Uric Acid as a Mediator of Endothelial Dysfunction in Patients with CKD

描述（由申请人提供）：本提案的目的是培养候选人Jalal博士的科学发展和实验室技能，使她成为一名独立的研究者，可以进行临床翻译研究。肾脏科与科罗拉多大学丹佛分校临床和转化研究中心合作，为Jalal博士提供了最佳环境，以检查降低血清尿酸水平对中度慢性肾病（CKD）患者的内皮功能的影响，包括临床、生化和细胞水平。Jalal博士目前是科罗拉多大学丹佛健康科学中心的助理教授。通过她的主要导师Johnson博士，以及由经验丰富的科学和临床研究人员组成的广泛网络，Jalal博士将为独立学术生涯的发展奠定基础。内皮功能障碍、炎症和氧化应激在CKD患者中普遍存在，并在动脉粥样硬化和CKD进展中发挥核心作用。由于多种因素，CKD患者是高尿酸血症。尿酸与内皮功能障碍的病因有关。实验证据表明，它通过炎症和氧化应激介导其对脉管系统的下游影响。我们假设尿酸诱导氧化应激和炎症，并导致伴有高尿酸血症的III期CKD患者内皮功能障碍。在她的授权中，Jalal博士提出了一项随机对照临床试验，80名血清尿酸水平为bbb70 mg/dL的III期CKD患者将被随机分配到安慰剂或别嘌呤醇组，为期3个月。该提案的具体目标包括：1。通过测量肱动脉血流介导的舒张，确定降低血清尿酸可改善内皮依赖性舒张2。2 .确定降低血清尿酸水平将减轻全身炎症和氧化应激；确定降低血清尿酸水平将抑制内皮细胞激活炎症和氧化途径的免疫荧光。对于这些特定目标，将在基线和研究期结束时进行测量，并将随机分配到别嘌呤醇组和随机分配到安慰剂组之间的基线变化进行比较。这项研究的结果将回答一个重要的临床问题，并将导致可发表的工作。此外，该试验的发现可能会为更大规模的临床试验奠定基础，以评估降尿酸疗法对轻中度CKD患者心血管事件和CKD进展的影响。

DESCRIPTION (provided by applicant): The purpose of this proposal is to foster the scientific development and laboratory skills of the candidate, Dr. Jalal, so that she may become an independent investigator, who can perform clinical translation research. The Renal Division in collaboration with the Clinical and Translation Research Center at the University of Colorado Denver are in a position to provide Dr. Jalal with the optimal environment to examine the impact of lowering serum uric acid levels on endothelial function, at the clinical, biochemical, and cellular level, in patients with moderate chronic kidney disease (CKD). Dr. Jalal is currently as assistant professor at the University of Colorado at Denver Health Sciences Center. Through her primary mentor, Dr. Johnson, and an extensive network of experienced scientific and clinical researchers, Dr. Jalal will obtain the foundation for the development of an independent academic career. Endothelial dysfunction, inflammation, and oxidative stress are prevalent in patients with CKD, and play a central role in atherosclerosis and in CKD progression. Due to a variety of factors, patients with CKD are hyperuricemic. Uric acid has been implicated in the etiology of endothelial dysfunction. Experimental evidence suggests it mediates its downstream effects on the vasculature via inflammation and oxidative stress. We hypothesize that uric acid induces oxidative stress and inflammation, and contributes to endothelial dysfunction in patients with stage III CKD who are also hyperuricemic. In her grant, Dr. Jalal proposes a randomized controlled clinical trial, where 80 patients with stage III CKD and serum uric acid levels acid > 7mg/dL will be randomized to either placebo or allopurinol for 3 months. The specific aims of the proposal include: 1. determine of lowering serum uric acid improves endothelial dependant dilation by measuring brachial artery flow mediated dilation, 2. determine that lowering serum uric acid levels will mitigate systemic inflammation and oxidative stress, and 3. determine that lowering serum uric acid levels will curb endothelial cellular activation of inflammatory and oxidative pathways by immunofluorescence. For each of these specific aims, measurements will be obtained at baseline and the end of the study period, and changes from baseline will be contrasted between the group randomized to allopurinol and the group randomized to placebo. The results of this study will answer an important clinical question, and will result in publishable work. In addition, the findings of this trial will likely set the stage for larger clinical trials to evaluate the impact of uric acid lowering therapies on cardiovascular events and CKD progression in patients with mild- moderate CKD.