Zinc inhibits phosphate-induced vascular calcification through TNFAIP3-mediated suppression of NF-kB

Jakob Voelkl, Rashad Tuffaha, Trang T.D. Luong, Daniel Zickler, Jaber Masyout, Martina Feger, Nicolas Verheyen, Florian Blaschke, Makoto Kuro-o, Andreas Tomaschitz, Stefan Pilz, Andreas Pasch, Kai Uwe Eckardt, Juergen E. Scherberich, Florian Lang, Burkert Pieske, Ioana Alesutan

Research output: Contribution to journalReview articlepeer-review

103 Scopus citations


Background The high cardiovascular morbidity and mortality of patients with CKD may result in large part from medial vascular calcification, a process promoted by hyperphosphatemia and involving osteo-/chondrogenic transdifferentiation of vascular smooth muscle cells (VSMCs). Reduced serum zinc levels have frequently been observed in patients with CKD, but the functional relevance of this remains unclear. Methods We performed experiments in primary human aortic VSMCs; klotho-hypomorphic (kl/kl), subtotal nephrectomy, and cholecalciferol-overload mouse calcification models; and serum samples from patients with CKD. Results In cultured VSMCs, treatment with zinc sulfate (ZnSO4) blunted phosphate-induced calcification, osteo-/chondrogenic signaling, and NF-kB activation. ZnSO4 increased the abundance of zinc-finger protein TNF-a–induced protein 3 (TNFAIP3, also known as A20), a suppressor of the NF-kB pathway, by zinc-sensing receptor ZnR/GPR39-dependent upregulation of TNFAIP3 gene expression. Silencing of TNFAIP3 in VSMCs blunted the anticalcific effects of ZnSO4 under high phosphate conditions. kl/kl mice showed reduced plasma zinc levels, and ZnSO4 supplementation strongly blunted vascular calcification and aortic osteoinduction and upregulated aortic Tnfaip3 expression. ZnSO4 ameliorated vascular calcification in mice with chronic renal failure and mice with cholecalciferol overload. In patients with CKD, serum zinc concentrations inversely correlated with serum calcification propensity. Finally, ZnSO4 ameliorated the osteoinductive effects of uremic serum in VSMCs. Conclusions Zinc supplementation ameliorates phosphate-induced osteo-/chondrogenic transdifferentiation of VSMCs and vascular calcification through an active cellular mechanism resulting from GPR39-de-pendent induction of TNFAIP3 and subsequent suppression of the NF-kB pathway. Zinc supplementation may be a simple treatment to reduce the burden of vascular calcification in CKD.

Original languageEnglish (US)
Pages (from-to)1636-1648
Number of pages13
JournalJournal of the American Society of Nephrology
Issue number6
StatePublished - Jun 2018

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Zinc inhibits phosphate-induced vascular calcification through TNFAIP3-mediated suppression of NF-kB'. Together they form a unique fingerprint.

Cite this