Calciprotein Particles and Serum Calcification Propensity: Hallmarks of Vascular Calcifications in Patients with Chronic Kidney Disease.

Ciprian N Silaghi,Tamás Ilyés,Alexandra M Crăciun,Adriana J Van Ballegooijen

doi:10.3390/jcm9051287

Abstract

Cardiovascular complications are one of the leading causes of mortality worldwide and are strongly associated with atherosclerosis and vascular calcification (VC). Patients with chronic kidney disease (CKD) have a higher prevalence of VC as renal function declines, which will result in increased mortality. Serum calciprotein particles (CPPs) are colloidal nanoparticles that have a prominent role in the initiation and progression of VC. The T50 test is a novel test that measures the conversion of primary to secondary calciprotein particles indicating the tendency of serum to calcify. Therefore, we accomplished a comprehensive review as the first integrated approach to clarify fundamental aspects that influence serum CPP levels and T50, and to explore the effects of CPP and calcification propensity on various chronic disease outcomes. In addition, new topics were raised regarding possible clinical uses of T50 in the assessment of VC, particularly in patients with CKD, including possible opportunities in VC management. The relationships between serum calcification propensity and cardiovascular and all-cause mortality were also addressed. The review is the outcome of a comprehensive search on available literature and could open new directions to control VC.

Highlights

Serum calciprotein particles (CPPs) are colloidal nanoparticles comprising a combination of proteins (mainly fetuin-A, and albumin and Gla-rich protein (GRP)) and calcium (Ca2+) containing compounds, primarily calcium phosphate [1,2,3]
We used the term total CPP when referring to studies that did not specify the type of CPP analysed
The relatively recent discovery of CPPs opens up new possibilities for the prevention of vascular calcification (VC) and the attempt to quantify the serum calcification propensity via T50

Summary

Introduction

Serum calciprotein particles (CPPs) are colloidal nanoparticles comprising a combination of proteins (mainly fetuin-A, and albumin and Gla-rich protein (GRP)) and calcium (Ca2+) containing compounds, primarily calcium phosphate [1,2,3]. They are first formed by the binding of Ca2+ precursors to the acidic residues of fetuin-A, a glycoprotein secreted by the liver [1,4]. CPP I are small spherical colloidal nanoparticles that contain amorphous calcium phosphate, while CPP II contain crystalline calcium phosphate at their core, are larger than CPP I, and have a needle-shaped structure. The ripening process is influenced by a number of factors such as the concentration of fetuin-A, Ca2+, magnesium (Mg2+), phosphate (Pi), as well as the temperature and pH of the surrounding microenvironment [1,6,8]

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