Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Biological and Pharmacological Research Laboratories, Central Pharmaceutical Research Institute, Japan Tobacco Incorporated, Takatsuki, Japan.
Am J Physiol Renal Physiol. 2020 Feb 1;318(2):F388-F401. doi: 10.1152/ajprenal.00419.2019. Epub 2019 Dec 16.
Cardiovascular disease (CVD) is the main cause of death in patients with kidney disease. Hypoxia plays a crucial role in the progression of chronic kidney disease (CKD) and cardiovascular disease, which is associated with fibrosis, inflammation, and oxidative injury. Previous studies have indicated that prolyl hydroxylase (PHD) inhibitors, stabilizers of hypoxia-inducible factors (HIFs), can be used to treat acute organ injuries such as renal ischemia-reperfusion, myocardial infarction, and, in some contexts, CKD. However, the effects of PHD inhibitors on cardiovascular complications in CKD remain unknown. In the present study, we investigated whether HIF activation has a beneficial effect on kidney and cardiovascular outcomes in the remnant kidney model. We used the 5/6 nephrectomy model with the nitric oxide synthase inhibitor -nitro-l-arginine (20 mg/L in the drinking water). Rats received diet with 0.005% enarodustat (PHD inhibitor) or vehicle for 8 wk starting 2 wk before 5/6 nephrectomy. Activation of HIF by the PHD inhibitor reduced cardiac hypertrophy and ameliorated myocardial fibrosis in association with restored capillary density and improvement in mitochondrial morphology. With regard to kidneys, enarodustat ameliorated fibrosis in association with reduced proinflammatory cytokine expression, reduced apoptosis, and restored capillary density, even though renal endpoints such as proteinuria and serum creatinine levels were not significantly affected by enarodustat, except for blood urea nitrogen levels at 4 wk. In addition, cardiac hypertrophy marker genes, including atrial natriuretic peptide, were suppressed in P19CL6 cells treated with enarodustat. These findings suggest that PHD inhibitors might show beneficial effects in cardiovascular complications caused by CKD.
心血管疾病(CVD)是肾病患者的主要死亡原因。缺氧在慢性肾脏病(CKD)和心血管疾病的进展中起着关键作用,与纤维化、炎症和氧化损伤有关。先前的研究表明,脯氨酰羟化酶(PHD)抑制剂,缺氧诱导因子(HIF)稳定剂,可用于治疗急性器官损伤,如肾缺血再灌注、心肌梗死,在某些情况下还可用于治疗 CKD。然而,PHD 抑制剂对 CKD 心血管并发症的影响尚不清楚。在本研究中,我们研究了 HIF 激活对剩余肾脏模型中肾脏和心血管结局的有益影响。我们使用一氧化氮合酶抑制剂 -硝基-L-精氨酸(饮用水中 20mg/L)的 5/6 肾切除术模型。大鼠在 5/6 肾切除前 2 周开始接受含有 0.005%恩拉司他汀(PHD 抑制剂)或载体的饮食,持续 8 周。PHD 抑制剂激活 HIF 可减少心脏肥大,并改善心肌纤维化,同时恢复毛细血管密度并改善线粒体形态。关于肾脏,恩拉司他汀改善了纤维化,同时减少了促炎细胞因子的表达、减少了细胞凋亡并恢复了毛细血管密度,尽管恩拉司他汀对肾脏终点(如蛋白尿和血清肌酐水平)没有显著影响,但在 4 周时血尿素氮水平除外。此外,用恩拉司他汀处理的 P19CL6 细胞中,心脏肥大标记基因,包括心钠肽,被抑制。这些发现表明,PHD 抑制剂可能对 CKD 引起的心血管并发症有有益的作用。
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