Resistant starch type-2 enriched cookies modulate uremic toxins and inflammation in hemodialysis patients: a randomized, double-blind, crossover and placebo-controlled trial
Resistant starch type-2 enriched cookies modulate uremic toxins and inflammation in hemodialysis patients: a randomized, double-blind, crossover and placebo-controlled trial
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DOI：
10.1039/c9fo02939g
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发表时间：
2020-03-01
期刊：
影响因子：
6.1
通讯作者：
Mafra, Denise
中科院分区：
文献类型：
--
作者：
Esgalhado, Marta;Kemp, Julie Ann;Mafra, Denise
背景：本研究的目的是评估补充富含抗性淀粉（RS）的饼干对血液透析（HD）患者炎症相关的核转录因子（核红细胞2相关因子Nrf2，核因子κ B， nf - κ B） mRNA表达和肠道微生物群产生的尿毒症毒素水平的影响。方法：对26例HD患者进行随机、双盲、安慰剂对照交叉研究。在前四周，患者被分配食用富含抗性淀粉的饼干（每天16克RS）或安慰剂饼干。洗脱期结束后，再次以交叉的形式补充患者，再持续4周。rt-PCR检测外周血单核细胞（PBMC） Nrf2、nf - κ B和抗氧化酶mRNA表达，western blotting检测蛋白表达。评估氧化应激和炎症生物标志物以及尿毒症毒素。使用SAS的过程混合程序进行意向-治疗分析。结果：RS组治疗后Nrf2 mRNA平均表达量较基线值明显升高，且NQO1蛋白高表达。此外，RS组血浆IS水平降低。安慰剂组无显著性差异。结论：我们的研究结果表明，抗性淀粉丰富的饼干可能是一种很好的营养策略，可以降低来自肠道微生物群的硫酸吲哚酚水平，并减轻血液透析患者的炎症。
Background: The aim of this study was to evaluate the effect of resistant starch (RS) enriched cookies supplementation on mRNA expression of nuclear transcription factors (nuclear erythroid 2-related factor, Nrf2; nuclear factor kappa-B, NF-kappa B), involved with inflammation and on uremic toxins levels produced by the gut microbiota in hemodialysis (HD) patients. Methods: A randomized, double-blind, placebo-controlled crossover study with 26 HD patients was conducted. The patients were assigned to either resistant starch enriched cookies (16 g of RS per day) or placebo cookies supplementation during the first four weeks. After the washout period, patients were supplemented again, in the form of a crossover, for another 4 weeks. Nrf2, NF-kappa B, and antioxidant enzymes mRNA expression were measured by rt-PCR and protein expression by western blotting assay from isolated peripheral blood mononuclear cells (PBMC). Oxidative stress and inflammatory biomarkers, as well as uremic toxins, were evaluated. Intention-to-treat analysis was performed, using the proc mixed procedure in SAS. Results: In RS group, post-treatment mean mRNA Nrf2 expression was market increased from baseline values, associated with a high expression of NQO1 protein. Besides, IS plasma levels were reduced in the RS group. No significant difference was observed in the placebo group. Conclusion: Our results suggested that resistant starch enriched cookies may be a good nutritional strategy to reduce indoxyl sulfate levels derived from the gut microbiota and also attenuate the inflammation in hemodialysis patients.