Volume 49, Issue 5, May 2024, 102519Author links open overlay panel, , , AbstractBackground

Cardiovascular calcification is a pervasive issue throughout chronic kidney disease (CKD) progression. Autophagy, a fundamental cellular process, exerts significant influence on various cardiac pathologies, including arrhythmias, atherosclerosis, heart failure, and notably, valvular, and vascular calcifications. Beclin-1, a crucial eukaryotic protein, plays a major regulatory role in autophagy as part of the phosphatidylinositol-3-kinase (PI3K) complex. Recent evidence suggests a protective role for Beclin-1-mediated autophagy in CKD vascular calcification, raising its potential as a novel therapeutic target in this context.

We aimed to

Investigate the association between serum Beclin 1 levels and the presence of cardiovascular valvular calcification in hemodialysis patients.

Results

This study evaluated a cohort of 102 hemodialysis patients, evenly divided into two groups based on echocardiographic findings. All participants underwent serum Beclin 1 measurement and transthoracic echocardiography. Patients with acute kidney injury, active malignancy, or diabetes were excluded. Our study revealed significant differences between the two groups in terms of: Serum Beclin 1 levels, all parameters of lipid profile, prevalence of ischemic heart disease, serum albumin levels and Total calcium. Echocardiography in Group 1 showed that most cases (60.78%) exhibited mild aortic valve calcification. Additionally, significant relationships were observed between Beclin 1 and: ischemic heart disease (p=0.011) Aortic valve calcification on echocardiography (p < 0.001) Interestingly, lower Beclin 1 levels were associated with more severe valve calcification. A Beclin 1 cutoff value of ≤ 35.5 ng/ml demonstrated the highest sensitivity (98%) and specificity (92%).

Conclusion

Our findings suggest that the serum Beclin 1 level could be incorporated into a predictive model for cardiac valvular calcification in hemodialysis patients.

Section snippetsBackground

Autophagy is a complex, multi-step cellular process orchestrated by several key components. Among these critical elements are: Light chain 3 proteins conjugated with phosphatidylethanolamine (LC3-PE), which serve as markers of autophagic activity. Autophagy-related proteins (ATG5 and ATG7), essential factors in autophagosome formation and execution. Beclin-1, a central regulatory protein that activates ATG5 and ATG7, initiating the autophagic cascade. (1)1

Deciphering the intricate details of

Aim of the study

The primary objective of this study was to evaluate the relationship between serum Beclin 1 and the presence or severity of valvular calcification in hemodialysis patients.

Methods

This cross-sectional study was conducted over an 8-month period (January to August 2023) at the nephrology department's haemodialysis unit within Ain Shams University Hospitals. Participants were enrolled consecutively throughout the study period. A total of 102 patients with ESRD receiving regular haemodialysis at Ain Shams University Hospital dialysis units were enrolled in this study. Based on their echocardiographic assessment, they were categorized into two groups:

Demographic and clinical data of the studied individuals

The study encompassed 102 hemodialysis patients their characteristics are present in details in table 1 . The studied groups were comparable in demographic data without any statistical differences noted.

HTN represent the most common cause of ESRD followed by glomerulonephritis then interstitial kidney disease. Group I had higher cases with IHD with highly significant difference between both groups (P <0.001)

Table 2 Showing that Statistical analysis revealed substantial differences between the

Discussion

This study revealed a statistically significant elevation in beclin 1 levels within Group 2 compared to Group 1 (p < 0.001). Specifically, the average beclin 1 level in Group 1 was 24.5 ± 8.2, while in Group 2, it was significantly higher at 49.3 ± 13.5.

Supporting our findings, Chen et al.6 study, it was supporting our findings, this study hypothesized that impaired kidney function causes autophagy activation failure They observed significantly higher beclin 1 levels in HD patients without

Conclusions

Beclin 1 Levels Offer Strong Indication of Heart Valve Calcification in Dialysis Patients. Our study revealed a strong link between low serum beclin 1 levels and severe valvular calcification in hemodialysis patients. This suggests that beclin 1, a protein involved in autophagy, could be a valuable predictive marker for this heart valve condition.

Patients with severe valvular calcification had significantly lower beclin 1 levels compared to those with lesser or no calcification.

A beclin 1 level

Co – authors

Hayam Ahmed Hebah: Professor of Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt.

Hadeer Moamen Kamel: M.B.B.Ch. Ain Shams University, Cairo, Egypt.

Islam Mahmoud Bastawy: Associate Professor of Cardiology, Ain Shams University, Cairo, Egypt.

Declaration

Ethical Considerations: All data were treated with confidentiality and available with the principal investigator only. The protocol was approved by the ethics committee of faculty of the Medicine, Ain Shams University, Cairo, Egypt No. FWA 000017585. Participation in the study was strictly voluntary. After providing potential participants with detailed information about the research objectives and procedures, we secured their written informed consent.

Approval and agreement of publication

All authors reviewed and approved the final manuscript, and collectively agree with the presented results and conclusions.

Data availability

All data generated or analyzed during this study are included in this published article, any further data needed upon request from corresponding author.

Funding

No fund was received.

Authors' contributions

Conceptualization and methodology: H H and FA with I B jointly conceived the study idea and developed the research tools. They also provided ongoing oversight and revision during patient recruitment and tool refinement.

Data collection and analysis: F A and H M was responsible for collecting, analyzing, and interpreting the research data.

Manuscript writing and interpretation: F A and H M collaborated on defining the study methodology, interpreting the results, and drafting the manuscript.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Acknowledgment

NA

References (13)M Naguib et al.Serum level of the autophagy biomarker Beclin-1 in patients with diabetic kidney disease

Diabetes Res Clin Pract

(2018)

G. Schlieper et al.Vascular access calcification predicts mortality in hemodialysis patients

Kidney Int

(2008)

H G Cédric et al.The protective effects of the autophagic and lysosomal machinery in vascular and valvular calcification: a systematic review

Int J Mole Sci

(2020)

Alexander H Frauscher et al.Autophagy Protects From Uremic Vascular Media calcification

Front Immunol.

(2018)

J. Huang et al.The predictive value of coronary artery calcification score combined with bone mineral density for the 2-year risk of cardiovascular events in maintenance hemodialysis patients

Int Urol Nephrol.

(2022)

SS Somji et al.Adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam, Tanzania

Int J Nephrol

(2020)

There are more references available in the full text version of this article.

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