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研究生:黃昱紳
研究生(外文):Yu-Shen Huang
論文名稱:二甲雙胍對鉛誘導腎損傷大鼠之尿液代謝體學分析
論文名稱(外文):Metabolomic studies of metformin’s effects on Pb-induced nephrotoxicity in rats urine
指導教授:李仁愛
指導教授(外文):Jen-Ai Lee
學位類別:博士
校院名稱:臺北醫學大學
系所名稱:藥學系(碩博士班)
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:152
中文關鍵詞:鉛、代謝體學、腎損傷、二甲雙胍
外文關鍵詞:Lead (Pb)、metabolomics、nephrotoxicity、metformin
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  • 被引用被引用:1
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慢性腎臟病的盛行率逐年上升,而暴露於鉛環境會增加罹患慢性腎臟病之風險。由於現今腎功能指標不足以診斷鉛誘導腎損傷,故相關生物標記仍需進一步被開發和研究。二甲雙胍(metformin,Met)為第二型糖尿病第一線用藥,過去研究指出可用於改善腎損傷,但詳細機轉仍須進一步探討。本研究首先以標靶式代謝體學探討二甲雙胍用於治療鉛誘導腎損傷之可能性,並透過非標靶式尿液代謝體學找尋鉛誘導腎損傷之早期生物標記,並探討不同劑量之二甲雙胍腎保護機轉之相關機轉。雄性Wistar大鼠以含鉛飲用水(250 ppm Pb(NO3)2)誘導腎損傷,而二甲雙胍經口投與50或100 mg/kg/d作為腎保護藥物,持續投與28天。本研究以NMR搭配多變量分析進行非標靶式尿液代謝體學研究,並將七個潛在的生物標記進行定量。研究結果顯示,250 ppm鉛誘導腎損傷於臨床生化檢驗並無明顯之變化,但腎組織於近端腎小管處有明顯損傷。相較於對照組,鉛損傷組大鼠之腎臟甲基乙二醛(methylglyoxal)(control vs. Pb, 36.40 ± 5.69 vs. 56.86 ± 17.47 μg/mg protein, p < 0.01)和尿中D-乳酸(D-lactate)(Pb vs. Pb+Met, 0.32 ± 0.13 vs. 0.68 ± 0.28 μmol/mg creatinine, p < 0.01)皆顯著性地上升。合併投與二甲雙胍(50 mg/kg/d)可顯著地降低腎臟甲基乙二醛(Pb vs. Pb+Met, 56.86 ± 17.47 vs. 39.91 ± 4.00 μg/mg protein, p < 0.05)和尿中D-乳酸(Pb vs. Pb+Met, 0.68 ± 0.28 vs. 0.32 ± 0.08 μmol/mg creatinine, p < 0.01),來延緩腎損傷。接著,尿液代謝體學中將七個潛在的代謝物進行定量分析,結果顯示除了尿中D-乳酸之外,尿中胍乙酸(guanidinoacecitc acid)(control vs. Pb, 19.35 ± 4.74 vs. 26.31 ± 5.40 μg/mg creatinine, p < 0.05)和δ-胺基乙醯丙酸(δ-aminolevulinic acid)(control vs. Pb, 0.55 ± 0.11 vs. 24.25 ± 6.55 μg/mg creatinine, p < 0.01)在鉛腎損傷下有顯著性地上升。合併投與二甲雙胍發現低劑量二甲雙胍之腎臟保護效果優於高劑量。本研究首次提出腎臟甲基乙二醛以及尿中D-乳酸、尿中胍乙酸以及δ-胺基乙醯丙可望成為早期鉛誘導腎損傷之生物標記,此外,透過標靶式以及非標靶式代謝體學亦發現尿中D-乳酸於鉛誘導腎損傷下有顯著性地上升。二甲雙胍腎保護效果主要透過降低甲基乙二醛及其代謝物D-乳酸來達到改善鉛誘導腎損傷。研究成果將可望應用於診斷早期鉛誘導腎損傷,了解二甲雙胍劑量對於延緩鉛誘導腎損傷之差異。根據研究結果推測,投與二甲雙胍(600 mg/day)於成人(60 kg)可能可有效地延緩低濃度鉛誘導之腎損傷,特別是早期且非高血糖之腎損傷。
The prevalence of chronic kidney disease is increased year by year. Heavy metal (Pb) is one of the environmental pollutant. Expose to Pb is one of the risk factor that leads to chronic kidney disease. Due to current biomarkers are not sensitive to diagnosis of Pb-induced renal injury, novel biomarkers need to be discovered. Metformin is first-line oral therapy for type II diabetic mellitus. Our studies demonstrated that metformin could attenuate renal injury, but mechanism of its action is need to be elucidated. First of all, we want to investigating the reno-protection of metformin effect on Pb-induced nephrotoxicty in rats with targeted metabolomics. Then, non-targeted urinary metabolomics is applied for discovery the early biomarkers of Pb-induced renal injury and investigating the mechanism of reno-protection of metformin. Male Wistar rats were received 250 ppm Pb(NO3)2 in drinking water, and orally administered metformin (50 or 100 mg/kg/d) for consecutive 28 days. Non-targeted urinary metabolomics were carried out with NMR coupled with multivariate analysis. The seven potential biomarkers were further quantification. The results showed that Pb induced renal injury at proximal tubule without alteration of clinical chemistry. Compared with the control group, renl methylglyoxal (36.40 ± 5.69 vs. 56.86 ± 17.47 μg/mg protein, p < 0.01) and urinary D-lactate (0.32 ± 0.13 vs. 0.68 ± 0.28 μmol/mg creatinine, p < 0.01) were significantly increased in Pb rats. After cotreated with metformin (50 mg/kg/d), renal injury were attenuated, and renal methylglyoxal (56.86 ± 17.47 vs. 39.91 ± 4.00 μg/mg protein, p < 0.05) and urinary D-lactate (0.68 ± 0.28 vs. 0.32 ± 0.08 μmol/mg creatinine, p < 0.01) were signficantly decreased compared with the Pb-treated group. After urinary metabolomics analysis, potential biomarkers were quantified. The results showed that urinary guanidinoacetic acid (19.35 ± 4.74 vs. 26.31 ± 5.40 μg/mg creatinine, p < 0.05), urinary δ-aminolevulinic acid (0.55 ± 0.11 vs. 24.25 ± 6.55 μg/mg creatinine, p < 0.01) and urinary D-lactate were significantly increased in the Pb group compared with the control group. After co-treated with metformin, low-dose metformin (50 mg/kg/d) had better renoprotective ability than high-dose (100 mg/kg/d) one. This is the first study demonstrating that renal methylglyoxal and urinary D-lactate, guanidinoacetic acid and δ-aminolevulinic acid are potential biomarkers of early diagnosis of Pb-induced renal injury. In addition, urinary D-lactate was signficantlty increased in Pb-induced nephrotixcity rats in both targeted and non-targeted metabolomics. The reno-protection of metformin is attributable to decrease methylglyoxal and its metabolite, D-lactate. Our study provides sensitive biomarkers to early diagnosis of low-level Pb-induced renal injury and reno-protective effect of metformin. Based on our results, we speculated that administration of metformin (600 mg/day) might possibly attenuate low-level Pb-induced renal injury in adults (60 kg), especially in the early stage of renal injury without hyperglycemia.
目錄
目錄 I
圖目錄 IV
表目錄 VI
附錄表 VII
縮寫表 VIII
摘要 XII
Abstract XIV
第一章 緒論 1
第二章 文獻回顧 4
2.1 代謝體學 4
2.2 甲基乙二醛 9
2.2.1 甲基乙二醛之來源 11
2.2.2 甲基乙二醛之代謝 12
2.2.3 甲基乙二醛之致病機轉與相關疾病 15
2.3 乳酸 16
2.3.1 乳酸來源 17
2.3.2 乳酸代謝與排泄 19
2.3.3 乳酸中毒與相關疾病 20
2.3.4 乳酸之分析方法 22
2.4 重金屬-鉛 24
2.4.1 鉛之吸收、分布、代謝及排泄 24
2.4.2 鉛誘導腎損傷之流行病學 24
2.4.3 鉛誘導腎損傷之相關機轉 25
2.4.3 鉛中毒之臨床特徵與診斷鉛誘導腎損傷之生物標記 26
2.4.4暴露於鉛之代謝體學研究 29
2.4.5臨床治療鉛中毒 30
2.5 二甲雙胍 32
2.5.1 二甲雙胍之藥物動力學 33
2.5.2 二甲雙胍之藥效動力學 34
2.5.3 二甲雙胍之乳酸中毒 34
2.5.4 二甲雙胍臨床應用 35
第三章 研究目的 37
第四章 研究材料與方法 38
4.1 研究材料 38
4.2 研究方法 42
4.2.1 動物實驗 42
4.2.2 生物檢品採樣與前處理 43
4.2.3 血液生化分析 43
4.2.4 腎臟蛋白質定量分析 43
4.2.5 尿蛋白定量分析 44
4.2.6 腎臟組織學量化評估 45
4.2.7 尿中肌酸酐定量分析 45
4.2.8 生物檢品之甲基乙二醛定量分析 46
4.2.9 生物檢品之D-與L-乳酸定量分析 49
4.2.10 腎臟與血清之乳酸脫氫酵素活性測定 53
4.2.11 尿液代謝體學分析 54
4.2.12 尿中N-acetyl--D-glucosaminidase定量分析 58
4.2.13 尿中δ-aminolevulinic acid定量分析 60
4.2.14 尿中Guanidinoacetic acid、Hippurica acid和Indoleacetic acid定量分析 63
4.2.15 統計分析 65
第五章 結果與討論 67
第一節 二甲雙胍對鉛誘導腎損傷大鼠之影響與標靶式代謝體學研究 67
5.1.1 實驗動物體重、飲水量和臨床生化指標之影響 67
5.1.2 腎組織病理學評估與量化 71
5.1.3 生物檢品之甲基乙二醛含量變化 71
5.1.4 生物檢品之D-和L-LA含量變化 75
5.1.5 腎臟與血清中乳酸脫氫酶活性之變化 75
5.1.6 討論 81
第二節 不同劑量之二甲雙胍對鉛誘導腎損傷大鼠之非標靶式尿液代謝體學 85
5.2.1 實驗動物體重、飲水量以及臨床生化指標之變化 85
5.2.2 腎臟與肝臟組織學與損傷量化分析 88
5.2.3 NMR-based尿液代謝體學搭配多變量分析之結果 91
5.2.4 驗證尿中潛在生物標記之含量變化 106
5.2.5 討論 113
第六章 結論 120
第七章 未來展望 120
參考文獻 122
附錄 147

圖目錄
Figure 1. Nephritis, nephritic syndrome and nephrosis ranked within ten of leading causes of death in Taiwan in 1994-2016. 1
Figure 2. Metabolomics events from 1980 onwards. 6
Figure 3. Publications of NMR- or MS-based metabolomics between 2002 to 2017. 7
Figure 4. The chemical structure of methylglyoxal. 11
Figure 5. The formation of methylglyoxal from glucose, triglyceride, amino acids, and β-hydroxybutyrate. 13
Figure 6. The metabolic pathways involved in MG detoxification. 14
Figure 7. The chemical structures of L- and D-lactate. 16
Figure 8. Methylglyoxal converts it into D-lactate through glyoxalase system. 17
Figure 9. The formation of L-lactate from pyruvate and L-alanine. 18
Figure 10. The structure of 2,1,3-benzoxadiazole backbone and derivatization reagent of NBD-PZ. 23
Figure 11. Blood Pb level and its related physiological functions in children and adults. 27
Figure 12. The structure of metformin. 32
Figure 13. Relevant structures for the metformin−methylglyoxal reaction. 36
Figure 14. Derivatization scheme of methylglyoxla with DDP. 47
Figure 15. Derivatization scheme of D- and L-lactate with NBD-PZ. 51
Figure 16. The stationary phase of Chiralpak AD-RH. 52
Figure 17. Schematic diagram for the enzymatic assay of NAG activity. 59
Figure 18. Derivatization scheme of δ-aminolevulinic acid with acetylacetone and formaldehyde 62
Figure 19. Metformin’s effect of final body weight and daily drinking water volume on Pb-induced nephrotoxicity rats. 68
Figure 20. Metformin’s effect of clinical chemistry on Pb-induced nephrotoxicity rats. 69
Figure 21. Metformin’s effect of urinalysis on Pb-induced nephrotoxicity rats. 70
Figure 22. Evaluation of renal architecture with hematoxylin and eosin stain and the sum of the tubulointerstitial histological score were obtained from rat kidneys. 72
Figure 23. Chromatograms of methylglyoxal from standard solution and biological samples. 73
Figure 24. Determination of methylglyoxal levels in rat urine, kidney and serum. 74
Figure 25. Chromatograms of D-, and L-lactate from standard solution using column-switching system. 76
Figure 26. Chromatograms of NBD-D,L-lactate and quantitative results from rat urine. 77
Figure 27. Chromatograms of NBD-D,L-lactate and quantitative results from rat serum. 78
Figure 28. Chromatograms of NBD-D,L-lactate and quantitative results from rat kidney. 79
Figure 29. Different doses of metformin’s effect of body weight and water intake on Pb-induced nephrotoxicity rats. 86
Figure 30. Metformin’s effect of renal histological examination on Pb-induced nephrotoxicity in rats. 89
Figure 31. Metformin’s effect of hepatic histological examination on Pb-induced toxicity in rats. 90
Figure 32. 1H-NMR spectra of urinary metabolomics in Pb-induced nephrotoxicity rats co-treated with metformin. 93
Figure 33. PCA of score plot and loading plot. 96
Figure 34. PLS-DA of score plot and loading plot. 97
Figure 35. PLS-DA of LOOCV and permutation test. 98
Figure 36. Pathway analysis. 104
Figure 37. The chemical structure of guanidinoacetic acid, hippuric acid and indoleacetic acid. 105
Figure 38. The chromatogram of δ-aminolevulinic acid in standard solution and rat urine. 108
Figure 39. Metformin’s effects on potential biomarkers of Pb-induced nephrotoxicity in rat urine. 110
Figure 40. Hypothesis of metformin’s effect on low-level Pb-induced nephrotoxicity in rats with metformin treatment. 119
Figure 41. Metformin’s effect of renal and urinary metabolites on low-level Pb-induced nephrotoxicity in rats with metformin treatment. 121

 
表目錄
Table 1. Comparison between the GC-MS, LC-MS and NMR-based metabolomics. 8
Table 2. The advantages and disadvantages of non-targeted and targeted metabolomics. 8
Table 3. The alteration of D- or L-lactate in different diseases. 21
Table 4. Current biomarkers of Pb-induced nephrotoxicity. 28
Table 5. Chelation therpay for symptomatic or asymptomatic patients 31
Table 6. List of selected multiple reaction monitoring parameters for each analyte and internal standard. 66
Table 7. Metformin’s effect on the lactate dehydrogenase (LDH) activity in Pb-induced nephrotoxic rats. 80
Table 8. Different doses of metformin’s effect of clinical chemistry and urinalysis on Pb-induced nephrotoxicity rats. 87
Table 9. The significant alteration peaks in 1H-NMR spectra between the five groups. 94
Table 10. Identified metabolites from 1D and 2D-NMR spectra. 99
Table 11. The pathway analysis of significant altered metabolites. 104
Table 12. Metformin’s effects on potential biomarkers of Pb-induced nephrotoxicity in rat urine. 107
Table 13. Precision and accuracy of determination of δ-aminolevulinic acid in rat urine using HPLC with fluorescence detector. 109
Table 14. Precision and accuracy of determination of guanidinoacetic acid, indoleacetic acid, and hippuric acid in standard solution using LC-MS/MS. 111
Table 15. Precision, accuracy, recovery and matrix effect for determination of guanidinoacetic acid, indoleacetic acid, and hippuric acid in rat urine using LC-MS/MS. 112
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