Gao Jingli, Huang Liuyifei, Zhang Yuzhan, Wei Lei, Yu Zhixiang, Xing Yan, Yuan Jinguo, Ning Xiaoxuan, Sun Shiren
Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Geriatric, Xijing Hospital, Air Force Medical University, Xi'an, China.
Front Physiol. 2025 Jun 6;16:1602865. doi: 10.3389/fphys.2025.1602865. eCollection 2025.
Acute kidney injury (AKI) represents a clinical syndrome with a bleak short-term prognosis, posing a high risk for the development of chronic kidney diseases and end-stage kidney disease. The underlying mechanisms of AKI are still not fully understood, and effective intervention strategies remain elusive. Enormous energy is required to meet the functional activity in hypermetabolic tubular epithelial cells (TECs), the most vulnerable cell types during AKI. Recent evidence has shed light on the reprogramming of metabolic pathways and the shift in energy substrates under pathological conditions. The reprogrammed metabolic pathway initially serves to compensate for energy shortages and supply substrates for cell repair during the early stages of AKI. However, sustained metabolic dysregulation tend to become detrimental for tubular repair and regeneration. Intriguingly, dynamic alterations in specific metabolites extend beyond their conventional roles as metabolic byproducts, actively participating in pathophysiology through multifaceted regulatory mechanisms during AKI. As yet, clinical therapy for AKI has not yet incorporated the intervention of metabolic disorders, highlighting a vast potential for extensive application. This review aims to summarize recent studies on the role of metabolic pathway reprogramming and metabolites in AKI, while discussing promising therapeutic strategies targeting metabolic reprogramming.
急性肾损伤(AKI)是一种临床综合征,短期预后不佳,是慢性肾脏病和终末期肾病发生的高风险因素。AKI的潜在机制仍未完全明确,有效的干预策略也尚难寻觅。在AKI过程中,高度代谢的肾小管上皮细胞(TECs)是最脆弱的细胞类型,维持其功能活动需要大量能量。最近的证据揭示了病理条件下代谢途径的重编程以及能量底物的转变情况。重编程的代谢途径最初是为了在AKI早期阶段弥补能量短缺并为细胞修复提供底物,但持续的代谢失调往往对肾小管修复和再生产生不利影响。有趣的是,特定代谢物的动态变化不仅限于其作为代谢副产物的传统作用,在AKI期间还通过多方面的调节机制积极参与病理生理过程。目前,AKI临床治疗尚未纳入对代谢紊乱的干预,这凸显了其广泛应用的巨大潜力。本综述旨在总结近期关于代谢途径重编程和代谢物在AKI中的作用的研究,同时探讨针对代谢重编程的有前景的治疗策略。
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