Intestinal alkaline phosphatase modulation by food components: predictive, preventive, and personalized strategies for n
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REVIEW
Intestinal alkaline phosphatase modulation by food components: predictive, preventive, and personalized strategies for novel treatment options in chronic kidney disease L. Alvarenga 1 & L. F. M. F. Cardozo 2 & B. Lindholm 3 & P. Stenvinkel 3 & D. Mafra 1,2 Received: 2 October 2020 / Accepted: 30 October 2020 / Published online: 18 November 2020 # European Association for Predictive, Preventive and Personalised Medicine (EPMA) 2020
Abstract Alkaline phosphatase (AP) is a ubiquitous membrane–bound glycoprotein that catalyzes phosphate monoesters’ hydrolysis from organic compounds, an essential process in cell signaling. Four AP isozymes have been described in humans, placental AP, germ cell AP, tissue nonspecific AP, and intestinal AP (IAP). IAP plays a crucial role in gut microbial homeostasis, nutrient uptake, and local and systemic inflammation, and its dysfunction is associated with persistent inflammatory disorders. AP is a strong predictor of mortality in the general population and patients with cardiovascular and chronic kidney disease (CKD). However, little is known about IAP modulation and its possible consequences in CKD, a disease characterized by gut microbiota imbalance and persistent low-grade inflammation. Mitigating inflammation and dysbiosis can prevent cardiovascular complications in patients with CKD, and monitoring factors such as IAP can be useful for predicting those complications. Here, we review IAP’s role and the results of nutritional interventions targeting IAP in experimental models to prevent alterations in the gut microbiota, which could be a possible target of predictive, preventive, personalized medicine (PPPM) to avoid CKD complications. Microbiota and some nutrients may activate IAP, which seems to have a beneficial impact on health; however, data on CKD remains scarce. Keywords Intestinal alkaline phosphatase . Chronic kidney disease . Inflammation . Gut microbiota . Predictive diagnosis . Predictive preventive personalized medicine (PPPM/3 PM)
Introduction Alkaline phosphatases (APs) are ubiquitous membrane-bound glycoproteins that catalyze phosphate monoesters’ hydrolysis at an alkaline pH optimum, with the highest activity at pH 9.7. In humans, four different alkaline phosphatase isozymes are known, originating from distinct gene loci. Tissue nonspecific AP (tnAP), also known as TNSAP, TNAP, AP-TNAP,
* L. Alvarenga [email protected] 1
Post Graduation Program in Medical Sciences, (UFF) Federal Fluminense University Niterói-Rio de Janeiro (RJ), Niterói, Brazil
2
Post Graduation Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, Rio de Janeiro (RJ), Brazil
3
Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
expressed mainly in the liver, bone, and kidney, comprising > 90% of circulating AP. Also, there are the placental-type AP (pAP); germ cell AP, known as placental-like AP; GCAP, plAP-like, or AP-1; and the intestinal AP (IAP) [1].
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