| Autor: |
Zhou, Luping, Pereiro, Marc Torres, Li, Yanqun, Derigs, Marcus, Kuenne, Carsten, Hielscher, Thomas, Huang, Wei, Kränzlin, Bettina, Tian, Gang, Kobayashi, Kazuhiro, Lu, Gia-Hue Natalie, Roedl, Kevin, Schmidt, Claudia, Günther, Stefan, Looso, Mario, Huber, Johannes, Xu, Yong, Wiech, Thorsten, Sperhake, Jan-Peter, Wichmann, Dominic |
| Předmět: |
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| Zdroj: |
Science Translational Medicine; 10/2/2024, Vol. 16 Issue 767, p1-16, 16p |
| Abstrakt: |
Acute kidney injury (AKI) is a frequent and challenging clinical condition associated with high morbidity and mortality and represents a common complication in critically ill patients with COVID-19. In AKI, renal tubular epithelial cells (TECs) are a primary site of damage, and recovery from AKI depends on TEC plasticity. However, the molecular mechanisms underlying adaptation and maladaptation of TECs in AKI remain largely unclear. Here, our study of an autopsy cohort of patients with COVID-19 provided evidence that injury of TECs by myoglobin, released as a consequence of rhabdomyolysis, is a major pathophysiological mechanism for AKI in severe COVID-19. Analyses of human kidney biopsies, mouse models of myoglobinuric and gentamicin-induced AKI, and mouse kidney tubuloids showed that TEC injury resulted in activation of the glucocorticoid receptor by endogenous glucocorticoids, which aggravated tubular damage. The detrimental effect of endogenous glucocorticoids on injured TECs was exacerbated by the administration of a widely clinically used synthetic glucocorticoid, dexamethasone, as indicated by experiments in mouse models of myoglobinuric- and folic acid–induced AKI, human and mouse kidney tubuloids, and human kidney slice cultures. Mechanistically, studies in mouse models of AKI, mouse tubuloids, and human kidney slice cultures demonstrated that glucocorticoid receptor signaling in injured TECs orchestrated a maladaptive transcriptional program to hinder DNA repair, amplify injury-induced DNA double-strand break formation, and dampen mTOR activity and mitochondrial bioenergetics. This study identifies glucocorticoid receptor activation as a mechanism of epithelial maladaptation, which is functionally important for AKI. Editor's summary: Acute kidney injury (AKI) is a complication of critically ill patients with COVID-19. Dexamethasone is a synthetic glucocorticoid used to treat severe COVID-19. Zhou et al. combined data from patients who died in association with COVID-19, human tissue, and mouse models of AKI and found that renal tubular epithelial cell (TEC) damage from myoglobinuria resulted in glucocorticoid receptor activation and worse injury. Mice given myoglobinuric injury and dexamethasone treatment had exacerbated TEC damage. Human kidney slices and TEC organoids from both humans and mice corroborated this exacerbated damage. Inhibiting endogenous glucocorticoid production or inactivating the glucocorticoid receptor ameliorated TEC damage in these models. TEC damage was linked to DNA damage and mitochondrial impairment. These data suggest that glucocorticoid receptor activation aggravates renal injury. —Brandon Berry [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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