Lai Weijing, Huang Rongshuang, Wang Bo, Shi Min, Guo Fan, Li Lingzhi, Ren Qian, Tao Sibei, Fu Ping, Ma Liang
Department of Nephrology Kidney Research Institute West China Hospital of Sichuan University Chengdu China.
Department of Nephrology Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College Chengdu China.
MedComm (2020). 2023 Jul 14;4(4):e330. doi: 10.1002/mco2.330. eCollection 2023 Aug.
Although inhibition of neprilysin (NEP) might be a therapeutic strategy with the potential to improve the outcome of chronic kidney disease (CKD), the versatile function of NEP with its mechanism remains obscure in kidney fibrosis. In the study, we found that NEP was abnormally increased in tubular epithelial cells of CKD patients, as well as unilateral ureteral obstruction and adenine diet-induced mice. Treatment with a United States Food and Drug Administration-approved NEP inhibitor Sacubitrilat (LBQ657) could alleviate ferroptosis, tubular injury, and delay the progression of kidney fibrosis in experimental mice. Similarly, genetic knockdown of NEP also inhibited tubular injury and fibrosis in transforming growth factor (TGF)-β1 -induced tubular cells. Mechanically, NEP overexpression aggravated the ferroptotic and fibrotic phenotype, which was restored by acyl-CoA synthetase long-chain family member 4 (ACSL4) knockdown. The NEP silencing attenuated TGF-β1-induced tubular cell ferroptosis and was exacerbated by ACSL4 overexpression. Collectively, for the first time, a novel aspect of NEP was explored in kidney fibrosis through ACSL4-mediated tubular epithelial cell ferroptosis. Our data further confirmed that NEP inhibition exerted a promising therapeutic against fibrotic kidney diseases.
尽管抑制中性肽链内切酶(NEP)可能是一种有望改善慢性肾脏病(CKD)预后的治疗策略,但NEP在肾纤维化中的多功能作用及其机制仍不清楚。在本研究中,我们发现NEP在CKD患者的肾小管上皮细胞中异常增加,在单侧输尿管梗阻和腺嘌呤饮食诱导的小鼠中也是如此。用美国食品药品监督管理局批准的NEP抑制剂沙库巴曲缬沙坦(LBQ657)治疗可减轻实验小鼠的铁死亡、肾小管损伤,并延缓肾纤维化进展。同样,NEP基因敲低也可抑制转化生长因子(TGF)-β1诱导的肾小管细胞损伤和纤维化。机制上,NEP过表达加重了铁死亡和纤维化表型,而酰基辅酶A合成酶长链家族成员4(ACSL4)敲低可使其恢复。NEP沉默减轻了TGF-β1诱导的肾小管细胞铁死亡,而ACSL4过表达则使其加重。总的来说,我们首次通过ACSL4介导的肾小管上皮细胞铁死亡,在肾纤维化中探索了NEP的一个新方面。我们的数据进一步证实,抑制NEP对纤维化肾病具有良好的治疗前景。