the metabolism of PPi have been associated with vascular calcifications. PPi is synthesized from extracellular ATP by nucleotide pyrophosphatase/phosphodiesterase from extracellular ATP hydrolysis. PPi is hydrolyzed into Pi by tissue-nonspecific alkaline phosphatase. ATP can be hydrolyzed to Pi via the ectonucleoside triphosphate diphosphohydrolase family. All these enzymes must be in balance, thereby preventing calcifications. However, diseases like CKD or diabetes induce alterations in their levels. Administration of PPi could open up new treatment options for these patients. Resumen: La calcificación vascular es una enfermedad caracterizada por depósitos de fosfato de calcio, principalmente hidroxiapatita, en las estructuras cardiovasculares, dando como resultado calcificaciones ectópicas. Se ha relacionado con un mayor riesgo de padecer enfermedades cardiovasculares e infarto de miocardio en pacientes diabéticos y enfermos renales crónicos. Las células del musculo liso vasculares son sensibles a cambios en los niveles de fosforo inorgánico (Pi), adaptando y modificando su función y promoviendo cambios que desencadenan calcificaciones. El Pi es regulado por hormona paratiroidea y vitamina D. Cambios en el transporte de Pi son el primer factor responsable en la regulación de la homeostasis del Pi y el proceso de calcificación.La síntesis de inhibidores de calcificación es el principal mecanismo por el que las células nos protegen frente a la calcificación vascular. El pirofosfato extracelular (PPi) es un potente inhibidor endógeno de los depósitos de fosfato-calcio, tanto in vivo como in vitro. Enfermos renales crónicos muestran bajos niveles de pirofosfato y una mayor actividad de la enzima fosfatasa alcalina. Diversas enzimas relacionadas con el metabolismo del PPi extracelular se han relacionado con calcificación vascular. El PPi se sintetiza a partir de ATP extracelular por la nucleótido pirofosfatasa/fosfodiesterasa a partir de la hidrólisis del ATP extracelular. El PPi es hidrolizado a Pi por la fosfatasa alcalina no específica de tejido. El ATP puede ser hidrolizado a Pi por la familia ectonucleósido trifosfato difosfohidrolasa. Todas estas enzimas deben estar en equilibrio, evitando así las calcificaciones; sin embargo, dolencias como la enfermedad renal crónica o la diabetes provocan alteraciones en sus niveles. La administración de pirofosfato puede abrir nuevas vías de tratamiento en estos pacientes. Keywords: Vascular calcification, Pyrophosphate, Chronic kidney disease, Haemodialysis, Hydroxyapatite, Palabras clave: Calcificación vascular, Pirofosfato, Enfermedad renal crónica, Hemodiálisis, Hidroxiapatita
Reference Key
azpiazu2018nefrologarole Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Daniel Azpiazu;Sergio Gonzalo;Emilio González-Parra;Jesús Egido;Ricardo Villa-Bellosta
Journal european journal of preventive cardiology
Year 2018
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S0211699517301893
Keywords
diseases of the genitourinary system urology

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