Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Physiol Rep. 2024 Mar;12(5):e15961. doi: 10.14814/phy2.15961.
The role of NRF2 in kidney biology has received considerable interest over the past decade. NRF2 transcriptionally controls genes responsible for cellular protection against oxidative and electrophilic stress and has anti-inflammatory functions. NRF2 is expressed throughout the kidney and plays a role in salt and water handling. In disease, animal studies show that NRF2 protects against tubulointerstitial damage and reduces interstitial fibrosis and tubular atrophy, and may slow progression of polycystic kidney disease. However, the role of NRF2 in proteinuric glomerular diseases is controversial. Although the NRF2 inducer, bardoxolone methyl (CDDO-Me), increases glomerular filtration rate in humans, it has not been shown to slow disease progression in diabetic kidney disease and Alport syndrome. Furthermore, bardoxolone methyl was associated with negative effects on fluid retention, proteinuria, and blood pressure. Several animal studies replicate findings of worsened proteinuria and a more rapid progression of kidney disease, although considerable controversy exists. It is clear that further study is needed to better understand the effects of NRF2 in the kidney. This review summarizes the available data to clarify the promise and risks associated with targeting NRF2 activity in the kidney.
在过去的十年中,NRF2 在肾脏生物学中的作用引起了相当大的关注。NRF2 转录控制负责细胞对抗氧化和亲电应激的基因,并具有抗炎作用。NRF2 在肾脏中表达,并在盐和水的处理中发挥作用。在疾病中,动物研究表明 NRF2 可防止肾小管间质损伤,减少间质纤维化和肾小管萎缩,并可能减缓多囊肾病的进展。然而,NRF2 在蛋白尿性肾小球疾病中的作用存在争议。尽管 NRF2 诱导剂 bardoxolone 甲酯(CDDO-Me)可增加人类肾小球滤过率,但它并未显示可延缓糖尿病肾病和 Alport 综合征中疾病的进展。此外,bardoxolone 甲酯与液体潴留、蛋白尿和血压升高的负面效应有关。尽管存在相当大的争议,但几项动物研究复制了蛋白尿恶化和肾脏疾病进展更快的发现。显然,需要进一步的研究来更好地了解 NRF2 在肾脏中的作用。这篇综述总结了现有数据,以阐明靶向肾脏 NRF2 活性的相关风险和获益。