Reactive Oxygen Species and Their Involvement in Red Blood Cell Damage in Chronic Kidney Disease

Abstract

Reactive oxygen species (ROS) released in cells are signaling molecules but can also modify signaling proteins. Red blood cells perform a major role in maintaining the balance of the redox in the blood. The main cytosolic protein of RBC is hemoglobin (Hb), which accounts for 95-97%. Most other proteins are involved in protecting the blood cell from oxidative stress. Hemoglobin is a major factor in initiating oxidative stress within the erythrocyte. RBCs can also be damaged by exogenous oxidants. Hb autoxidation leads to the generation of a superoxide radical, of which the catalyzed or spontaneous dismutation produces hydrogen peroxide. Both oxidants induce hemichrome formation, heme degradation, and release of free iron which is a catalyst for free radical reactions. To maintain the redox balance, appropriate antioxidants are present in the cytosol, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and peroxiredoxin 2 (PRDX2), as well as low molecular weight antioxidants: glutathione, ascorbic acid, lipoic acid, α-tocopherol, β-carotene, and others. Redox imbalance leads to oxidative stress and may be associated with overproduction of ROS and/or insufficient capacity of the antioxidant system. Oxidative stress performs a key role in CKD as evidenced by the high level of markers associated with oxidative damage to proteins, lipids, and DNA in vivo. In addition to the overproduction of ROS, a reduced antioxidant capacity is observed, associated with a decrease in the activity of SOD, GPx, PRDX2, and low molecular weight antioxidants. In addition, hemodialysis is accompanied by oxidative stress in which low-biocompatibility dialysis membranes activate phagocytic cells, especially neutrophils and monocytes, leading to a respiratory burst. This review shows the production of ROS under normal conditions and CKD and its impact on disease progression. Oxidative damage to red blood cells (RBCs) in CKD and their contribution to cardiovascular disease are also discussed.

Figure 1

Endogenous low molecular weight antioxidants.

Figure 2

Exogenous low molecular weight antioxidants.

Figure 3

Reactive oxygen species production from superoxide anion radical and biological material damage by ROS. O₂^•-, a precursor of other ROS, such as H₂O₂, which can oxidize chloride to HClO in the presence of MPO, ¹O₂ from HClO, and NO which produce ONOO⁻ and HO^• release in the Fenton reaction.

Figure 4

Red blood cell membrane damage from internal and external sources and hemoglobin (Hb) release. Ferryl (Hb[FeIV=O]) and ferryl radical form of hemoglobin (Hb[FeIV=O‧‧‧Tyr^•]). MDA: malondialdehyde; 4-HNE: 4-hydroxynonenal.

Figure 5

Uremic toxins, inflammation, and reactive oxygen species lead to chronic kidney disease, cardiovascular disease, thrombosis, and atherosclerosis.