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Uremic toxin (microbiome-derived) (None in widespread use; sometimes abbreviated as "uremic toxins" or "UT")

Target
None in widespread use; sometimes abbreviated as "uremic toxins" or "UT"
Molecular classification
Other (uremic toxins — small molecules, e.g. indoxyl sulfate, p-cresyl sulfate, TMAO), Other (microbial community — not a single molecule)
01

Overview

Uremic toxins comprise a heterogeneous class of small molecules generated either directly by microbial fermentation of dietary substrates (such as amino acids and choline) or by host-microbial co-metabolism. The gut microbiome regulates the composition and quantity of these toxins, particularly in conditions like chronic kidney disease, where impaired renal clearance leads to systemic accumulation. Excess gut-derived uremic toxins drive multiple pathogenic processes, including inflammation, oxidative stress, cellular apoptosis, and disruption of tissue barriers, contributing to multiorgan dysfunction in affected individuals. Therapeutic strategies target both the removal of uremic toxins and the modulation of the gut microbiome to reduce toxin production.

Other names
Gut-derived uremic toxinsMicrobiota-derived uremic toxinsMicrobial uremic toxinsGut microbiome (in context of kidney disease)
02

Mechanism of action

Adsorption/sequestration of uremic toxins in the gut (AST-120) Modification of the microbiome to reduce production or increase degradation of toxins [probiotics/prebiotics/fecal transplant]

03

Biological functions

Metabolic byproducts (microbial metabolism)Induction of inflammationActivation of immune responsesPromotion of oxidative stressDisruption of epithelial barriers
04

Disease associations

Chronic kidney disease (CKD)Cardiovascular diseaseAnemiaMetabolic dysfunction (insulin resistance)Bone diseaseOther (systemic effects from toxin accumulation)
05

Safety considerations

Lack of efficacy in clinical trials (e.g., AST-120)Potential for gut barrier disruption/infection with fecal transplantUnintended alterations in microbiome composition
06

Interacting drugs

AST-120 (Kremezin®): oral adsorbent for indoles and p-cresol sulfate

1 more in the full profile.

07

Biomarkers

Plasma indoxyl sulfatePlasma p-cresyl sulfatePlasma trimethylamine-N-oxide (TMAO)Levels of other nitrogenous compounds (e.g., polyols, aliphatic amines)

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