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Abstract
Background and Aims
Intradialytic hypoxemia is associated with oxidative stress, endothelial dysfunction, inflammation, higher erythropoietin requirements, and higher all-cause hospitalization and mortality in hemodialysis (HD) patients (Meyring-Wosten, et al., 2016). The aim of the present study was to further expand our insights into the hypoxia-uremia axis by investigating the oxidative balance in endothelial cells (EC) under hypoxic and uremic conditions.
Method
Human umbilical EC were incubated with DMEM medium supplemented with 10% of fetal bovine serum (FBS; control) or with sera obtained from healthy subjects (S-CON) or HD patients (S-HD, 1:10), respectively, for 40 minutes, 4 hours, and 24 hours under normoxic (21% O2) or hypoxic (5% O2) conditions (Culture Chamber ProOx, Biospherix). EC were analyzed by flow cytometer (BD Accuri™ C6 Plus) to assess a) intracellular production of reactive oxygen species (ROS, DCFH-DA probe, Abcam); b) reduced glutathione (GSH) content (ThiolTracker Violet probe, Thermo Fisher Scientific).
Results
S-HD increased intracellular ROS production at all time points compared to S-CON. Moreover, ROS production was higher under hypoxic conditions. ROS production declined after 24 hours. S-HD induced slightly higher GSH content when compared to S-CON in normoxia (Table 1).
Conclusion
In our in vitro experiments, hypoxia and uremia jointly favor EC oxidative imbalance. This effect is particularly pronounced after 4 hours. Translational studies are warranted to explore the clinical relevance of our findings.
Table:
Baseline (of 100%): EC incubated in DMEM medium supplemented with 10% FBS + antibiotics
Normoxia (21% O2)
Hypoxia (5% O2)
ROS production [%]
28.9±2.4
52.3±7.2
GSH content [%]
8.4±1
8.1±0.8
Values after Incubation with S-CON or S-HD
40 minutes
4 hours
24 hours
ROS production
Normoxia
Hypoxia
Normoxia
Hypoxia
Normoxia
Hypoxia
S-CON [%]
102±5.2
121±6.32&
102.5±7.3
109.2±9.2
34.2±7.3
50.5±14.5
S-HD [%]
130.7±8.7*
146.2±8.3*&
150±13.9*
190.3±37.6*
71.8±11.4*
94.8±19.3*&
GSH content
Normoxia
Hypoxia
Normoxia
Hypoxia
Normoxia
Hypoxia
S-CON [%]
8.9±1.3&
6.5±2.3
7.6±1.2
7.4±1.6
7.9±1.5
8.1±1.2
S-HD [%]
12.7±1.8*&
6.3±0.9
9.3±1.6*
9.8±1.8*
10.4±1.3*&
7.5±0.8
*
p <0.05 compared to control for the same O2 concentration. & p<0.05 normoxia vs hypoxia.