MTP Themes
1. Management of dyslipidemia and prevention of CVD in CKD
Professor :
Christoph Wanner Germany
Moderator :
Tetsuo Shoji Japan
Purpose :
To clarify whether or not we should treat dyslipidemia in patients with CKD to reduce CVD risk. If yes, whom, when and how?
Discussion :
(1) Observational studies on serum lipids and CVD in CKD, (2) Results of RCTs in CKD, (3) Sub-analyses in CKD of large trials, and (4) possible renoprotective actions of statins.
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2. Cardiovascular complications in chronic kidney disease from the epidemiological view
Professor :
Alan S. Go USA
Moderator :
Kent Doi Japan
Eisei Noiri Japan
Purpose :
Chronic kidney disease and end-stage renal disease are associated with excess risks for cardiovascular events and death. However, the associations between kidney dysfunction and specific types of cardiovascular events (for example, acute coronary syndromes, ischemic vs. hemorrhagic stroke, heart failure, and sudden cardiac death) may vary. This session will explore the epidemiological approach to evaluating the risks of different cardiovascular complications linked to kidney disease which may have implications for better understanding underlying mechanisms and approaches to prevention.
Discussion :
(i) What is the epidemiological evidence about the specific absolute and relative risks of different cardiovascular events associated with varying severity of kidney dysfunction? What are the most rigorous design and analytic approaches to examining these risks in international populations?
(ii) What is the CVRN (Cardiovascular Research Network) and what it its potential for improving our understanding of cardio-renal syndromes? Do Japan and other Asian countries need a similar research network?
(iii) How can we estimate the underlying physiological mechanism by analyzing epidemiological data? Can we do bedside-to-bench translation?
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3. Oxygen abnormalities in renal-cardiovascular injury: Hypoxia, oxidative stress, AGEs/carbonyl stress.
Professor :
Charles van Ypersele de Strihou
Belgium
Toshio Miyata Japan
Moderator :
Josephine M. Forbes Australia
Takefumi Mori Japan
Kotaro Takeda Japan
Purpose :
Elucidation of sequential events stemming from oxygen abnormalities (hypoxia, oxidative stress, and AGEs/carbonyl stress), linking to clinical disorders (hypertension, diabetes, insulin resistance, obesity), and eventually leading to cardiovascular injury (hopefully including discussion on potential therapeutic interventions).
Discussion :
First day :
To unravel the cause-effect relationship of the pathological axis stemming from oxygen abnormalities (hypoxia, oxidative stress, AGEs/carbonyl stress, etc)
Second day :
To discuss on the intriguing link of oxygen abnormalities to clinical disorders (hypertension, diabetes, insulin resistance, obesity) and their consequences (vascular injury). If time allows, we extend to potential therapeutic perspectives against oxygen abnormalities.
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4. Circulating factors involved in the cardiorenal syndrome: pathophysiological and therapeutic aspects
Professor :
Ravi Thadhani
Sadayoshi Ito Japan
Moderator :
Takashi Wada Japan
Purpose :
Cardiorenal syndrome (CRS) has been widely recognized as one of the most important complications in patients with chronic kidney disease. However, the precise pathogenesis of CRS remains to be investigated. We would like to discuss the mechanisms involved in CRS by focusing on circulating blood, especially humoral factors and cellular components in circulation.
Discussion :
Humoral factors :
Renin-angiotensin system, ADMA, Reactive oxygen species, Midkine, BNP
Cellular compornents :
Fibrocytes, Vascular smooth muscle progenitor cells
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5. Cardio-renal-anemia syndrome: basic aspects and evidence-based medicine
Professor :
Robert Toto
Moderator :
Masaomi Nangaku Japan
Tetsuhiro Tanaka Japan
Purpose :
To understand the pathophysiology of cardio-renal-anemia syndrome, theoretical basis, and clinical evidence to treat renal anemia
Discussion :
First day :
Understand the pathophysiological effects on various organs by anemia as well as the pleiotropic effects of erythropoietin
Second day :
Discuss the current evidence of large-scale prospective studies on renal anemia (CREATE, CHOIR, TREAT)
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6. Klotho and FGF23 in the CKD
Professor :
Myles Wolf USA
Makoto Kuro-o USA
Moderator :
Ken Tsuchiya Japan
Hidekazu Sugiura Japan
Purpose :
In this session, we are planning to discuss the role of multi-potential protein, Klotho in the CKD. Of course, first priority issue in this session is discussing the cross-talk between Klotho and phosphate, especially in the progression of CKD. In addition, the potentiality of Klotho related to CKD, such as IGF, anemia and erythropoietin, etc., will be discussed.
Discussion :
First day :
Klotho and phosphate.
Second day :
the potentiality of Klotho in the CKD, excluding phosphate issue.
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7. Role of proximal tubular cell injury in the development of cardiovascular disease
Professor :
Olivier Devuyst Belgium
Moderator :
Akihiko Saito Japan
Taiji Matsusaka Japan
Purpose :
Proximal tubule cells mediate the metabolism of substances such as advanced glycation endproducts and ADMA that are involved in the development of cardiovascular disease (CVD). The cells also produce activated vitamin D3 and glutathione peroxidase 3 that protect vascular systems against injury. Therefore, the impaired cellular functions are very likely to be associated with the development of CVD, and studies are needed to elucidate the mechanisms and the strategies of treatments.
Discussion :
What are the mechanisms of proximal tubular injury in CKD and its effects on vascular damage?
How should we treat proximal tubular injury to prevent the development of both ESRD and CVD?
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8. Why is albuminuria/proteinuria a marker of cardiovascular risk?: Mechanism, screening and treatment.
Professor :
Carmine Zoccali Italy
Moderator :
Tsuneo Konta Japan
Purpose :
The clinical importance of albuminuria/proteinuria is underestimated in Japan. The aim of this meeting is to deepen the understanding of the role of albuminuria/proteinuria in the development of cardiovascular diseases by clarifying its mechanism and relation with other risk factors such as hypertension, diabetes, obesity and salt intake.
Discussion :
First day :
To clarify the mechanism how albuminuria/proteinuria links to vascular damages by verifying the data from experimental, clinical and epidemiological studies.
Second day :
To discuss how to screen and treat the patients with albuminuria/proteinuria for the prevention of cardiovascular events, in consideration of life style, comorbidities and cost-benefit.
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9. Renin-angiotensin-aldosterone blockade in cardiovascular/renal diseases
Professor :
Hermann G. Haller Germany
Moderator :
Akira Nishiyama Japan
Satoshi Morimoto Japan
Atsuhiro Ichihara Japan
Purpose :
Update the pathophysiological roles of the renin-angiotensin-aldosterone system in cardiovascular/renal disease and discuss on the potential therapeutic perspectives.
Discussion :
First day :
Update the recent evidence for the pathophysiological role of the renin-angiotensin-aldosterone system in cardiovascular/renal disease. Then, discuss on the potential therapeutic perspectives of renin-angiotensin-aldosterone inhibitors in cardiovascular/renal disease.
Second day :
Discuss what kind of future preclinical and clinical studies should be needed to demonstrate the beneficial effects of the renin-angiotensin-aldosterone inhibitors on each specific disease.
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10. Linking obesity to CKD: Elucidating the molecular mechanisms underlying these disorders focusing on adipocytokines and other molecules.
Professor :
Kumar Sharma USA
Moderator :
Motoko Yanagita Japan
Miki Nagase Japan
Purpose :
Obesity predisposes towards renal diseases independently of diabetes and hypertension. Insulin resistance, oxidative stress, and inflammation due to obesity have all been implicated in declining renal function, but the molecular mechanisms still remained to be elucidated. Adipocytes secrete various adipocytokines controlling energy homeostasis as well as renal function. In addition, some molecules affect the generation of adipose tissues as well as kidney homeostasis. In this MTP, we will discuss the underlying mechanism linking obesity to CKD, focusing on adipocytokines and other molecules affecting both adipose tissues and kidney function, possibly including the discussion on potential therapeutic perspectives and application for biomarkers.
Discussion :
1. candidates of adipocytokines and other molecules affecting both kidney and adipose tissues.
e.g. adiponectin, leptin, visfatin, BMP, aldosterone, fatty acids
2. site of action of these molecules in the kidney.
e.g. podocyte, vasculature, proximal tubules, stem/progeitor population
3. possible application for therapeutic approach and prognostic biomarkers.
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11. A link of glomerular dysfunction and cardiovascular diseases: from basic research to clinical practice
Professor :
Jürgen Floege Germany
Moderator :
Reiko Inagi Japan
Takehiko Wada Japan
Takamoto Ohse Japan
Purpose :
(i) The purpose of this session is to share the updated informations on pathomechanisms of glomerular injury (various cellular stress responses including oxidative or endoplasmic reticulum stress, inflammation etc.) and its contribution to cardiovascular damages.
(ii) The goal of this session is to clarify how to translate the current basic insights into clinical practice for prevention of glomerular and cardiovascular diseases.
Discussion :
DAY1 :
Each participant will present (or discuss) his current basic/clinical data or opinion regarding glomerular dysfunction in various glomerular diseases. Then, we will discuss and point out the link of glomerular disease and cardiovascular disease.　The professor and moderators will present their own stuffs to active the discussion.
DAY2 :
Based on the updated informations, which were discussed on the first day, we will discuss the strategies for prevention/therapy against glomerular as well as cardiovascular diseases.
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12. Update of physiology and biological activities of EPO, and anemia management by ESAs
Professor :
Kai-Uwe Eckardt Germany
Moderator :
Hirokazu Honda Japan
Purpose :
We will discuss of state-of-art of EPO researches from several aspects including the regulation of the production, its several actions to various organs in addition to the erythropoietic activity. The clinical issues of ESAs recently addressed will be also discussed.
Discussion :
16th April :
Discussion on basic researches of EPO including physiology of EPO including its production, receptors and the actions in several cells and organs, so on.
17th April :
Discussion on clinical researches and issues of ESAs including PRCA, thrombogenesis, ESA hyporesponsiveness, so on.
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13. Biomarkers for cardiovascular/renal disease
Professor :
Hiroyuki Kobori USA
Ton Rabelink Netherlands
Moderator :
Yoshio Terada Japan
Shuji Arima Japan
Seiji Ueda Japan
Purpose :
Update the available biomarkers for cardiovascular/renal disease and understand their utilities. And, discuss the possible future biomarkers for monitoring cardiovascular and renal status.
Discussion :
First day :
Update the available biomarkers for cardiovascular/renal disease.
Second day :
Discuss what kind of new biomarkers should be discovered for monitoring cardiovascular and renal status in pathophysiological conditions.
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14. Cardiovascular disease in ESRD patients: How to treat hypertension
Professor :
Gérard M. London France
Moderator :
Kunihiro Yamagata Japan
Kunitoshi Iseki Japan
Purpose :
* Update of the clinical research on blood pressure control in ESRD patients
* Discuss about the target levels of blood pressure and class of antihypertensives for ESRD patients.
Discussion :
Cardiovascular disease remains as a leading cause of death in chronic dialysis patients. So-far, treatment by erythropoietin and statins have been failed to reduce them. Guideline for treatment of hypertension is necessary in this high-risk population.
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15. Renal-cardiovascular injury in diabetes and metabolic syndrome
Professor :
Mark Cooper Australia
Moderator :
Kenichi Shikata Japan
Daisuke Koya Japan
Purpose :
Elucidation of clinical problems and pathogenesis of renal-cardiovascular injuries in diabetes and metabolic syndrome. (hopefully including discussion on potential therapeutic interventions).
Discussion :
First day :
To discuss on clinical problems and evidence of renal-cardiovascular relationship in vascular complications in diabetes and metabolic syndrome.
Second day :
To discuss on new insights of pathogenesis of renal-cardiovascular injuries in diabetes and metabolic syndrome.
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16. Vascular calcification in CKD: vitamin-D, klotho, FGF23 and calcimimetics (cinacalcet)
Professor :
Ziad A. Massy France
Moderator :
Yoshitaka Isaka Japan
Nobuhiko Joki Japan
Purpose :
Vascular calcification is a complex, regulated process that involves the molecular interplay between calcification stimulators and inhibitors. FGF23–klotho is a recently identified molecule involved in the control of phosphate homeostasis and vitamin-D metabolism, and play a role for inhibitory effect of vascular calcification. The purposes of this session are 1) to discuss the role of vitamin D, FGF23, and klotho on the progression of vascular calcification in CKD setting, and 2) to search the possible treatment strategy including calcimimetics to prevent this dramatic complication.
Discussion :
1) FGF23/Klotho can directly inhibit vascular calcification, or the effects are due to reducing calcification promoting minerals?
2) How should we approach to delay or stop the progression of vascular calcification in patients with CKD in real world clinical setting now.
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17. Cell-based therapies for vascular injury: advances and perspectives
Professor :
Michael Goligorsky USA
Moderator :
Christodoulos Xinaris Italy
Takashi Yokoo Japan
Purpose :
Recent advances in stem cell research have brought the possibility of organ regeneration using somatic stem cells for clinical organ replacement one step closer to realization. In nephrology, several studies suggest that endothelial progenitors or other stem cells may contribute to the repair of renal vascular injury and give rise to new therapeutic approaches for kidney diseases. In the Meet the Professor Breakfast, we will seek the most realistic and clinically applicable stem cell therapy for renal vascular disease.
Discussion :
Which cell type is the most reasonable for clinical application?
Which strategy (i.e. intravenous, subcapsular or others) should be selected?
Which experimental model should be used?
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18. Angiogenesis and CKD
Professor :
Takahiko Nakagawa USA
Moderator :
Yohei Maeshima Japan
Duk-Hee Kang Korea
Purpose :
The role of angiogenesis associated factors has been studied and found to be complicated in the kidney. For example, VEGF, a major angiogenic factor, could be an indispensable factor in maintaining glomerular filtrating function and morphological structures of glomerular and peritubular capillaries while VEGF also mediates renal injury, in particular, in diabetic nephropathy. Therefore, blockade of VEGF has recently been proposed as a novel therapeutic strategy in diabetic nephropathy. In this session, we will discuss about 1) the biological roles of angiogenesis-associated factors, and 2) therapeutic potential to modulate angiogenesis in the normal and diseased kidneys.
Discussion :
Beneficial aspect of angiogenic factors and mechanisms determining the role of angiogenesis in CKD.
Potential therapeutic approaches by modulating angiogenesis-associated factors in CKD.
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19. Aspects of vascular changes in renal biopsy
Professor :
Agnes B. Fogo USA
Moderator :
Yukio Yuzawa Japan
Shoichi Maruyama Japan
Takenori Ozaki Japan
Purpose :
To update the pathological changes of renal vasculatures, including glomerular capillaries and lymphatic vessels.
To link the vascular pathology with pathogenesis and clinical aspects.
Discussion :
What can we know from the vascular changes in patients with FSGS, lupus nephritis, transplant nephropathy, etc?
Is lymphatic angiogenesis good or bad for the kidney?
Discussion on the renal biopsy cases, which show vascular changes, will be welcomed.
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20. Cardiovascular hormones and the kidney: renoprotective roles of natriuretic peptides and implication in drug development Canceled
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21. Effect of VD and its analogs on the outcomes of CKD
Professor :
Tilman Drüeke France
Moderator :
Masahide Mizobuchi Japan
Masafumi Fukagawa Japan
Purpose :
Since the experimental and clinical studies suggest that the VD-VDR axis, which is involved in regulating cardiovascular functions, is impaired in patients with CKD, vitamin D and its analogs are considered to be useful for treating cardiovascular complications in these patients. On the other hand, discrepancy also exists regarding the beneficial effects of vitamin D supplementation on cardiovascular health in subjects with normal kidney function. To reduce the risk of mortality in patients with CKD, we should know 1) if VD therapy is necessary, 2) which kind of VD (native or analogs) we should use, and 3) when the treatment should be started.
Discussion :
1) optimal serum concentrations of calcitriol and its metabolites
2) effect of VDR activation in cardiovascular system
3) the ultimate maker which refers to applicable VDR activation
4) the mechanisms by which different VDs have differential effects on cardiovascular complications
5) pleiotropic effects of VD beyond mineral metabolism
6) comparison of the actions of VDs with calcimimetic compounds on cardiovascular system
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22. Involvement of endothelial damages on vascular injury associated with malnutrition, inflammation, and atherosclerosis (MIA) syndrome in patients with undergoing dialysis therapy
Professor :
James Leiper UK
Moderator :
Hitoshi Sugiyama Japan
Hiroaki Ogata Japan
Hideyasu Kiyomoto Japan
Purpose :
　 The purpose of this session is to provide young trainees and junior faculty an opportunity to meet personally with an active senior state-of-art professor who can provide insights in the field of vascular injury in CKD and dialysis therapy as well as career guidance in a small interactive group setting.
　 The goal is to discuss MIA syndrome, its mechanisms and biomarkers associated with vascular injury in patients with progressed CKD including dialysis therapy. It has been reported recently that vascular damages induced in patients with receiving hemodialysis (HD) may be induced by abnormalities of ADMA/DDAH pathway in parts that causes initially endothelial dysfunction. The endothelial cells are known to regulate the vascular tone and the anti-coagulation in circulating system. The abnormalities of ADMA/DDAH pathway in endothelial cells cause oxidative stress and lead to the progression of arthrosclerosis and calcification in HD patients. Therefore, our specific goal set how we manage the suppression of oxidative stress and regulate the abnormality of ADMA/DDAH pathway in dialysis patients.
　 An established professor will help for the participants to understand the topics such as systemic and local inflammation observed in HD. Another goal is to get contact with an established state-of-art professor for young trainees and junior faculties for the future development of their own research and career.
Discussion :
- MIA syndrome, its mechanisms and biomarkers in chronic kidney disease and end-stage renal disease.
- Endothlium deterioration and vascular injury, systemic and local inflammation in dialysis therapy.
- How do we manage the patients undergoing dialysis therapy?
i.e. What kind of Vitamin D analogue, phosphorus binders and should be recommended for various condition of dialysis patients.
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23. A panoramic view of vascular injury in chronic kidney disease (CKD) by comprehensive renal gene and/or protein expression profiling analysis
Professor :
Matthias Kretzler USA
Clemens D. Cohen Switzerland
Moderator :
Ichiei Narita Japan
Yoshinari Yasuda Japan
Purpose :
Chronic kidney disease (CKD) is prevalent in the whole world, and the action to overcome CKD and its co-morbidities is emerging as one of the most important health issues. Vascular injury plays a major role both in CKD and in CVD. For improvement of CKD prognosis and prevent CVD event, it is mandatory to establish new therapeutic approaches in addition to the conventional therapies. By using comprehensive renal gene and/or protein expression profiling analysis combined with bio-informatics, promising pathways could be screened out from complex patho-physiological mechanisms in CKD. In this session, recent advancement of comprehensive profiling analysis regarding vascular injury will be reviewed and practical clinical approaches for CKD will be discussed with a panoramic view.
Discussion :
a) Recent advancement of comprehensive gene and/or protein expression analysis regarding vascular injury in CKD
b) Bio-informatic approach: which is a promising pathway for CKD treatment?
c) How should we treat CKD patients based on fruits from basic researches?
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