title: In vivo and in vitro effects of simvastatin on inflammatory markers in pre-dialysis patients.
abstract: BACKGROUND
  The beneficial effects of statins in reducing cardiovascular events have been attributed predominantly to their lipid-lowering effects, recent studies suggest that these effects might be due to their anti-inflammatory properties. We here investigate the in vivo and in vitro effects of simvastatin on cytokine production in pre-dialysis chronic renal failure patients.
  
  
  METHODS
  Our clinical study has been designed as a randomized double-blind placebo controlled study. A total of 55 chronic kidney disease (CKD) patients at stages 3 and 4 (mean creatinine clearance 45 ml/min, range 15-60) were randomly assigned to receive simvastatin 40 mg/day or placebo, added to their ongoing treatment, for 6 months. Blood samples were obtained at baseline, and after 3 and 6 months of observation for the determination of lipids, inflammatory markers and renal function. For the in vitro studies, the effect of increasing doses of simvastatin on cytokine production [namely interleukin (IL)-6 and IL-8] in human cultured monocytes from 10 healthy subjects (HS) and 15 CKD patients stimulated by lipopolysaccharide (LPS) was investigated.
  
  
  RESULTS
  A significant reduction in total cholesterol from 221+/-44 mg/dl to 184+/-41 mg/dl (3 months) and to 186+/-39 mg/dl (6 months) (P<0.02) and low-density lipoprotein cholesterol from 139+/-40 mg/dl to 104+/-29 mg/dl (3 months) and to 100+/-31 mg/dl (6 months) (P<0.001) was observed in the 28 patients treated with simvastatin. In this group, C-reactive protein (CRP) levels significantly decreased from 2.6 mg/l [interquartile range (IQR 4.9)] to 2.0 mg/l (IQR 1.9) (P = 0.03) at 6 months (P<0.05). A parallel reduction of IL-6 levels from 5.1 pg/ml (IQR 3.8) to 3.5 pg/ml (IQR 3.1) (P = 0.001) at 6 months was also observed. No significant reduction in inflammatory markers [CRP from 5.1 mg/l (IQR 1.9) to 5.4 mg/l (IQR 1.3) (P = NS) at 6 months] or plasma lipids [LDL-cholesterol from 127+/-32 mg/dl to 131+/-21 mg/dl (6 months)] was observed in the 27 patients of the placebo group. In the in vitro studies, the average value for cell-associated IL-6 and IL-8 was higher in CKD (155+/-95 pg/ml monocytes for IL-6 and 722+/-921 pg/ml monocytes for IL-8) vs HS (137+/-87 pg/ml monocytes and 186+/-125 pg/ml monocytes) (P<0.01) and was not affected by simvastatin alone. LPS resulted in a significant increase in cytokine production (IL-6: 1954+/-321 pg/ml monocytes for CKD and 1451+/-237 pg/ml monocytes for HS; P<0.001); the simultaneous addition of increasing doses of simvastatin to these cultures induced a dose-dependent inhibition of IL-6 and IL-8 production in stimulated peripheral blood mononuclear cells in all groups.
  
  
  CONCLUSIONS
  These results indicate that simvastatin in commonly used doses has an in vitro and in vivo anti-inflammatory effect in CKD patients, and may play an important role in counteracting the mechanisms involved on the pathogenesis of cardiovascular disease.
authors.affiliation: Department of Internal Medicine, Postgraduate School of Nephrology, University of Pisa, Pisa, Italy. v.panichi@med.unipi.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.forename: Sabrina
authors.initials: S
authors.lastname: Paoletti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mantuano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Manca-Rizza
authors.forename: Cristina
authors.initials: C
authors.lastname: Filippi
authors.forename: Samuele
authors.initials: S
authors.lastname: Santi
authors.forename: Daniele
authors.initials: D
authors.lastname: Taccola
authors.forename: Carlo
authors.initials: C
authors.lastname: Donadio
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Tramonti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Innocenti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casto
authors.forename: Cristina
authors.initials: C
authors.lastname: Consani
authors.forename: Giulietta
authors.initials: G
authors.lastname: Sbragia
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Franzoni
authors.forename: Fabio
authors.initials: F
authors.lastname: Galetta
authors.forename: Erica
authors.initials: E
authors.lastname: Panicucci
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barsotti
mesh_terms: D015415:Biomarkers / Q000097:blood; D002478:Cells, Cultured; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000096:biosynthesis* / Q000097:blood; D016209:Interleukin-8 / Q000096:biosynthesis* / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019821:Simvastatin / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D015850:Interleukin-6; D016209:Interleukin-8; D019821:Simvastatin