Unilateral Ischemia-reperfusion Injury Research Articles

Scutellarin alleviates renal ischemia-reperfusion injury by inhibiting the MAPK pathway and pro-inflammatory macrophage polarization.

Renal ischemia-reperfusion injury (IRI) is an integral process in renal transplantation, which results in compromised graft survival. Macrophages play an important role in both the early inflammatory period and late fibrotic period in response to IRI. In this study, we investigated whether scutellarin (SCU) could protect against renal IRI by regulating macrophage polarization. Mice were given SCU (5-50 mg/kg) by gavage 1 h earlier, followed by a unilateral renal IRI. Renal function and pathological injury were assessed 24 h after reperfusion. The results showed that administration of 50 mg/kg SCU significantly improved renal function and renal pathology in IRI mice. In addition, SCU alleviated IRI-induced apoptosis. Meanwhile, it reduced macrophage infiltration and inhibited pro-inflammatory macrophage polarization. Moreover, in RAW 264.7 cells and primary bone marrow-derived macrophages (BMDMs) exposed to SCU, we found that 150 μM SCU inhibited these cells to polarize to an inflammatory phenotype induced by lipopolysaccharide (LPS) and interferon-γ (IFN-γ). However, SCU has no influence on anti-inflammatory macrophage polarization invivo and invitro induced by in interleukin-4 (IL-4). Finally, we explored the effect of SCU on the activation of the mitogen-activated protein kinase (MAPK) pathway both invivo and invitro. We found that SCU suppressed the activation of the MAPK pathway, including the extracellular signal-regulated kinase (ERK), Jun N-terminal kinase (JNK), and p38. Our results demonstrated that SCU protects the kidney against IRI by inhibiting macrophage infiltration and polarization toward pro-inflammatory phenotype via the MAPK pathway, suggesting that SCU may be therapeutically important in treatment of IRI.

Double-negative T cells have a reparative role after experimental severe ischemic acute kidney injury.

T cells mediate organ injury and repair. A proportion of unconventional kidney T cells called double-negative (DN) T cells (TCR+ CD4- CD8-), with anti-inflammatory properties, were previously demonstrated to protect from early injury in moderate experimental acute kidney injury (AKI). However, their role in repair after AKI has not been studied. We hypothesized that DN T cells mediate repair after severe AKI. C57B6 mice underwent severe (40 min) unilateral ischemia-reperfusion injury (IRI). Kidney DN T cells were studied by flow cytometry and compared with gold-standard anti-inflammatory CD4+ regulatory T cells (Tregs). In vitro effects of DN T cells and Tregs on renal tubular epithelial cell (RTEC) repair after injury were quantified with live-cell analysis. DN T cells, Tregs, CD4, or vehicle were adoptively transferred after severe AKI. Glomerular filtration rate (GFR) was measured using fluorescein isothiocyanate (FITC)-sinistrin. Fibrosis was assessed with Masson's trichrome staining. Profibrotic genes were measured with qRT-PCR. Percentages and the numbers of DN T cells substantially decreased during repair phase after severe AKI, as well as their activation and proliferation. Both DN T cells and Tregs accelerated RTEC cell repair in vitro. Post-AKI transfer of DN T cells reduced kidney fibrosis and improved GFR, as did Treg transfer. DN T cell transfer lowered transforming growth factor (TGF)β1 and α-smooth muscle actin (αSMA) expression. DN T cells reduced effector-memory CD4+ T cells and IL-17 expression. DN T cells undergo quantitative and phenotypical changes after severe AKI, accelerate RTEC repair in vitro as well as improve GFR and renal fibrosis in vivo. DN T cells have potential as immunotherapy to accelerate repair after AKI.NEW & NOTEWORTHY Double-negative (DN) T cells (CD4- CD8-) are unconventional kidney T cells with regulatory abilities. Their role in repair from acute kidney injury (AKI) is unknown. Kidney DN T cell population decreased during repair after ischemic AKI, in contrast to regulatory T cells (Tregs) which increased. DN T cell administration accelerated tubular repair in vitro, while after severe in vivo ischemic injury reduced kidney fibrosis and increased glomerular filtration rate (GFR). DN T cell infusion is a potential therapeutic agent to improve outcome from severe AKI.

Lipolysis-Stimulated Lipoprotein Receptor in Proximal Tubule, BMP-SMAD Signaling, and Kidney Disease.

Lipolysis-stimulated lipoprotein receptor (LSR) is a single-pass membrane protein which plays essential roles in tricellular tight junction organization in epithelium and endothelium, but its function in kidney physiology and disease development remains unknown. Conditional Lsr deletion mice were generated and analyzed to investigate function of LSR in proximal tubule. Unilateral ischemia-reperfusion was used as injury model to investigate the role of LSR in acute kidney injury (AKI) and the progression to chronic kidney disease (CKD). Detailed mechanistic analyses were conducted using whole-transcriptome RNA sequencing, immunofluorescence, dual-luciferase reporter gene assay, coimmunoprecipitation, RNA immunoprecipitation, and adeno-associated virus-mediated gene overexpression and knockdown. The nuclear localization of LSR was found in the kidney. Proximal tubule-specific Lsr knockout mice exhibited alleviated kidney damage and fibrosis than those in wildtype mice in response unilateral ischemia-reperfusion injury. Loss of LSR resulted in downregulation of Chrdl1 and activation of BMP-SMAD signaling in proximal tubules. Treatment with CHRDL1 counteracted the protective effect of LSR deletion in the unilaterally ischemic injured kidney. Additionally, systemic delivery of Chrdl1 shRNA attenuated injury-induced kidney fibrosis. LSR formed a complex with 14-3-3θ in the nucleus of proximal tubular cells, thereby reducing the interaction between human antigen R and 14-3-3θ, consequently leading to the translocation of unbound human antigen R to the cytoplasm. The absence of LSR promoted the association of 14-3-3θ with human antigen R, potentially resulting in decreased human antigen R levels in the cytoplasm. Reduced human antigen R levels impaired Chrdl1 mRNA stability, subsequently leading to the activation of BMP-SMAD signaling. Deletion of LSR in proximal tubule deregulated Chrdl1 to activate BMP-SMAD signaling and ameliorated kidney disease.

#1453 EZH2 is an epigenetic regulator of renal gluconeogenesis in chronic kidney disease through downregulation of PCK1

Abstract Background and Aims Impaired renal gluconeogenesis has been recently identified as a hallmark of chronic kidney diseases (CKD), and is tightly correlated with the progression of renal tubulointerstitial fibrosis. The methyltransferase enhancer of zeste homolog 2 (EZH2) is an epigenetic regulator playing an important role in renal tubulointerstitial fibrosis. Whether renal gluconeogenesis can be epigenetically regulated is currently unknown. In the current study, we studied EZH2-mediated epigenetic regulation of renal gluconeogenesis in three different mouse models of renal fibrosis. Method Mouse models of renal fibrosis were established by unilateral ureteral obstruction (UUO) operation, unilateral ischemia reperfusion injury or folic acid (FA) injection. Human proximal tubular cell line (HK2), primary tubular cells or primary tubules was used as an in vitro or ex vivo model. EZH2 was conditional knockout or inhibited by 3-DZNeP in mice. Inhibition of EZH2 by 3-DZNeP or overexpressed by adenovirus was performed in vitro. RNA sequencing and cleavage under targets and tagmentation (CUT&Tag) sequencing analysis were performed and followed by quantitative PCR, CUT&Tag and Western blotting analysis. Glucogenic metabolites were measured and systemic glucose metabolism was assessed by tolerance tests. Results By deletion of Ezh2 gene in mice through a ubiquitous expressed Cre/Esr1 system, we confirmed the pro-fibrotic effect of EZH2 in unilateral ureteral obstruction (UUO) kidneys. Through RNA sequencing and CUT&Tag sequencing analysis, we found that the phosphoenolpyruvate carboxykinase 1 (PCK1), a critical enzyme in gluconeogenesis, is negatively regulated by the methyltransferase EZH2 in fibrotic kidneys, which was further confirmed by quantitative PCR, CUT&Tag and Western blotting analysis in renal cells and UUO or FA kidneys. We further showed that pharmaceutical inhibition of EZH2 by 3-DZNeP enhances PCK1 expression in fibrotic kidneys of three mouse models. Moreover, the concentration of lactate, a glucogenic metabolic intermediate, was increased in mouse fibrotic kidneys, which was reduced by EZH2 inhibition. A further experiment showed that systemic glucose metabolism was impaired in UUO mice and restored by EZH2 inhibition as assessed by insulin or glucose tolerance test. Upregulated EZH2 in UUO kidneys is colocalized with the proximal tubular marker as shown by immunofluorescent staining. The direct anti-gluconeogenesis effect of EZH2 on renal proximal epithelial cells and primary renal tubules was shown by analysis of gluconeogenic gene expression and production of glucose or lactate in human HK2 cells treated with EZH2 inhibitor or exogeneous expression of EZH2 by adenovirus transfection. Importantly, we further confirmed the direct effect of tubular EZH2 on gluconeogenesis in tubular specific deleted EZH2 mice (Ezh2fl/fl;Cdh16-Cre). Moreover, inhibition of PCK1 by 3-mercaptopropionic acid abrogated the pro-gluconeogenic effect and anti-fibrotic effect of EZH2 inhibitor in renal cells and UUO kidneys. Finally, RNA sequencing data from kidney allograft biopsies showed that EZH2 is progressively increased in CKD patients. Conclusion We conclude that EZH2 promotes renal tubulointerstitial fibrosis through epigenetic inhibition of PCK1. Our study suggests that therapeutic restoration of the impaired renal gluconeogenesis is beneficial to CKD.

#1548 The involvement of soluble fms-like tyrosine kinase-1 in the transition from acute kidney injury to chronic kidney disease

Abstract Background and Aims Fms-like tyrosine kinase-1 (Flt-1) is a receptor for vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) and, playing a crucial role in angiogenesis and inflammation pathways. Soluble Flt-1 (sFlt-1) acts as a decoy for both VEGF and PlGF, regulating Flt-1-mediated angiogenesis and inflammation. We investigated the involvement of sFlt-1 in the transition from acute kidney injury to chronic kidney disease (CKD). Method Wild-type (WT) and sFlt-1 knock-out (KO) mice underwent ischemia-reperfusion injury (IRI) treatment. A unilateral 23-minute IRI and contralateral nephrectomy were performed to examine kidney function (AKI to CKD) for 2 weeks. To explore the downstream signaling pathway for sFlt-1 in the kidney, a unilateral 28-minute IRI was performed, and angiogenesis and cytokine expression arrays (Proteome Profiler Array Kits) were used to compare the relative expressions between 28-minute IRI and the contralateral untreated kidney cortices in both WT and sFlt-1 KO mice. Results A plasma sFlt-1 concentration was elevated just after IRI and reached its peak after 12 hours. Blood urea nitrogen (BUN) and plasma creatinine (pCre) levels peaked at 24 hours after IRI. The peak levels of BUN and pCre were significantly lower in sFlt-1 KO compared to those in WT mice (BUN 43.23 ± 5.9 mg/dL and 82.7 ± 13.0 mg/dL, p = 0.008, pCre 0.18 ± 0.03 mg/dL and 0.31 ± 0.04 mg/dL, p = 0.008 in KO and WT mice, respectively). Urinary KIM-1 (uKIM-1) levels 12 hours after IRI in WT mice were higher than those in sFlt-1 KO mice (WT vs sFlt-1 KO; uKIM-1 4.82 ± 0.83 pg/day vs 2.39 ± 0.98 pg/day, p = 0.09). Histopathological evaluation of the kidneys showed reduced monocyte infiltration in sFlt-1 KO mice compared to WT mice 14 days after IRI. In cytokine expression assay of kidney cortices 3 days after IRI, IRI-induced increased expressions of tissue repairs and immune response proteins such as TIMP-1, C5/C5a, and TREM-1 were alleviated in sFlt-1 KO mice compared to those in WT mice. In the Angiogenesis expression array of kidney cortices 1 day after IRI, there were no significant differences in the levels of IRI-induced increased expression of anti-/pro-angiogenesis factors, including TIMP-1, Cyr61, SerpinE1, angiogenin, platelet factor 4, collagen factor 3, MMP-9, and SDF-1, between WT and sFlt-1 KO mice. Conclusion The acute and chronic kidney damages after IRI was reduced in sFlt-1 KO mice compared to WT mice. The protective effect on the kidneys by eliminating sFlt-1 would be associated with immune response signaling such as TIMP-1, C5/C5a, and TREM-1 but not with anti-/pro-angiogenesis factors.

#2440 https://era.m-anage.com/era24/en-GB/Submit/submission/abstracts/197764/guidelines

Abstract Background and Aims Acute kidney injury (AKI) is a critical condition that is strongly related to elevated risks for the progression of chronic kidney disease (CKD). While tubulointerstitial inflammation (TII) is widely accepted as a significant factor in driving this process, the underlying mechanisms responsible for the development of TII are still largely unknown. T cells are increasingly recognized to be involved in tissue injury and exacerbation of the inflammatory response. However, the dynamic landscape of T cell infiltration and their contribution to the chronic transition of AKI remain largely unclear. In this study, we used single-cell RNA sequencing (scRNA-seq) to obtain a high-resolution profile of T cells in a model of unilateral ischemia-reperfusion injury (uIRI) induced AKI to CKD (AtoC) transition and intended to explain their roles during this progress. Method Unilateral ischemia-reperfusion injury (uIRI) at multiple time points was used to simulate the transformation of AtoC. Next, the kidneys were isolated into single-cell suspensions and single-cell RNA sequencing (sRNA-seg) was performed to observe the dynamic evolution of T cells during AtoC transition. Further subpopulations of T cells were analyzed and T cell maps were constructed by UMAP. These subpopulations were defined by characteristic genes and their functions were analyzed. The dynamic changes of T cell subsets during AtoC transformation were observed. RNA velocity and pseudotime analysis were used to observe the evolution of T cell subpopulations. Receptor and ligand interaction analysis of the mechanism by T cell subsets role during AtoC. Finally, the sequencing results were further verified by detailed in vitro and in vivo experiments. Results PAS and Masson showed that the model of unilateral ischemia-reperfusion injury (uIRI) induced AKI to CKD transition was successfully established. In the chronic phase after AKI, the aggregation of T cells gradually increased. During the transition from AKI to CKD, T cells can be divided into 9 cell subsets, mainly including CD8, TH1 and Treg cells. The proportion of CD8 subsets increased significantly during this process and may originate from proliferating T cell subtypes that emerged rapidly after AKI. Interestingly, CD8 T cells can specifically induce apoptosis of vascular endothelial cells through Fas ligand (FasI)-Fas signaling, which leads to the thinning of peritubular capillaries (PTCs), ultimately leading to the progression of renal fibrosis. Conclusion Our results suggest that CD8 T cells can cause the rarefaction of peritubular capillaries and ultimately lead to renal fibrosis, and targeted clearance of CD8 T cells is expected to become a new therapeutic target in the AtoC process.

#1914 Comprehensive single-cell sequencing and lipidomics identify diverse injury states and cholesterol dynamics of the PTs in AKI-to-CKD transition

Abstract Background and Aims The underlying cellular events and metabolic dysfunction of acute kidney injury (AKI) transformed to chronic kidney disease (CKD) is still largely unclear. Previous studies have suggested lipids and metabolites have a profound impact on acute and chronic inflammation. One of the main sites of renal lipid accumulation is the proximal tubule cells (PTs). Here we demonstrated the injury states and cholesterol dynamics of PTs and its potential function in AKI to CKD in unilateral ischemia-reperfusion injury (UIR) mice model. Method We employed single-cell combinatorial indexing lipidomics to analyze 15 mouse kidneys from a mouse model of failed repaired UIR at five time points. We identified cell types through unsupervised clustering analysis. Differential gene expression, enrichment analysis and main function scoring were applied to define functional heterogeneity and injury states of PTs. Next, pseudotime analysis of differentiation transitions was performed to create the diverse PT lineages. Finally, using SCENIC analysis, we identified the key transcription factors that drive the differentiation of PTs. Results We identified 13 main cell clusters and the dynamic changes in the process of AKI to CKD transition were analysed. A remarkable decrease in PTs after injury at day 1 followed with a recovery at day 3 post AKI were observed. Spatiotemporal profiling of the main cell types showed that the most injured areas in the acute stages of kidney injury are primarily concentrated in the outer stripe, specifically the region where the proximal straight tubules (PSTs) are located. In order to gain a higher resolution of the dynamics of PST subtypes during AKI to CKD, we performed sub-clustering analysis specifically on PSTs, partitioning them into 10 subclusters. Single-cell analysis identified maladaptive PSTs (PST-5) with the highest apoptosis and ferroptosis scores. Notably, pseudotime analysis revealed that PST-5 differentiated from PST-4, which has the highest lipid metabolism score. Indeed, among all the cells in the kidney, the PTs exhibited the most active metabolic reprogramming due to their differentiation and redifferentiation early after AKI. Lipid omics profiling reveals an abnormal elevation of the cholesterol metabolites 27-hydroxycholesterol (27-OH) and 25-hydroxycholesterol (25-OH) following AKI. Interestingly, the PST-4-specific expression of Cyp7b1 served as a key enzyme regulating the concentration of 27-OH. This gene has been found to be significantly absent after AKI. Moreover, the binding of 27HC, a natural ligand, to endogenous estrogen receptor alpha (ERα) leads to the upregulation of heme oxygenase 1 (Hmox1), thereby promoting ferroptosis. Finally, SCENIC analysis revealed that Cyp7b1-mediated accumulation of 27-HC is dependent on the transcription factor Atf3. Conclusion Our results indicate that Cyp7b1 deficiency confers ferroptosis, which are primarily dependent on the upregulation of cellular cholesterol homeostasis and 27-HC secretion, leading to the progression of AKI. These findings suggest that the Cyp7b1/Hmox1/Atf3/27-HC axis may serve as a potential therapeutic target for preventing the development of CKD.

#921 Interferon regulatory factor 4 (IRF4)-specific deletion on dendritic cells protects against kidney inflammation and injury in IRI-induced AKI/AKD

Abstract Background and Aims Ischemia-reperfusion injury (IRI) is a frequent clinical cause of acute kidney injury and disease (AKI/AKD) which can lead to acute tubular necrosis and irreversible kidney function loss. Mononuclear phagocytes, including dendritic cells (DCs), Monocytes, and macrophages, play important roles in various phases of injury and repair processes. Previous research has indicated that conventional dendritic cells (cDCs) are subdivided into cDC1s and cDC2s, and these two subsets could have opposing functions. We also demonstrated that cDC1s have a protective role as deficiency of cDC1s results in aggravated inflammation and injury in the IRI-induced AKI/AKD model in our previous study. Based on these researches, we aim to investigate the function of cDC2s in the IRI-induced AKI/AKD model. Method We used interferon regulatory factor 4 (IRF4)-deficient mice (IRF4fl/flClec9acre) to specifically delete IRF4 on DC lineage cells as our experimental group, and used wide-type mice as our control group. After unilateral IRI (UIRI) surgery, we measured the GFR and plasma creatinine of the mice on day 1 (D1) and day 5 (D5), then collected the injured kidney issue after sacrificing mice. We compared the differences between IRF4fl/flClec9acre mice and wild-type mice in terms of DC subpopulation changes, neutrophil accumulation, T cell differentiation, intensity of inflammatory responses, and tissue repair capabilities in damaged kidney tissue, by using techniques such as immunohistochemistry, immunofluorescence, flow cytometry, qRT-PCR, etc. Results ([KOMean-WTMean] ± SEM): IRF4fl/flClec9acre mice showed a lower percentage of cDC2s without affecting cDC1s in the kidney compared with wide-type mice (D1: −0.04467 ± 0.01356, P = 0.0301; D5: −1.108 ± 0.2248, P = 0.0004). During post-ischemic AKI/AKD, IRF4 deficiency in cDCs had several beneficial effects compared to wild-type mice, including reducing renal tubular cell injury (PAS score D1: −0.9375 ± 0.1523, P < 0.0001; PAS score D5: −1.119 ± 0.1445, P < 0.0001), decreasing loss of kidney function (GFR D1: 8.983 ± 4.091, P = 0.1041; GFR D5: 14.9 ± 5.01, P = 0.0172), and promoting kidney function recovery. This was associated with increased expression of anti-inflammatory cytokines (IL-4 D1: 4.486 ± 1.363, P = 0.0079; IL-4 D5: 3.403 ± 1.447, P = 0.0366; IL-10 D1: 2.103 ± 0.7342, P = 0.0299; IL-10 D5: 2.654 ± 0.8859, P = 0.0166), decreased expression of pro-inflammatory cytokines(TNF-α D1: −1.418 ± 0.5467, P = 0.0433; TNF-α D5: −2.434 ± 1.919, P = 0.0074; IL-23a D1: −1.320 ± 0.3432, P = 0.0061; IL-23a D5: −16.12 ± 3.587, P = 0.0004) and acute tubular cell death, reduced neutrophil chemoattractant expression (CXCL-2) (Fig. 6) and recruitment of neutrophils (−6.107 ± 1.664, P = 0.0214), and differentiation of Th2 (−0.1867 ± 0.03333, P = 0.005) and Th17 cells (−0.1767 ± 0.01333, P = 0.0002). Conclusion In conclusion, our data demonstrate a critical role of IRF4 in the kidney cDC2 subset and highlight that deficiency of cDC2s can protect against kidney inflammation, reduce kidney injury, and promote kidney recovery in the IRI-induced AKI/AKD model. This suggests that cDC2s have an immunoregulatory role in AKI/AKD and could serve as a potential therapeutic target for kidney inflammation.

#1593 ARGDRR, a novel disintegrin, attenuates AKI to CKD-related renal fibrosis

Abstract Background and Aims Acute kidney injury (AKI) can lead to progress renal fibrosis, resulting in chronic kidney disease (CKD) and end stage renal disease (ESRD). Nevertheless, the underlying pathological mechanisms remain unclear. Platelet activation has been demonstrated as one of the important factors involved in the pathophysiology of AKI, and studies show the therapeutic potential for using platelet inhibitors or antagonists in ischemia-reperfusion (IR)-induced AKI models. However, drug-induced side effects, including thrombotic microangiopathies (TMA)-related kidney damage, thrombocytopenia and bleeding, hinder clinical application in AKI or CKD treatment. Our newly developed dual effect disintegrin, ARGDRR, is derived from snake venom exert a high affinity to αIIbβ3 and αvβ3 binding affinity without causing bleeding and other thrombosis-related side effects. Method We performed a unilateral ischemia-reperfusion injury (UIRI) model to investigate integrin αIIb(Itga2b) and β3(Itgb3) mRNA levels in the injured kidney for 15 days. For exploring the therapeutic efficiency of ARGDRR in AKI, we administered ARGDRR post-ischemic injury and measured platelet activation after 24 hours using quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) for Itgb3, Lcn2, and CD42b. For exploring the therapeutic efficiency of ARGDRR in CKD progression, we administrated ARGDRR daily for 15 days after IRI with nephrectomy, and examined the difference of renal dysfunction, renal fibrosis, and cell death compared to sham group. Results We found that platelet activation with progressively increased mRNA level of platelet glycoprotein IIb-GPIIIa (Itga2b and Itgb3) in the UIRI kidney over time. After 24 hr of ischemic AKI, ARGDRR administration reduced Lcn2 and Itgb3 mRNA level and CD42b positive area in the kidney, indicating its efficacy in protecting the kidneys by inhibiting platelet activation and aggregation. In AKI to CKD transition, serum creatine and blood urea nitrogen (BUN) were significantly lower both in efficacious and high dose of ARGDRR administration group. ARGDRR significantly reduced CD42b expression and increased LTL positive area. Also, ARGDRR administration alleviated renal fibrosis, cell apoptosis and senescence-related molecules p21 and Ctgf expression in the AKI to CKD transition. Conclusion Our results have successfully proved our hypothesis that disintegrin-ARGDRR has the potential for renal protection in the transition of AKI to CKD through inhibition of platelet activation and aggregation during acute injury.

Renal epithelial-derived miR-17~92 inhibits STAT3 signaling, serving a sex-specific and renoprotective role in the development of AKI

Prerenal acute kidney injury (AKI) is a sudden loss of kidney excretory function from reduced blood flow to the kidney. Sex differences in the degree of injury have been recognized, the causes of which are ill-defined. While a role for miRs (microRNAs) in AKI has been recognized, there are no reports of sex differences in miR regulation after injury. Here we investigated sex differences in miR regulation in proximal tubular epithelial cells during AKI with IRI (ischemia reperfusion injury) in vivo and miR regulation of signal transducer and activator of transcription 3 (STAT3) signaling in vitro. We hypothesize that sex-differentially expressed miR-17~92 serves as a negative regulator of STAT3 signaling, repressing proinflammatory signaling in tubular epithelium during AKI. We recapitulated the phenotype that males have a higher level of injury compared to females with proportional intensity and duration of IRI in a murine AKI model. C57BL/6J mice underwent 25 minutes of unilateral IRI with a contralateral nephrectomy and sacrificed 18 hours post-reperfusion. Injured male tubules showed a significant increase in Kidney injury molecule-1 (Kim-1) expression (n³3, fold change=75.28 ± 35.92) whereas injured females showed no change, confirming that injured males experience a higher level of tubular injury than females with a matched degree of ischemia. Control female tubules showed significantly higher baseline expression of miR-17~92 compared to control males (n ³ 5, difference between means ± SEM: miR-17a, 2.337 ± 0.6322; miR-18a, 5.841 ± 2.008; miR-19a, 5.041 ± 1.232; miR- 19b, 3.826 ± 0.9791; miR-20a, 3.826 ± 1.053; miR-92a, 5.627 ± 1.588). MiR-17~92 expression in injured male tubules significantly increased compared to male controls. Even after this increase, miR-17~92 expression in male tubules was lower compared to miR-17~92 in injured females. Mir-17~92 is predicted to target STAT3 and components of the interleukin-6 (IL6)/STAT3 pathway. qPCR showed a significant increase in Stat3 expression after IRI in both sexes, but only a significant increase in IL6 and heme oxygenase-1 in injured males. To investigate miR regulation of STAT3 in vitro, we used a human proximal tubule cell line (HK2) model. Recombinant IL6 induced STAT3 protein expression and phosphorylation, and increased miR-17~92 expression. By altering miR-17~92 expression in HK2 cells we demonstrated that expression of STAT3 in response to IL6 is regulated, in part, by these miRs. These data provide the first example of sex-differential miR regulation in response to IRI. The elevated baseline expression of miR-17~92 in the female mice may provide a novel mechanism to account for sex-differences in IRI-AKI and may form part of the mechanism to protect female kidney epithelia from IRI and AKI. This work is supported by the NIH (DK102843 to MBB), (NIH R01DK102843-08S1 to AS), NIH (DK137419 and DK125015 to JH) and NIH (5R01DK131991 and 5R01DK064005 to RT). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sex-related differences in SIRT3-mediated mitochondrial dynamics in renal ischemia/reperfusion injury

The prevalence of renal ischemia/reperfusion injury (IRI) in premenopausal women is considerably lower than that in age-matched men. This suggests that sex-related differences in mitochondrial function and homeostasis may contribute to sexual dimorphism in renal injury, though the mechanism remains unclear. Mouse model of unilateral left renal IRI with contralateral kidney enucleation, Ovariectomy in female mice, and a human embryonic kidney (HEK) cell model of hypoxia-reoxygenation were used to study how estrogen affects the sexual dimorphism of renal IRI through SIRT3 in vitro and in vivo, respectively. Here, we demonstrate differential expression of renal SIRT3 may induce sexual dimorphism in IRI using the renal IRI model. Higher SIRT3 level in female mice was associated with E2-induced protection of renal tubular epithelium, reduced mitochondrial reactive oxygen species (ROS), and IRI resistance. In hypoxia-reoxygenated HEK cells, SIRT3 knockdown increased oxidative stress, shifted the interconnected mitochondrial network toward fission, exacerbated hypoxia/reoxygenation-induced endoplasmic reticulum stress (ERS), and abolished the protective effects of E2 on IRI. Mechanistically, the SIRT3 level is E2-dependent and that E2 increases the SIRT3 protein level via estrogen receptor. SIRT3 targeted an i-AAA protease, yeast mitochondrial AAA metalloprotease (YME1L1), and hydrolyzed long optic atrophy 1 (L-OPA) to short-OPA1 (S-OPA1) by deacetylating YME1L1, regulating mitochondrial dynamics toward fusion to reduce oxidative stress and ERS. These findings explored the mechanism by how estrogen alleviates renal IRI and providing a basis for potential therapeutic interventions targeting SIRT3.

Hypermethylation leads to the loss of HOXA5, resulting in JAG1 expression and NOTCH signaling contributing to kidney fibrosis

Epigenetic regulations, including DNA methylation, are critical to the development and progression of kidney fibrosis, but the underlying mechanisms remain elusive. Here, we show that fibrosis of the mouse kidney was associated with the induction of DNA methyltransferases and increases in global DNA methylation and was alleviated by the DNA methyltransferase inhibitor 5-Aza-2’-deoxycytidine (5-Aza). Genome wide analysis demonstrated the hypermethylation of 94 genes in mouse unilateral ureteral obstruction kidneys, which was markedly reduced by 5-Aza. Among these genes, Hoxa5 was hypermethylated at its gene promoter and this hypermethylation was associated with reduced HOXA5 expression in fibrotic mouse kidneys after ureteral obstruction or unilateral ischemia-reperfusion injury. 5-Aza prevented Hoxa5 hypermethylation, restored HOXA5 expression, and suppressed kidney fibrosis. Down-regulation of HOXA5 was verified in human kidney biopsies from patients with chronic kidney disease and correlated with the increased kidney fibrosis and DNA methylation. Kidney fibrosis was aggravated by conditional knockout of Hoxa5 and alleviated by conditional knockin of Hoxa5 in kidney proximal tubules of mice. Mechanistically, we found that HOXA5 repressed Jag1 transcription by directly binding to its gene promoter, resulting in the suppression of JAG1-NOTCH signaling during kidney fibrosis. Thus, our results indicate that loss of HOXA5 via DNA methylation contributes to fibrogenesis in kidney diseases by inducing JAG1 and consequent activation of the NOTCH signaling pathway.

Antibiotic-induced intestinal microbiota depletion can attenuate the acute kidney injury to chronic kidney disease transition via NADPH oxidase 2 and trimethylamine-N-oxide inhibition

Intestinal microbiota and their metabolites affect systemic inflammation and kidney disease outcomes. Here, we investigated the key metabolites associated with the acute kidney injury (AKI)-to chronic kidney disease (CKD) transition and the effect of antibiotic-induced microbiota depletion (AIMD) on this transition. In 61 patients with AKI, 59 plasma metabolites were assessed to determine the risk of AKI-to-CKD transition. An AKI-to-CKD transition murine model was established four weeks after unilateral ischemia-reperfusion injury (IRI) to determine the effects of AIMD on the gut microbiome, metabolites, and pathological responses related to CKD transition. Human proximal tubular epithelial cells were challenged with CKD transition-related metabolites and inhibitory effects of NADPH oxidase 2 (NOX2) signals were tested. Based on clinical metabolomics, plasma trimethylamine N-oxide (TMAO) was associated with a significant increased risk for AKI-to-CKD transition [adjusted odds ratio 4.389 (95% confidence interval 1.106–17.416)]. In vivo, AIMD inhibited a unilateral IRI-induced increase in TMAO, along with a decreased in apoptosis, inflammation, and fibrosis. The expression of NOX2 and oxidative stress decreased after AIMD. In vitro, TMAO induced fibrosis with NOX2 activation and oxidative stress. NOX2 inhibition successfully attenuated apoptosis, inflammation, and fibrosis with suppression of G2/M arrest. NOX2 inhibition (in vivo) showed improvement in pathological changes with a decrease in oxidative stress without changes in TMAO levels. Thus, TMAO is a key metabolite associated with the AKI-to-CKD transition and NOX2 activation was identified as a key regulator of TMAO-related AKI-to-CKD transition both in vivo and in vitro.

CXC chemokine receptor 7 ameliorates renal fibrosis by inhibiting β-catenin signaling and epithelial-to-mesenchymal transition in tubular epithelial cells

Renal fibrosis is a common feature of various chronic kidney diseases. However, the underlying mechanism remains poorly understood. The CXC chemokine receptor (CXCR) family plays a role in renal fibrosis; however, the detailed mechanisms have not been elucidated. In this study, we investigated the potential role of CXCR7 in mediating renal fibrosis. CXCR7 expression is decreased in unilateral ischemia–reperfusion injury (UIRI) and unilateral ureteral obstruction mouse models. Furthermore, CXCR7 was specifically expressed primarily in the Lotus Tetragonolobus Lectin-expressing segment of tubules, was slightly expressed in the peanut agglutinin-expressing segment, and was barely expressed in the Dolichos biflorus agglutinin-expressing segment. Administration of pFlag-CXCR7, an overexpression plasmid for CXCR7, significantly inhibited the activation of β-catenin signaling and protected against the progression of epithelial-to-mesenchymal transition (EMT) and renal fibrosis in a UIRI mouse model. Using cultured HKC-8 cells, we found that CXCR7 significantly downregulated the expression of active β-catenin and fibrosis-related markers, including fibronectin, Collagen I, and α-SMA. Furthermore, CXCR7 significantly attenuated TGF-β1-induced changes in β-catenin signaling, EMT and fibrosis. These results suggest that CXCR7 plays a crucial role in inhibiting the activation of β-catenin signaling and the progression of EMT and renal fibrosis. Thus, CXCR7 could be a novel therapeutic target for renal fibrosis.

Effects of poly (ADP-ribose) polymerase inhibitor treatment on the repair process of ischemic acute kidney injury

Excessive activation of poly (ADP-ribose) polymerase (PARP) contributes to ischemic acute kidney injury (AKI). PARP inhibition has been shown to be beneficial in renal ischemia–reperfusion injury (IRI) in the early phase, but its role in the repair process remains unclear. The effects of JPI-289, a novel PARP inhibitor, during the healing phase after renal IRI were investigated. IRI was performed on 9-week-old male C57BL/6 mice. Saline or JPI-289 100 mg/kg was intraperitoneally administered once at 24 h or additionally at 48 h after IRI. Hypoxic HK-2 cells were treated with JPI-289. Renal function and fibrosis extent were comparable between groups. JPI-289 treatment caused more prominent tubular atrophy and proinflammatory intrarenal leukocyte phenotypes and cytokines/chemokines changes at 12 weeks after unilateral IRI. JPI-289 treatment enhanced gene expressions associated with collagen formation, toll-like receptors, and the immune system in proximal tubules and endothelial cells after IRI. JPI-289 treatment at 3 or 6 h after hypoxia facilitated proliferation of hypoxic HK-2 cells, whereas further treatment after 24 h suppressed proliferation. Delayed inhibition of PARP after renal IRI did not facilitate the repair process during the early healing phase but rather may aggravate renal tubular atrophy during the late healing phase in ischemic AKI.

Heat-treated and/or lysozyme-treated <i>Enterococcus faecalis</i> (FK-23) improves the progression of renal disease in a unilateral ischemia-reperfusion injury rat model

Heat-treated and/or lysozyme-treated <i>Enterococcus faecalis</i> (FK-23) improves the progression of renal disease in a unilateral ischemia-reperfusion injury rat model

Abstract 16879: Endothelial Prolyl Hydroxylase 3 Regulates Post-Ischemic Kidney Injury Through HIF Dependent Mechanisms

Introduction: Acute kidney injury (AKI) is highly prevalent clinical condition after cardiac surgeries and is associated with high morbidity and mortality in hospitalized patients. Ischemia reperfusion injury (IRI) is one of the major causes of AKI. Previously, we have reported a critical role for the endothelial oxygen sensor prolyl hydroxylase (PHD2) in ischemic AKI. Recently, we found that prolyl hydroxylase 3 (PHD3) shows robust increase in kidney endothelium after renal IRI. However, its role in ischemic AKI is unknown. Hypothesis: We hypothesized that endothelial PHD3 regulates post-ischemic kidney injury. Methods: To delete endothelial PHD3, VECadherin (Cdh5)-CreER transgenic mice were crossed to mice carrying conditional PHD3 allele, generating PHD3 iEC mice. To test the HIF-dependent role of PHD3, we generated Cdh5CreER; Phd3 flox/flox Arnt flox/flox mice ( PHD3ARNT iEC ). Inactivating ARNT (aryl hydrocarbon receptor nuclear translocator), also known as Hif-1β, blocks HIF signaling. Unilateral IRI was induced by renal artery clamping, and tamoxifen treatment was started at day 1 post IRI, followed by analysis at day 14. Results: Compared to Cre - controls, inactivation of Phd3 in endothelial cells (ECs) following IRI exacerbated kidney damage and inflammation, as indicated by increased expression of kidney injury molecule 1 ( Kim1 ) and profibrotic genes lysyl oxidase-like 2 ( Loxl2 ), transforming growth factor-beta 1 ( Tgfb1 ) , smooth muscle actin ( Acta2 ) and collagen deposition assessed by Picro Sirius red staining (n=6-7; p< 0.05). Post-ischemic inactivation of ARNT along with PHD3 ameliorated the effects of only PHD3 inactivation and normalized levels of Kim1 , Loxl2 , Tgfb1 and collagen deposition ( n=7; p< 0.05) . In vitro suppression of PHD3 in human primary EC using PHD3-siRNA showed significant upregulation of inflammatory molecules such as ICAM1 (Intercellular Adhesion Molecule 1), VCAM1 (Vascular Cell Adhesion Molecule 1), C-X-C motif chemokine ligand 9 and 10 ( CXCL9 and CXCL10 ), which were again blunted by ARNT- siRNA treatment (n= 3; p< 0.05). Conclusions: In summary, our data support a critical role for endothelial PHD3 in regulating post-ischemic kidney inflammation and fibrosis through HIF-dependent mechanisms.

Dynamics of necroptosis in kidney ischemia-reperfusion injury.

Necroptosis, a pathway of regulated necrosis, involves recruitment and activation of RIPK1, RIPK3 and MLKL, leading to cell membrane rupture, cell death and release of intracellular contents causing further injury and inflammation. Necroptosis is believed to play an important role in the pathogenesis of kidney ischemia-reperfusion injury (IRI). However, the dynamics of necroptosis in kidney IRI is poorly understood, in part due to difficulties in detecting phosphorylated MLKL (pMLKL), the executioner of the necroptosis pathway. Here, we investigated the temporal and spatial activation of necroptosis in a mouse model of unilateral warm kidney IRI, using a robust method to stain pMLKL. We identified the period 3-12 hrs after reperfusion as a critical phase for the activation of necroptosis in proximal tubular cells. After 12 hrs, the predominant pattern of pMLKL staining shifted from cytoplasmic to membrane, indicating progression to the terminal phase of necroptotic cell death. Mlkl-ko mice exhibited reduced kidney inflammation at 12 hrs and lower serum creatinine and tubular injury at 24 hrs compared to wild-type littermates. Interestingly, we observed increased apoptosis in the injured kidneys of Mlkl-ko mice, suggesting a relationship between necroptosis and apoptosis in kidney IRI. Together, our findings confirm the role of necroptosis and necroinflammation in kidney IRI, and identify the first 3 hrs following reperfusion as a potential window for targeted treatments.

MircroRNA-92b as a negative regulator of the TGF-β signaling by targeting the type I receptor

Transforming growth factor β1 (TGFβ1) has been identified as a major pathogenic factor underlying the development of chronic kidney disease (CKD). This study investigated the role of miR-92b-3p in the progression of renal fibrosis in unilateral ureteral occlusion (UUO) and unilateral ischemia-reperfusion injury (uIRI) mouse models, as well as explored its underlying mechanisms in human proximal tubular epithelial (HK2) cells. We found that renal fibrosis increased in UUO mice after miR-92b knockout, while it reduced in miR-92b overexpressing mice. MiR-92b knockout aggravated renal fibrosis in uIRI mice. RNA-sequencing analysis, the luciferase reporter assay, qPCR analysis, and western blotting confirmed that miR-92b-3p directly targeted TGF-β receptor 1, thereby ameliorating renal fibrosis by suppressing the TGF-β signaling pathway. Furthermore, we found that TGF-β suppressed miR-92b transcription through Snail family transcriptional repressors 1 and 2. Our results suggest that miR-92b-3p may serve as a novel therapeutic for mitigating fibrosis in CKD.

Exploring the role of Hmox1 in ferroptosis and immune infiltration during renal ischemia-reperfusion injury

Ischemia-reperfusion injury (IRI) is inevitable in kidney transplantations and, as a complex pathophysiological process, it can be greatly impacted by ferroptosis and immune inflammation. Our study aimed to identify the biomarkers of renal IRI (RIRI) and elucidate their relationship with immune infiltration. In this study, the GSE148420 database was used as a training set to analyze differential genes and overlap them with ferroptosis-related genes to identify hub genes using a protein–protein interaction (PPI) network, the least absolute shrinkage and selection operator (LASSO), and random forest algorithm (RFA). We verified the hub gene and ferroptosis-related phenotypes in a verification set and animal experiments involving unilateral IRI with contralateral nephrectomy in rats. Gene set enrichment analysis (GSEA) of single genes was conducted according to the hub gene to predict related endogenous RNAs (ceRNAs) and drugs to establish a network. Finally, we used the Cibersort to analyze immunological infiltration and conducted Spearman’s correlation analysis. We identified 5456 differential genes and obtained 26 ferroptosis-related differentially expressed genes. Through PPI, LASSO, and RFA, Hmox1 was identified as the only hub gene and its expression levels were verified using verification sets. In animal experiments, Hmox1 was verified as a key biomarker. GSEA of single genes revealed the seven most related pathways, and the ceRNAs network included 138 mRNAs and miRNAs. We predicted 11 related drugs and their three-dimensional structural maps. Thus, Hmox1 was identified as a key biomarker and regulator of ferroptosis in RIRI and its regulation of ferroptosis was closely related to immune infiltration.