FC091: Changes in the Gut Microbiome and Systemic Metabolome in an In Vivo Model of Peritoneal Dialysis Supplemented with Alanyl-Glutamine
Authors: Hoogenboom Robin , Manuel Sacnun Juan , Kratochwill Klaus , Herzog Rebecca 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Long-term usage of peritoneal dialysis (PD) leads to morphological and functional changes—such as progressive thickening, vascularization and vasculopathy—of the peritoneum, thereby limiting PD efficiency. Vasculopathy induces changes in permeability of the endothelial barrier, which has been suggested to influence the gut microbiome (gMB). Microbial dysbiosis in turn can potentiate inflammation, a risk factor for cardiovascular disease (CVD). The complex interplay of molecules associated with CKD and PD with the gMB is hypothesized to be in causal relationship with occurrences of cardiovascular events and progression of CVD. Novel PD fluids that slow or prevent these processes are in need. The immunomodulatory and cytoprotective compound alanyl-glutamine (AG) has been shown in other model systems to improve the endothelial barrier function, supposedly protecting the gMB from the extraintestinal environment. Our aim is to identify changes of the gMB and the systemic metabolome caused by the addition of AG to PD under conditions of CKD.

METHOD
Mice (C57/Bl6 NCrl) underwent a 5/6 nephrectomy to induce uraemia. Via a subcutaneously implanted catheter the animals received five times per week a daily injection of 2 mL PD fluid (3.86% glucose with/without 8 mM AG) for six weeks to a total of 30 injections. During the experiment, mice received standard chow and tap water ad libitum. At the end of the experiment, fecal samples from three different intestinal sites and stool were collected and a serum sample was drawn from each mouse. Tissue samples from parietal and visceral peritoneum and relevant organs were preserved for paraffin and cryo sections. Peritoneal effluent cells were spun down and snap-frozen in liquid nitrogen and the supernatant was stored on −80°C. Bacterial ribosomal RNA (rRNA) was isolated from each fecal sample and the V4 region of the 16S rRNA was amplified. Assessment of the plasma metabolome was performed by targeted mass spectrometry (MxP Quant 500, Biocrates, Austria). The experiment was approved by the institutional animal ethics committee.

RESULTS
Elevated creatinine levels after subtotal nephrectomy confirmed the uremic status of the mice. Descriptive analysis of the gMB showed decreased Shannon diversity, indicating reduced bacterial diversity, in uremic and PD fluid receiving mice over time, whereas AG receiving and control mice retained a stable Shannon diversity. Furthermore, the gMB of mice exposed to PD fluid with AG showed five bacterial classes and 13 bacterial orders to be differently abundant versus mice exposed to PD fluid without AG. In the colon of uremic mice Clostridia was decreased versus control. Serum concentrations of 630 metabolites were assessed by our metabolomics approach. A significant increase in alanine and glutamine serum concentrations was seen in mice exposed to AG supplemented PD fluid. Further, 17 amino acids and four biogenic amines showed to be differently abundant in mice exposed to AG supplemented PD fluid versus without AG. Lastly, plasma of uremic mice showed a significant increase of the toxic amino acid symmetric dimethyl arginine (SDMA) and citrulline.

CONCLUSION
Exposure to PD fluid and having chronic kidney disease both affect the gut microbiome and systemic metabolome. Supplementation of AG to PD fluid showed changes at overall microbiome diversity and serum metabolites. Further analysis of these changes in the context of tissue alterations will clarify functional differences of the cytoprotective additive AG. Preservation of the mesothelial and endothelial barrier function may represent a mechanistic explanation for the observed improvement in protein loss and systemic inflammation in a recent phase II clinical trial in PD patients. Better understanding of the gut-peritoneal barrier may open up new therapeutic targets for improving clinical outcome of PD treatment and its long-term efficacy.