Serum sclerostin: the missing link in the bone-vessel cross-talk in hemodialysis patients?

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• 作者：S. Pelletier ; C. B. Confavreux ; J. Haesebaert…
• 关键词：CKD ; MBD ; Cortical thickness ; Hemodialysis ; Sclerostin ; Vascular calcification
• 刊名：Osteoporosis International
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：26
• 期：8
• 页码：2165-2174
• 全文大小：293 KB
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• 作者单位：S. Pelletier (1) (2) (3) <br> C. B. Confavreux (2) (3) <br> J. Haesebaert (3) (4) <br> F. Guebre-Egziabher (3) (5) (6) <br> J. Bacchetta (3) (7) <br> M.-C. Carlier (8) <br> L. Chardon (9) <br> M. Laville (1) (10) (3) (5) <br> R. Chapurlat (2) (3) <br> G. M. London (11) <br> M.-H. Lafage-Proust (12) <br> D. Fouque (1) (3) (5) <br><br>1. Département de Néphrologie - Batiment 3C, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France <br> 2. INSERM UMR 1033, H?pital Edouard Herriot, 69003, Lyon, France <br> 3. Université de Lyon, Lyon, France <br> 4. P?le Information Médicale Evaluation Recherche, Hospices Civils de Lyon, 69003, Lyon, France <br> 5. CARMEN, INSERM 1060, Université Claude Bernard Lyon1, Lyon, France <br> 6. Département de Néphrologie, H?pital Edouard Herriot, 3 place d’Arsonval, 69437, Lyon, France <br> 7. Centre de Référence des Maladies Rénales Rares, H?pital Femme Mère Enfant, 69500, Bron, France <br> 8. Hospices Civils de Lyon, Fédération de Biochimie, Groupement Hospitalier Sud, 69495, Pierre Bénite, France <br> 9. Hospices Civils de Lyon, Fédération de Biochimie, Groupement Hospitalier Est, 69003, Lyon, France <br> 10. AURAL,rue Villon, 69003, Lyon, France <br> 11. Service de Néphrologie, Centre Hospitalier Manhès, Fleury Mérogis, and INSERM UMR 970, H?pital Européen Georges Pompidou, Paris, France <br> 12. INSERM UMR 1059, Centre Hospitalier Universitaire, 42023-42055, Saint-Etienne, France <br>
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health<br>Orthopedics<br>Gynecology<br>Endocrinology<br>Rheumatology<br>
• 出版者：Springer London
• ISSN：1433-2965

文摘

Summary We found for the first time that in maintenance hemodialysis patients, higher sclerostin serum level was associated with severe abdominal aortic calcification (AAC). In addition, cortical bone microarchitecture (density and thickness) assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at tibia was also independently associated with severe AAC. These results suggest that sclerostin may be involved in the association of mineral and bone disorder with vascular calcification in hemodialysis patients. Introduction Severe abdominal aortic calcifications are predictive of high cardiovascular mortality in maintenance hemodialysis (MHD) patients. In patients with end-stage renal disease, a high aortic calcification score was associated with lower bone turnover on bone biopsies. Thus, we hypothesized that sclerostin, a Wnt pathway inhibitor mainly secreted by osteocytes and acting on osteoblasts to reduce bone formation, may be associated with vascular calcifications in MHD patients. Methods Fifty-three MHD patients, aged 53?years [35-3] (median [Q1–Q3]) were included. Serum was sampled before the MHD session to assay sclerostin. Framingham score was computed and the abdominal aortic calcification (AAC) score was assessed according to Kauppila method on lateral spine imaging using DEXA. Tibia bone status was evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Patients were distributed into two groups according to their AAC score: patients with mild or without AAC (score below 6) versus patients with severe AAC (score of 6 and above). Results In multivariate analysis, after adjustment on age, dialysis duration and diabetes, serum sclerostin and cortical thickness were independently associated with severe AAC (odds ratio (OR)--.43 for each 0.1?ng/mL increase [95?% confidence interval (CI) 1.10-.83]; p--.006 and 0.16 for 1 SD increase [0.03-.73]; p--.018, respectively). A second cardiovascular model adjusted on Framingham score and the above mentioned confounders showed similar results. Conclusions Elevated sclerostin serum level and poorer tibia cortical bone structure by HR-pQCT were positively and independently associated with higher odds of severe AAC in MHD patients. Serum sclerostin may become a biomarker of mineral and bone disorder and vascular risk in MHD patients.