Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
J Transl Med. 2023 Jun 1;21(1):359. doi: 10.1186/s12967-023-04171-x.
BACKGROUND: Chronic kidney disease (CKD) is one of the most significant cardiovascular risk factors, playing vital roles in various cardiovascular diseases such as calcific aortic valve disease (CAVD). We aim to explore the CKD-associated genes potentially involving CAVD pathogenesis, and to discover candidate biomarkers for the diagnosis of CKD with CAVD. METHODS: Three CAVD, one CKD-PBMC and one CKD-Kidney datasets of expression profiles were obtained from the GEO database. Firstly, to detect CAVD key genes and CKD-associated secretory proteins, differentially expressed analysis and WGCNA were carried out. Protein-protein interaction (PPI), functional enrichment and cMAP analyses were employed to reveal CKD-related pathogenic genes and underlying mechanisms in CKD-related CAVD as well as the potential drugs for CAVD treatment. Then, machine learning algorithms including LASSO regression and random forest were adopted for screening candidate biomarkers and constructing diagnostic nomogram for predicting CKD-related CAVD. Moreover, ROC curve, calibration curve and decision curve analyses were applied to evaluate the diagnostic performance of nomogram. Finally, the CIBERSORT algorithm was used to explore immune cell infiltration in CAVD. RESULTS: The integrated CAVD dataset identified 124 CAVD key genes by intersecting differential expression and WGCNA analyses. Totally 983 CKD-associated secretory proteins were screened by differential expression analysis of CKD-PBMC/Kidney datasets. PPI analysis identified two key modules containing 76 nodes, regarded as CKD-related pathogenic genes in CAVD, which were mostly enriched in inflammatory and immune regulation by enrichment analysis. The cMAP analysis exposed metyrapone as a more potential drug for CAVD treatment. 17 genes were overlapped between CAVD key genes and CKD-associated secretory proteins, and two hub genes were chosen as candidate biomarkers for developing nomogram with ideal diagnostic performance through machine learning. Furthermore, SLPI/MMP9 expression patterns were confirmed in our external cohort and the nomogram could serve as novel diagnosis models for distinguishing CAVD. Finally, immune cell infiltration results uncovered immune dysregulation in CAVD, and SLPI/MMP9 were significantly associated with invasive immune cells. CONCLUSIONS: We revealed the inflammatory-immune pathways underlying CKD-related CAVD, and developed SLPI/MMP9-based CAVD diagnostic nomogram, which offered novel insights into future serum-based diagnosis and therapeutic intervention of CKD with CAVD.
背景:慢性肾脏病(CKD)是心血管疾病的重要危险因素之一,在钙化性主动脉瓣疾病(CAVD)等多种心血管疾病中发挥着重要作用。本研究旨在探索与 CKD 相关的潜在参与 CAVD 发病机制的基因,并发现用于诊断 CKD 合并 CAVD 的候选生物标志物。
方法:从 GEO 数据库中获取三个 CAVD、一个 CKD-PBMC 和一个 CKD-Kidney 数据集的表达谱。首先,通过差异表达分析和 WGCNA 检测,以发现 CAVD 关键基因和 CKD 相关分泌蛋白。采用蛋白质-蛋白质相互作用(PPI)、功能富集和 cMAP 分析揭示 CKD 相关致病基因及 CKD 相关 CAVD 的潜在机制,以及 CAVD 治疗的潜在药物。然后,采用 LASSO 回归和随机森林等机器学习算法筛选候选生物标志物,并构建用于预测 CKD 相关 CAVD 的诊断列线图。此外,还应用 ROC 曲线、校准曲线和决策曲线分析评估列线图的诊断性能。最后,使用 CIBERSORT 算法探索 CAVD 中的免疫细胞浸润。
结果:通过对 CAVD 数据集进行整合分析,通过差异表达分析和 WGCNA 分析,共鉴定出 124 个 CAVD 关键基因。通过对 CKD-PBMC/Kidney 数据集的差异表达分析,筛选出 983 个 CKD 相关分泌蛋白。PPI 分析确定了包含 76 个节点的两个关键模块,被认为是 CAVD 中与 CKD 相关的致病基因,通过富集分析,这些基因主要富集在炎症和免疫调节中。cMAP 分析发现美替拉酮(metyrapone)可能是治疗 CAVD 的更有潜力的药物。CAVD 关键基因与 CKD 相关分泌蛋白之间存在 17 个重叠基因,通过机器学习选择两个关键基因作为构建列线图的候选生物标志物,具有理想的诊断性能。此外,在我们的外部队列中验证了 SLPI/MMP9 的表达模式,并且该列线图可作为区分 CAVD 的新型诊断模型。最后,免疫细胞浸润结果揭示了 CAVD 中的免疫失调,并且 SLPI/MMP9 与侵袭性免疫细胞显著相关。
结论:本研究揭示了 CKD 相关 CAVD 的炎症-免疫途径,并开发了基于 SLPI/MMP9 的 CAVD 诊断列线图,为 CKD 合并 CAVD 的未来基于血清的诊断和治疗干预提供了新的见解。
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