Alkaline Phosphatases in the Complex Chronic Kidney Disease-Mineral and Bone Disorders
Por:
Bover, J, Urena, P, Aguilar, A, Mazzaferro, S, Benito, S, Lopez-Baez, V, Ramos, A, daSilva, I, Cozzolino, M
Publicada:
1 ago 2018
Resumen:
Alkaline phosphatases (APs) remove the phosphate (dephosphorylation) needed in multiple metabolic processes (from many molecules such as proteins, nucleotides, or pyrophosphate). Therefore, APs are important for bone mineralization but paradoxically they can also be deleterious for other processes, such as vascular calcification and the increasingly known cross-talk between bone and vessels. A proper balance between beneficial and harmful activities is further complicated in the context of chronic kidney disease (CKD). In this narrative review, we will briefly update the complexity of the enzyme, including its different isoforms such as the bone-specific alkaline phosphatase or the most recently discovered B1x. We will also analyze the correlations and potential discrepancies with parathyroid hormone and bone turnover and, most importantly, the valuable recent associations of AP's with cardiovascular disease and/or vascular calcification, and survival. Finally, a basic knowledge of the synthetic and degradation pathways of APs promises to open new therapeutic strategies for the treatment of the CKD-Mineral and Bone Disorder (CKD-MBD) in the near future, as well as for other processes such as sepsis, acute kidney injury, inflammation, endothelial dysfunction, metabolic syndrome or, in diabetes, cardiovascular complications. However, no studies have been done using APs as a primary therapeutic target for clinical outcomes, and therefore, AP's levels cannot yet be used alone as an isolated primary target in the treatment of CKD-MBD. Nonetheless, its diagnostic and prognostic potential should be underlined.
Filiaciones:
Bover, J:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
Urena, P:
Univ Paris 05, Necker Hosp, Dept Nephrol & Dialysis, Clin Landy, Paris, France
Univ Paris 05, Necker Hosp, Dept Renal Physiol, Paris, France
Aguilar, A:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
Mazzaferro, S:
Sapienza Univ Rome, Dept Cardiovasc Resp Nephrol & Geriatr Sci, Rome, Italy
Benito, S:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
Lopez-Baez, V:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
Ramos, A:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
daSilva, I:
Fundacio Puigvert, IIB St Pau, Dept Nephrol, RedinRen, Barcelona 340350, Spain
Cozzolino, M:
DiSS Univ Milan, San Paolo Hosp, Div Renal, Lab Expt Nephrol, Milan, Italy
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