Abstract

BackgroundBalkan endemic nephropathy (BEN) represents a chronic progressive interstitial nephritis in striking correlation with uroepithelial tumours of the upper urinary tract. The disease has endemic distribution in the Danube river regions in several Balkan countries.DNA methylation is a primary epigenetic modification that is involved in major processes such as cancer, genomic imprinting, gene silencing, etc. The significance of CpG island methylation status in normal development, cell differentiation and gene expression is widely recognized, although still stays poorly understood.MethodsWe performed whole genome DNA methylation array analysis on DNA pool samples from peripheral blood from 159 affected individuals and 170 healthy individuals. This technique allowed us to determine the methylation status of 27 627 CpG islands throughout the whole genome in healthy controls and BEN patients. Thus we obtained the methylation profile of BEN patients from Bulgarian and Serbian endemic regions.ResultsUsing specifically developed software we compared the methylation profiles of BEN patients and corresponding controls and revealed the differently methylated regions. We then compared the DMRs between all patient-control pairs to determine common changes in the epigenetic profiles.SEC61G, IL17RA, HDAC11 proved to be differently methylated throughout all patient-control pairs. The CpG islands of all 3 genes were hypomethylated compared to controls. This suggests that dysregulation of these genes involved in immunological response could be a common mechanism in BEN pathogenesis in both endemic regions and in both genders.ConclusionOur data propose a new hypothesis that immunologic dysregulation has a place in BEN etiopathogenesis.

Highlights

  • Balkan endemic nephropathy (BEN) represents a chronic progressive interstitial nephritis in striking correlation with uroepithelial tumours of the upper urinary tract

  • Balkan endemic nephropathy (BEN) represents a chronic interstitial nephritis confined to certain regions on the Balkan peninsula - spreading in villages in Serbia, Romania, Croatia, Bosnia and Herzegovina and Bulgaria [1,2]

  • There are different papers reporting on numerous viruses (Picorna virus, Polyoma virus, Herpes simplex 1 and 2, Adenovirus, Hepatitis B, Cytomegalovirus, Epstein-Barr virus) found in kidney samples of BEN patients [9,10], there is no substantial evidence supporting viral etiopathogenesis of BEN

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Summary

Introduction

Balkan endemic nephropathy (BEN) represents a chronic progressive interstitial nephritis in striking correlation with uroepithelial tumours of the upper urinary tract. Balkan endemic nephropathy (BEN) represents a chronic interstitial nephritis confined to certain regions on the Balkan peninsula - spreading in villages in Serbia, Romania, Croatia, Bosnia and Herzegovina and Bulgaria [1,2]. Significant differences in soil concentration of heavy metals such as Mg, Mo, Cd, Pb As, Se, Ca, Cu are observed between endemic and non-endemic regions [6], there is no direct link of a toxic effect of any heavy metal to the disease development. Since BEN has similarities in pathomorphological characteristics with Chinese herbal nephropathy, a common etiology (toxic effect of the aristolochic acid) of both disorders was proposed. There is no irrefutable evidence supporting the effect of aristolochic acid on BEN development. There are different papers reporting on numerous viruses (Picorna virus, Polyoma virus, Herpes simplex 1 and 2, Adenovirus, Hepatitis B, Cytomegalovirus, Epstein-Barr virus) found in kidney samples of BEN patients [9,10], there is no substantial evidence supporting viral etiopathogenesis of BEN

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