Laboratory of Cellular, Genetic, and Molecular Nephrology, Renal Division, University of São Paulo Medical School, São Paulo - SP, Brazil.
Faculty of Medicine, Federal University of Alagoas, Av. Lourival Melo Mota, S/N Tabuleiro do Martins, Maceió - AL, 57072-900, Brazil.
Sci Rep. 2023 Aug 26;13(1):13985. doi: 10.1038/s41598-023-39299-9.
CKD progression depends on the activation of an intricate set of hemodynamic and inflammatory mechanisms, promoting renal leukocyte infiltration, inflammation and fibrosis, leading to renal function loss. There are currently no specific drugs to detain renal fibrogenesis, which is a common end-point for different nephropathies. Clinical therapy for CKD is mostly based on the management of hypertension and proteinuria, partially achieved with renin-angiotensin-aldosterone system (RAAS) blockers, and the control of inflammation by immunosuppressive drugs. The aim of the present study was to verify if the administration of tamoxifen (TAM), an estrogen receptor modulator, clinically employed in the treatment of breast cancer and predicted to exert antifibrotic effects, would promote additional benefits when associated to a currently used therapeutic scheme for the conservative management of experimental CKD. Wistar rats underwent the NAME model of hypertensive nephrosclerosis, obtained by daily oral administration of a nitric oxide synthesis inhibitor, associated to dietary sodium overload. The therapeutic association of TAM to losartan (LOS), and mofetil mycophenolate (MMF) effectively reduced the severe hypertension, marked albuminuria and glomerular damage exhibited by NAME animals. Moreover, the association also succeeded in limiting renal inflammation in this model, and promoted further reduction of ECM interstitial accumulation and renal fibrosis, compared to the monotherapies. According to our results, the association of TAM to the currently used conservative treatment of CKD added significant antifibrotic effects both in vivo and in vitro, and may represent an alternative to slow the progression of chronic nephropathy.
CKD 的进展取决于一系列复杂的血液动力学和炎症机制的激活,这些机制促进了肾脏白细胞浸润、炎症和纤维化,导致肾功能丧失。目前尚无专门的药物可以阻止肾纤维化,而肾纤维化是不同肾病的常见终点。CKD 的临床治疗主要基于高血压和蛋白尿的管理,部分通过肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂实现,以及通过免疫抑制药物控制炎症。本研究旨在验证他莫昔芬(TAM)的给药是否会带来额外的益处,他莫昔芬是一种雌激素受体调节剂,临床上用于治疗乳腺癌,并被预测具有抗纤维化作用,与目前用于实验性 CKD 保守治疗的治疗方案联合使用时。Wistar 大鼠接受了高血压性肾硬化症的 NAME 模型治疗,该模型通过每天口服一氧化氮合成抑制剂,并伴有饮食性钠过载。TAM 与氯沙坦(LOS)和吗替麦考酚酯(MMF)的联合治疗有效降低了 NAME 动物的严重高血压、显著的蛋白尿和肾小球损伤。此外,与单药治疗相比,该联合治疗还成功地限制了该模型中的肾脏炎症,并进一步减少了 ECM 间质积聚和肾纤维化。根据我们的结果,TAM 与目前用于 CKD 保守治疗的联合治疗在体内和体外都具有显著的抗纤维化作用,可能是减缓慢性肾病进展的一种替代方法。