Xiao Liangxiang, Zhou Dong, Tan Roderick J, Fu Haiyan, Zhou Lili, Hou Fan Fan, Liu Youhua
State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; and Departments of Pathology and.
Departments of Pathology and.
J Am Soc Nephrol. 2016 Jun;27(6):1727-40. doi: 10.1681/ASN.2015040449. Epub 2015 Oct 9.
AKI is increasingly recognized as a major risk factor for progression to CKD. However, the factors governing AKI to CKD progression are poorly understood. In this study, we investigated this issue using moderate (20 minutes) and severe (30 minutes) ischemia/reperfusion injury (IRI) in mice. Moderate IRI led to acute kidney failure and transient Wnt/β-catenin activation, which was followed by the restoration of kidney morphology and function. However, severe IRI resulted in sustained and exaggerated Wnt/β-catenin activation, which was accompanied by development of renal fibrotic lesions characterized by interstitial myofibroblast activation and excessive extracellular matrix deposition. To assess the role of sustained Wnt/β-catenin signaling in mediating AKI to CKD progression, we manipulated this signaling by overexpression of Wnt ligand or pharmacologic inhibition of β-catenin. In vivo, overexpression of Wnt1 at 5 days after IRI induced β-catenin activation and accelerated AKI to CKD progression. Conversely, blockade of Wnt/β-catenin by small molecule inhibitor ICG-001 at this point hindered AKI to CKD progression. In vitro, Wnt ligands induced renal interstitial fibroblast activation and promoted fibronectin expression. However, activated fibroblasts readily reverted to a quiescent phenotype after Wnt ligands were removed, suggesting that fibroblast activation requires persistent Wnt signaling. These results indicate that sustained, but not transient, activation of Wnt/β-catenin signaling has a decisive role in driving AKI to CKD progression.
急性肾损伤(AKI)越来越被认为是进展为慢性肾脏病(CKD)的主要危险因素。然而,关于AKI进展为CKD的影响因素,人们了解甚少。在本研究中,我们利用小鼠中度(20分钟)和重度(30分钟)缺血/再灌注损伤(IRI)来研究这一问题。中度IRI导致急性肾衰竭和短暂的Wnt/β-连环蛋白激活,随后肾脏形态和功能恢复。然而,重度IRI导致Wnt/β-连环蛋白持续且过度激活,同时伴有肾纤维化病变的发展,其特征为间质肌成纤维细胞激活和细胞外基质过度沉积。为了评估持续的Wnt/β-连环蛋白信号在介导AKI进展为CKD中的作用,我们通过过表达Wnt配体或对β-连环蛋白进行药物抑制来调控该信号。在体内,IRI后5天过表达Wnt1可诱导β-连环蛋白激活,并加速AKI进展为CKD。相反,此时用小分子抑制剂ICG-001阻断Wnt/β-连环蛋白可阻碍AKI进展为CKD。在体外,Wnt配体可诱导肾间质成纤维细胞激活并促进纤连蛋白表达。然而,去除Wnt配体后,激活的成纤维细胞很容易恢复为静止表型,这表明成纤维细胞激活需要持续的Wnt信号。这些结果表明,Wnt/β-连环蛋白信号的持续而非短暂激活在驱动AKI进展为CKD中起决定性作用。