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Arterial “inflammaging” drives vascular calcification in children on dialysis

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Pilar Sanchis, Chin Yee Ho, Yiwen Liu, Leilani E. Beltran, Sadia Ahmad, Anne P. Jacob, Malgorzata Furmanik, Joanne Laycock, David A. Long, Rukshana Shroff, Catherine M. Shanahan

Original languageEnglish
Pages (from-to)958-972
Number of pages15
JournalKidney International
Volume95
Issue number4
Early online date1 Mar 2019
DOIs
Publication statusPublished - 1 Apr 2019

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Abstract

Children on dialysis have a cardiovascular mortality risk equivalent to older adults in the general population, with the development of medial vascular calcification, an age-associated pathology. We hypothesized that premature vascular ageing contributes to calcification in children with advanced chronic kidney disease (CKD). Vessels from children with Stage 5 CKD with and without dialysis had evidence of increased oxidative DNA damage. The senescence markers p16 and p21 were also increased in vessels from children on dialysis. Treatment of vessel rings ex vivo with calcifying media increased oxidative DNA damage in vessels from children with Stage 5 CKD, but not in those from healthy controls. Vascular smooth muscle cells cultured from children on dialysis exhibited persistent DNA damage, impaired DNA damage repair, and accelerated senescence. Under calcifying conditions vascular smooth muscle cells from children on dialysis showed increased osteogenic differentiation and calcification. These changes correlated with activation of the senescence-associated secretory phenotype (SASP), an inflammatory phenotype characterized by the secretion of proinflammatory cytokines and growth factors. Blockade of ATM-mediated DNA damage signaling reduced both inflammation and calcification. Clinically, children on dialysis had elevated circulating levels of osteogenic SASP factors that correlated with increased vascular stiffness and coronary artery calcification. These data imply that dysregulated mineral metabolism drives vascular ‘inflammaging’ by promoting oxidative DNA damage, premature senescence, and activation of a pro-inflammatory SASP. Drugs that target DNA damage signaling or eliminate senescent cells may have the potential to prevent vascular calcification in patients with advanced CKD.

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