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Tryptophan metabolites suppress the Wnt pathway and promote adverse limb events in chronic kidney disease
Nkiruka V. Arinze, … , Nader Rahimi, Vipul C. Chitalia
Nkiruka V. Arinze, … , Nader Rahimi, Vipul C. Chitalia
Published November 9, 2021
Citation Information: J Clin Invest. 2022;132(1):e142260. https://doi.org/10.1172/JCI142260.
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Research Article Nephrology Vascular biology

Tryptophan metabolites suppress the Wnt pathway and promote adverse limb events in chronic kidney disease

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Abstract

Chronic kidney disease (CKD) imposes a strong and independent risk for peripheral artery disease (PAD). While solutes retained in CKD patients (uremic solutes) inflict vascular damage, their role in PAD remains elusive. Here, we show that the dietary tryptophan-derived uremic solutes including indoxyl sulfate (IS) and kynurenine (Kyn) at concentrations corresponding to those in CKD patients suppress β-catenin in several cell types, including microvascular endothelial cells (ECs), inhibiting Wnt activity and proangiogenic Wnt targets in ECs. Mechanistic probing revealed that these uremic solutes downregulated β-catenin in a manner dependent on serine 33 in its degron motif and through the aryl hydrocarbon receptor (AHR). Hindlimb ischemia in adenine-induced CKD and IS solute–specific mouse models showed diminished β-catenin and VEGF-A in the capillaries and reduced capillary density, which correlated inversely with blood levels of IS and Kyn and AHR activity in ECs. An AHR inhibitor treatment normalized postischemic angiogenic response in CKD mice to a non-CKD level. In a prospective cohort of PAD patients, plasma levels of tryptophan metabolites and plasma’s AHR-inducing activity in ECs significantly increased the risk of future adverse limb events. This work uncovers the tryptophan metabolite/AHR/β-catenin axis as a mediator of microvascular rarefaction in CKD patients and demonstrates its targetability for PAD in CKD models.

Authors

Nkiruka V. Arinze, Wenqing Yin, Saran Lotfollahzadeh, Marc Arthur Napoleon, Sean Richards, Joshua A. Walker, Mostafa Belghasem, Jonathan D. Ravid, Mohamed Hassan Kamel, Stephen A. Whelan, Norman Lee, Jeffrey J. Siracuse, Stephan Anderson, Alik Farber, David Sherr, Jean Francis, Naomi M. Hamburg, Nader Rahimi, Vipul C. Chitalia

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Figure 5

IS suppressed postischemic angiogenesis and β-catenin expression in mice.

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IS suppressed postischemic angiogenesis and β-catenin expression in mice...
(A) A group of 8- to 12-week-old C57BL/6 female mice were initiated on probenecid (n = 7) or probenecid plus IS (n = 7) and underwent HLI followed by harvest after 5 days. (B) Representative images of the posterior calf muscles from the ligated limbs of mice stained for α-actin and CD31. Total of 30 images per group (n = 7 mice/group). Insets show myocyte with surrounding capillaries. Scale bars: 25 μm. Original magnification ×400. (C) Integrated density of CD31+ was normalized to that of α-actin and presented as a ratio. A total of 30 images from 7 mice/group are represented, and the line represents the median. Student’s t test was performed. ***P = 0.001. (D) Lysates of posterior calf muscles of the ligated limb of mice were probed. Representative immunoblots from 3 separate mice from each group (n = 7 mice/group). (E) Normalized β-catenin in muscle lysates is presented in box-and-whisker plot. Student’s t test was performed. **P = 0.007. (F) Four to five random images of posterior calf muscles from the ligated limbs of mice were stained for β-catenin and CD31. Insets show a myocyte with β-catenin with surrounding capillaries. Blue dotted line represents ROI of a muscle surrounded by capillaries, and white dotted line represents the ROI of a muscle. White asterisk corresponds to β-catenin in a muscle. White arrowhead is directed to β-catenin in the capillary. Scale bars: 25 μm. Original magnification, ×400. (G) First, the integrated density was estimated from the ROI of area surrounded by blue dotted line (β-catenin in a muscle with surrounding capillary). Next, the integrated density was analyzed only from area surrounded by white dotted line (β-catenin in muscles). Their differences correspond to β-catenin in the capillaries. The integrated densities of capillaries and muscles from 30 random images (n = 7 mice/group) are shown. Lines represent the median. Student’s t test was performed. ***P < 0.001; *P = 0.05.

Copyright © 2022 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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