Objective: The efficacy and safety of renal denervation (RDN) have been established through a series of randomized, sham-controlled clinical trials. However, the method demonstrates a significant variability in blood pressure (BP) response among patients, making the identification of optimal candidates for the procedure a major challenge. Design and method: Hypertensive patients with uncontrolled BP undergoing RDN were included. Patients with severe chronic kidney disease, renal artery abnormalities, type 1 diabetes mellitus and secondary hypertension were excluded. Office blood pressure (OBP) and ambulatory blood pressure (ABP) were measured at screening visit before the RDN and at follow-up visit 3 months after the procedure. A cutoff value of 5 mmHg reduction in systolic ABP and/or 10 mmHg reduction in systolic OBP was set to classify the patients to responders or non-responders. Proteomic analysis of urine samples collected prior to RDN was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) techniques. Statistical analysis compared qualitative and quantitative differences in identified proteins, between BP responders and non-responders. Results: A total of 63 patients (74% BP responders) was included in the cohort. The quantitative and qualitative analysis of urine proteomics revealed 25 proteins significantly different between the two groups. Further advanced analysis incorporating logistic regression models successfully prioritized 6 proteins (Charged multivesicular body protein 1b, Amyloid-beta precursor protein, Filamin-C, Prostaglandin-H2 D-isomerase, Migration and invasion enhancer 1 and Trypsin-3) as the most promising candidate biomarkers for predicting the clinical response to RDN therapy. Among these proteins, most exhibited higher expression in responders, whereas Trypsin-3 showed lower expression in responders. Conclusions: In hypertensive patients undergoing RDN, urine proteomic analysis identified 6 proteins as promising candidate biomarkers associated with BP response post RDN. These proteins are involved in various cellular processes, including cell membrane functions, structural organization of the cytoskeleton, as well as regulation of the vascular tone. These findings support the potential utility of proteomic biomarkers for patient stratification prior to RDN, contributing to a precision medicine approach.
Polyzos et al. (Fri,) studied this question.