Integrin‐associated ILK and PINCH1 protein content are reduced in skeletal muscle of maintenance haemodialysis patients
Authors: Draicchio Fulvia , van Vliet Stephan , Ancu Oana , Paluska Scott A. , Wilund Kenneth R. , Mickute Monika , Sathyapalan Thozhukat , Renshaw Derek , Watt Peter , Sylow Lykke , Burd Nicholas A. , Mackenzie Richard WA 
Published: September 2020

Key points
Patients with renal failure undergoing maintenance haemodialysis are associated with insulin resistance and protein metabolism dysfunction.
Novel research suggests that disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in haemodialysis.
ILK, PINCH1 and pFAKTyr397 were significantly decreased in haemodialysis compared to controls, whereas Rac1 and Akt2 showed no different between groups.
Rac1 deletion in the Rac1 knockout model did not alter the expression of integrin‐associated proteins.
Phenylalanine kinetics were reduced in the haemodialysis group at 30 and 60 min post meal ingestion compared to controls; both groups showed similar levels of insulin sensitivity and β‐cell function.
Key proteins in the integrin–cytoskeleton linkage are reduced in haemodialysis patients, suggesting for the first time that integrin‐associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients.
AbstractMuscle atrophy, insulin resistance and reduced muscle phosphoinositide 3‐kinase‐Akt signalling are common characteristics of patients undergoing maintenance haemodialysis (MHD). Disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in MHD patients. Eight MHD patients (age: 56 ± 5 years: body mass index: 32 ± 2 kg m–2) and non‐diseased controls (age: 50 ± 2 years: body mass index: 31 ± 1 kg m–2) received primed continuous l‐[ring‐2H5]phenylalanine before consuming a mixed meal. Phenylalanine metabolism was determined using two‐compartment modelling. Muscle biopsies were collected prior to the meal and at 300 min postprandially. In a separate experiment, skeletal muscle tissue from muscle‐specific Rac1 knockout (Rac1 mKO) was harvested to investigate whether Rac1 depletion disrupted the cytoskeleton‐integrin linkage, allowing for cross‐model examination of proteins of interest. ILK, PINCH1 and pFAKTyr397 were significantly lower in MHD (P < 0.01). Rac1 and Akt showed no difference between groups for the human trial. Rac1 deletion in the Rac1 mKO model did not alter the expression of integrin‐associated proteins. Phenylalanine rates of appearance and disappearance, as well as metabolic clearance rates, were lower in the MHD group at 30 and 60 min post meal ingestion compared to controls (P < 0.05). Both groups showed similar levels of insulin sensitivity and β‐cell function. Key proteins in the integrin–cytoskeleton linkage are reduced in MHD patients, suggesting for the first time that integrin‐associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients.