Lanaspa Miguel A, Ishimoto Takuji, Cicerchi Christina, Tamura Yoshifuru, Roncal-Jimenez Carlos A, Chen Wei, Tanabe Katsuyuki, Andres-Hernando Ana, Orlicky David J, Finol Esteban, Inaba Shinichiro, Li Nanxing, Rivard Christopher J, Kosugi Tomoki, Sanchez-Lozada Laura G, Petrash J Mark, Sautin Yuri Y, Ejaz A Ahsan, Kitagawa Wataru, Garcia Gabriela E, Bonthron David T, Asipu Aruna, Diggle Christine P, Rodriguez-Iturbe Bernardo, Nakagawa Takahiko, Johnson Richard J
The Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, Colorado;
The Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, Colorado; Venezuelan Scientific Research Institute and University Hospital of Zulia, Maracaibo, Venezuela;
J Am Soc Nephrol. 2014 Nov;25(11):2526-38. doi: 10.1681/ASN.2013080901. Epub 2014 May 29.
Diabetes is associated with activation of the polyol pathway, in which glucose is converted to sorbitol by aldose reductase. Previous studies focused on the role of sorbitol in mediating diabetic complications. However, in the proximal tubule, sorbitol can be converted to fructose, which is then metabolized largely by fructokinase, also known as ketohexokinase, leading to ATP depletion, proinflammatory cytokine expression, and oxidative stress. We and others recently identified a potential deleterious role of dietary fructose in the generation of tubulointerstitial injury and the acceleration of CKD. In this study, we investigated the potential role of endogenous fructose production, as opposed to dietary fructose, and its metabolism through fructokinase in the development of diabetic nephropathy. Wild-type mice with streptozotocin-induced diabetes developed proteinuria, reduced GFR, and renal glomerular and proximal tubular injury. Increased renal expression of aldose reductase; elevated levels of renal sorbitol, fructose, and uric acid; and low levels of ATP confirmed activation of the fructokinase pathway. Furthermore, renal expression of inflammatory cytokines with macrophage infiltration was prominent. In contrast, diabetic fructokinase-deficient mice demonstrated significantly less proteinuria, renal dysfunction, renal injury, and inflammation. These studies identify fructokinase as a novel mediator of diabetic nephropathy and document a novel role for endogenous fructose production, or fructoneogenesis, in driving renal disease.
糖尿病与多元醇途径的激活有关,在该途径中,葡萄糖被醛糖还原酶转化为山梨醇。以往的研究集中在山梨醇在介导糖尿病并发症中的作用。然而,在近端小管中,山梨醇可转化为果糖,然后果糖主要由果糖激酶(也称为己酮糖激酶)代谢,导致ATP耗竭、促炎细胞因子表达和氧化应激。我们和其他人最近发现饮食中的果糖在肾小管间质损伤的发生和慢性肾脏病的进展中具有潜在的有害作用。在本研究中,我们调查了内源性果糖生成(与饮食中的果糖相对)及其通过果糖激酶的代谢在糖尿病肾病发展中的潜在作用。链脲佐菌素诱导糖尿病的野生型小鼠出现蛋白尿、肾小球滤过率降低以及肾小球和近端小管损伤。醛糖还原酶的肾表达增加;肾中山梨醇、果糖和尿酸水平升高;ATP水平降低,证实了果糖激酶途径的激活。此外,伴有巨噬细胞浸润的炎症细胞因子的肾表达显著。相比之下,糖尿病果糖激酶缺陷小鼠的蛋白尿、肾功能障碍、肾损伤和炎症明显减轻。这些研究确定果糖激酶是糖尿病肾病的一种新型介质,并证明了内源性果糖生成或果糖新生在驱动肾脏疾病中的新作用。