Liu Caihong, Wei Wei, Huang Yongxiu, Fu Ping, Zhang Ling, Zhao Yuliang
Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China.
Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China.
Metabolism. 2024 Sep;158:155974. doi: 10.1016/j.metabol.2024.155974. Epub 2024 Jul 10.
Acute kidney injury (AKI) is a frequent and severe complication of sepsis and is characterized by significant mortality and morbidity. However, the pathogenesis of septic acute kidney injury (S-AKI) remains elusive. Metabolic reprogramming, which was originally referred to as the Warburg effect in cancer, is strongly related to S-AKI. At the onset of sepsis, both inflammatory cells and renal parenchymal cells, such as macrophages, neutrophils and renal tubular epithelial cells, undergo metabolic shifts toward aerobic glycolysis to amplify proinflammatory responses and fortify cellular resilience to septic stimuli. As the disease progresses, these cells revert to oxidative phosphorylation, thus promoting anti-inflammatory reactions and enhancing functional restoration. Alterations in mitochondrial dynamics and metabolic reprogramming are central to the energetic changes that occur during S-AKI. In this review, we summarize the current understanding of the pathogenesis of metabolic reprogramming in S-AKI, with a focus on each cell type involved. By identifying relevant key regulatory factors, we also explored potential metabolic reprogramming-related therapeutic targets for the management of S-AKI.
急性肾损伤(AKI)是脓毒症常见且严重的并发症,具有显著的死亡率和发病率。然而,脓毒症性急性肾损伤(S-AKI)的发病机制仍不清楚。代谢重编程最初在癌症中被称为瓦伯格效应,与S-AKI密切相关。在脓毒症发作时,炎症细胞和肾实质细胞,如巨噬细胞、中性粒细胞和肾小管上皮细胞,都会发生代谢转变,向有氧糖酵解方向发展,以放大促炎反应并增强细胞对脓毒症刺激的耐受性。随着疾病进展,这些细胞会恢复到氧化磷酸化,从而促进抗炎反应并增强功能恢复。线粒体动力学和代谢重编程的改变是S-AKI期间发生的能量变化的核心。在本综述中,我们总结了目前对S-AKI中代谢重编程发病机制的理解,重点关注每种相关细胞类型。通过识别相关关键调节因子,我们还探索了与代谢重编程相关的潜在治疗靶点,用于S-AKI的管理。
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