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Toxins 2018, 10(10), 412; https://doi.org/10.3390/toxins10100412

Tryptophan-Derived Uremic Toxins and Thrombosis in Chronic Kidney Disease

1
Aix Marseille University, INSERM, INRA, C2VN, 13005 Marseille, France
2
LPNSA, Département de Biologie, Université d’Oran 1 Ahmed Benbella, 31000 Oran, Algérie
3
Centre de Néphrologie et Transplantation Rénale, AP-HM, 13005 Marseille, France
*
Author to whom correspondence should be addressed.
Received: 20 September 2018 / Revised: 9 October 2018 / Accepted: 10 October 2018 / Published: 12 October 2018
(This article belongs to the Special Issue Uremia and Cardiovascular Disease)
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Abstract

Patients with chronic kidney disease (CKD) display an elevated risk of thrombosis. Thrombosis occurs in cardiovascular events, such as venous thromboembolism, stroke, and acute coronary syndrome, and is a cause of hemodialysis vascular access dysfunction. CKD leads to the accumulation of uremic toxins, which exerts toxic effects on blood and the vessel wall. Some uremic toxins result from tryptophan metabolization in the gut through the indolic and the kynurenine pathways. An increasing number of studies are highlighting the link between such uremic toxins and thrombosis in CKD. In this review, we describe the thrombotic mechanisms induced by tryptophan-derived uremic toxins (TDUT). These mechanisms include an increase in plasma levels of procoagulant factors, induction of platelet hyperactivity, induction of endothelial dysfunction/ impairment of endothelial healing, decrease in nitric oxide (NO) bioavailability, and production of procoagulant microparticles. We focus on one important prothrombotic mechanism: The induction of tissue factor (TF), the initiator of the extrinsic pathway of the blood coagulation. This induction occurs via a new pathway, dependent on the transcription factor Aryl hydrocarbon receptor (AhR), the receptor of TDUT in cells. A better understanding of the prothrombotic mechanisms of uremic toxins could help to find novel therapeutic targets to prevent thrombosis in CKD. View Full-Text
Keywords: uremic toxins; thrombosis; chronic kidney disease; tryptophan uremic toxins; thrombosis; chronic kidney disease; tryptophan
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Addi, T.; Dou, L.; Burtey, S. Tryptophan-Derived Uremic Toxins and Thrombosis in Chronic Kidney Disease. Toxins 2018, 10, 412.

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