Nrf2 in Kidney Injury and Physiology

A special issue of Antioxidants (ISSN 2076-3921). This special issue belongs to the section "Health Outcomes of Antioxidants and Oxidative Stress".

Deadline for manuscript submissions: closed (1 July 2023) | Viewed by 13442

Special Issue Editor


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Guest Editor
Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
Interests: Nrf2; AKI; CKD; proteinuria; fibrosis

Special Issue Information

Dear Colleagues,

Acute kidney injury and progressive chronic kidney disease are debilitating diseases that can eventually lead to end-stage kidney disease. Acute kidney injury (AKI) has no effective treatment outside of supportive care, while treatment for the majority of CKD remains limited. The nuclear factor 2 erythroid 2 (NRF2) transcription factor is expressed in the kidney and upregulates cellular mechanisms involved in protection, including antioxidant responses, electrophile detoxifying genes, and anti-inflammatory effects. Its activity is restrained by Kelch-like ECH associated protein 1 (KEAP1) and glycogen synthase kinase 3 beta (GSK3B). Prior studies have demonstrated that NRF2 activity or enhancement protects against AKI, as well as AKI-to-CKD progression and interstitial fibrosis, suggesting a beneficial effect in the tubulointerstitial compartment of the kidney. However, the role of NRF2 in proteinuric glomerular diseases remains controversial. Some studies show that NRF2 reduces injury, while other studies demonstrate paradoxical increases in proteinuria and injury with NRF2 activation. Human trials show that NRF2 enhancers lead to short-term increases in glomerular filtration rate but can also worsen proteinuria. NRF2 has additional effects on renal salt and water handling and lipid metabolism. Additional research is required to determine the role of NRF2 in kidney physiology and disease, as well as the exact mechanisms of action for its effects.  This Special Issue will highlight research that improves our understanding of NRF2 in the kidney.

Dr. Roderick Tan
Guest Editor

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Keywords

  • Nrf2
  • Keap1
  • AKI
  • CKD
  • proteinuria
  • albuminuria
  • fibrosis

Published Papers (8 papers)

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Research

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20 pages, 53741 KiB  
Article
NRF2 Deficiency Attenuates Diabetic Kidney Disease in Db/Db Mice via Down-Regulation of Angiotensinogen, SGLT2, CD36, and FABP4 Expression and Lipid Accumulation in Renal Proximal Tubular Cells
by Ke Su, Shui-Ling Zhao, Wen-Xia Yang, Chao-Sheng Lo, Isabelle Chenier, Min-Chun Liao, Yu-Chao Pang, Jun-Zheng Peng, Kana N. Miyata, Jean-Francois Cailhier, Jean Ethier, Jean-Baptiste Lattouf, Janos G. Filep, Julie R. Ingelfinger, Shao-Ling Zhang and John S. D. Chan
Antioxidants 2023, 12(9), 1715; https://doi.org/10.3390/antiox12091715 - 04 Sep 2023
Cited by 2 | Viewed by 1221
Abstract
The role(s) of nuclear factor erythroid 2-related factor 2 (NRF2) in diabetic kidney disease (DKD) is/are controversial. We hypothesized that Nrf2 deficiency in type 2 diabetes (T2D) db/db mice (db/dbNrf2 knockout (KO)) attenuates DKD progression through the down-regulation of angiotensinogen (AGT), sodium-glucose [...] Read more.
The role(s) of nuclear factor erythroid 2-related factor 2 (NRF2) in diabetic kidney disease (DKD) is/are controversial. We hypothesized that Nrf2 deficiency in type 2 diabetes (T2D) db/db mice (db/dbNrf2 knockout (KO)) attenuates DKD progression through the down-regulation of angiotensinogen (AGT), sodium-glucose cotransporter-2 (SGLT2), scavenger receptor CD36, and fatty -acid-binding protein 4 (FABP4), and lipid accumulation in renal proximal tubular cells (RPTCs). Db/dbNrf2 KO mice were studied at 16 weeks of age. Human RPTCs (HK2) with NRF2 KO via CRISPR-Cas9 genome editing and kidneys from patients with or without T2D were examined. Compared with db/db mice, db/dbNrf2 KO mice had lower systolic blood pressure, fasting blood glucose, kidney hypertrophy, glomerular filtration rate, urinary albumin/creatinine ratio, tubular lipid droplet accumulation, and decreased expression of AGT, SGLT2, CD36, and FABP4 in RPTCs. Male and female mice had similar results. NRF2 KO attenuated the stimulatory effect of the Nrf2 activator, oltipraz, on AGT, SGLT2, and CD36 expression and high-glucose/free fatty acid (FFA)-stimulated lipid accumulation in HK2. Kidneys from T2D patients exhibited markedly higher levels of CD36 and FABP4 in RPTCs than kidneys from non-diabetic patients. These data suggest that NRF2 exacerbates DKD through the stimulation of AGT, SGLT2, CD36, and FABP4 expression and lipid accumulation in RPTCs of T2D. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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15 pages, 3053 KiB  
Article
Impaired NRF2 Inhibits Recovery from Ischemic Reperfusion Injury in the Aging Kidney
by Min Jee Jo, Ji Eun Kim, So Yon Bae, Eunjung Cho, Shin Young Ahn, Young Joo Kwon and Gang-Jee Ko
Antioxidants 2023, 12(7), 1440; https://doi.org/10.3390/antiox12071440 - 18 Jul 2023
Cited by 2 | Viewed by 1067
Abstract
Deteriorating kidney function is frequently observed in the elderly population, as well as vulnerability to acute kidney failure, such as ischemic/reperfusion injury (IRI), and inadequate recovery from IRI is one of the mechanisms of kidney dysfunction in the elderly. The potential mediators in [...] Read more.
Deteriorating kidney function is frequently observed in the elderly population, as well as vulnerability to acute kidney failure, such as ischemic/reperfusion injury (IRI), and inadequate recovery from IRI is one of the mechanisms of kidney dysfunction in the elderly. The potential mediators in the progression of kidney dysfunction in the aging kidney have not yet been clearly revealed. In this study, we investigated the role of nuclear factor erythroid 2-related factor 2 (NRF2), which is an essential regulator of cellular redox homeostasis, in restoring kidney function after IRI in the aging kidney. NRF2 expression decreased significantly in the kidneys of old mice, as well as histologic and functional renal recovery after IRI; 45-min renal pedicle clamping was retarded in old compared with young mice. Persistent renal injury during the recovery phase after IRI was aggravated in NRF2 knockout (KO) mice compared to wild-type mice. Oxidative stress occurred in NRF2 KO old mice during the IRI recovery phase along with decreased expression of mitochondrial OXPHOS-related proteins and a reduction in mitochondrial ATP content. In vitro, hypoxia/reoxygenation (H/R) injury was aggravated in senescent human proximal tubuloepithelial cells after NRF2 restriction using NRF2 siRNA, which also increased the level of oxidative stress and deteriorated mitochondrial dysfunction. Treating the mice with an NRF2 activator, CDDO-Me, alleviated the injury. These results suggest that NRF2 may be a therapeutic target for the aging kidney. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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25 pages, 85357 KiB  
Article
Activation of NRF2 Signaling Pathway Delays the Progression of Hyperuricemic Nephropathy by Reducing Oxidative Stress
by Panshuang Qiao, Yi Sun, Yiming Wang, Simei Lin, Yongpan An, Liang Wang, Jihan Liu, Yajun Huang, Baoxue Yang and Hong Zhou
Antioxidants 2023, 12(5), 1022; https://doi.org/10.3390/antiox12051022 - 28 Apr 2023
Cited by 2 | Viewed by 1882
Abstract
Hyperuricemia (HUA)-induced oxidative stress is a crucial contributor to hyperuricemic nephropathy (HN), but the molecular mechanisms underlying the disturbed redox homeostasis in kidneys remain elusive. Using RNA sequencing, together with biochemical analyses, we found that nuclear factor erythroid 2-related factor 2 (NRF2) expression [...] Read more.
Hyperuricemia (HUA)-induced oxidative stress is a crucial contributor to hyperuricemic nephropathy (HN), but the molecular mechanisms underlying the disturbed redox homeostasis in kidneys remain elusive. Using RNA sequencing, together with biochemical analyses, we found that nuclear factor erythroid 2-related factor 2 (NRF2) expression and nuclear localization levels were increased in early HN progression and then gradually declined below the baseline level. We identified the impaired activity of the NRF2-activated antioxidant pathway as a driver of oxidative damage in HN progression. Through nrf2 deletion, we further confirmed aggravated kidney damage in nrf2 knockout HN mice compared with HN mice. In contrast, the pharmacological agonist of NRF2 improved kidney function and alleviated renal fibrosis in mice. Mechanistically, the activation of NRF2 signaling reduced oxidative stress by restoring mitochondrial homeostasis and reducing NADPH oxidase 4 (NOX4) expression in vivo or in vitro. Moreover, the activation of NRF2 promoted the expression levels of heme oxygenase 1 (HO-1) and quinone oxidoreductase 1 (NQO1) and enhanced the antioxidant capacity of cells. Furthermore, the activation of NRF2 ameliorated renal fibrosis in HN mice through the downregulation of the transforming growth factor-beta 1 (TGF-β1) signaling pathway and ultimately delayed the progression of HN. Collectively, these results suggested NRF2 as a key regulator in improving mitochondrial homeostasis and fibrosis in renal tubular cells by reducing oxidative stress, upregulating the antioxidant signaling pathway, and downregulating the TGF-β1 signaling pathway. The activation of NRF2 represents a promising strategy to restore redox homeostasis and combat HN. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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9 pages, 700 KiB  
Communication
Nrf2 Protein Serum Concentration in Human CKD Shows a Biphasic Behavior
by Marianne Rasmussen, Kristian Horsman Hansen and Alexandra Scholze
Antioxidants 2023, 12(4), 932; https://doi.org/10.3390/antiox12040932 - 14 Apr 2023
Cited by 4 | Viewed by 1827
Abstract
Oxidative stress contributes to the progression of chronic kidney disease (CKD) and CKD-related mortality. The nuclear factor erythroid 2-related factor 2 (Nrf2) is essential in the regulation of cellular redox status, and Nrf2-activating therapies are under evaluation in several chronic diseases, including CKD. [...] Read more.
Oxidative stress contributes to the progression of chronic kidney disease (CKD) and CKD-related mortality. The nuclear factor erythroid 2-related factor 2 (Nrf2) is essential in the regulation of cellular redox status, and Nrf2-activating therapies are under evaluation in several chronic diseases, including CKD. It is therefore inevitable to understand how Nrf2 behaves in advancing CKD. We analyzed Nrf2 protein concentrations in patients with varying extents of CKD but without renal replacement therapy, and in healthy subjects. Compared to healthy controls, Nrf2 protein was upregulated in mild to moderate kidney function impairment (G1–3). Within the CKD population, we found a significant positive correlation between Nrf2 protein concentration and kidney function (estimated glomerular filtration rate). In severe kidney function impairment (G4,5), Nrf2 protein was reduced compared to mild to moderate kidney function impairment. We conclude that Nrf2 protein concentration in severe kidney function impairment is reduced relative to the mild to moderate kidney function impairment where increased Nrf2 protein concentrations prevail. With respect to the implementation of Nrf2 targeted therapies, it will be necessary to explore in which population of patients with CKD such therapies are able to effectively add to the endogenous Nrf2 activity. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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20 pages, 3876 KiB  
Article
Nrf2 Activation Does Not Protect from Aldosterone-Induced Kidney Damage in Mice
by Ronja Brinks, Christoph Jan Wruck, Jutta Schmitz and Nicole Schupp
Antioxidants 2023, 12(3), 777; https://doi.org/10.3390/antiox12030777 - 22 Mar 2023
Cited by 2 | Viewed by 1613
Abstract
Nuclear factor erythroid 2-related factor 2 (Nrf2) is downregulated in chronic kidney disease (CKD). Activation of Nrf2 might be a therapeutic option in CKD. Here we investigate the effect of Nrf2 activation on aldosterone (Aldo)-induced renal injury. Wild-type (WT) mice, transgenic Keap1 hypomorphic [...] Read more.
Nuclear factor erythroid 2-related factor 2 (Nrf2) is downregulated in chronic kidney disease (CKD). Activation of Nrf2 might be a therapeutic option in CKD. Here we investigate the effect of Nrf2 activation on aldosterone (Aldo)-induced renal injury. Wild-type (WT) mice, transgenic Keap1 hypomorphic (Nrf2ꜛ, genotype results in upregulation of Nrf2 expression) mice and WT mice treated with the Nrf2 activator sulforaphane (Sulf) received Aldo for 4 weeks. In Aldo-treated mice, kidneys were significantly heavier and pathologically altered, reflected by increased urinary albumin levels and tissue damage. In Nrf2ꜛ-Aldo mice the tubule damage marker NGAL was significantly decreased. Increased oxidative damage markers (8-OHdG, 15-isoprostane F2t) were measured in all Aldo-treated groups. Aldo-increased Nrf2 amounts were mainly found in the late tubule system. The amount of phosphorylated and thus putatively active Nrf2 was significantly increased by Aldo only in WT mice. However, expression of Nrf2 target genes NQO1 and HO1 was decreased in all Aldo-infused mice. GSK3β, which promotes Nrf2 degradation, was significantly increased in the kidneys of Aldo-treated WT mice. Neither genetic nor pharmacological Nrf2 activation was able to prevent oxidative injury induced by Aldo, probably due to induction of negative regulators of Nrf2. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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13 pages, 5571 KiB  
Article
Acidosis Activates the Nrf2 Pathway in Renal Proximal Tubule-Derived Cells through a Crosstalk with Renal Fibroblasts
by Marie-Christin Schulz, Virginie Dubourg, Alexander Nolze, Michael Kopf, Gerald Schwerdt and Michael Gekle
Antioxidants 2023, 12(2), 412; https://doi.org/10.3390/antiox12020412 - 08 Feb 2023
Cited by 3 | Viewed by 1513
Abstract
Crosstalk of renal epithelial cells with interstitial fibroblasts plays an important role in kidney pathophysiology. A previous study showed that crosstalk between renal epithelial cells and renal fibroblasts protects against acidosis-induced damage. In order to gain further mechanistic insight into this crosstalk, we [...] Read more.
Crosstalk of renal epithelial cells with interstitial fibroblasts plays an important role in kidney pathophysiology. A previous study showed that crosstalk between renal epithelial cells and renal fibroblasts protects against acidosis-induced damage. In order to gain further mechanistic insight into this crosstalk, we investigated the effect of acidosis on the transcriptome of renal epithelial cells (NRK-52E) and renal fibroblasts (NRK-49F) in co-culture by RNASeq, bioinformatics analysis and experimental validation. Cells were exposed to acidic media or control media for 48 h. RNA and protein from whole cell lysate were isolated. In addition, cells were fractionated into cytosol, nucleus and chromatin. RNASeq data were analyzed for differential expression and pathway enrichment (ingenuity pathway analysis, IPA, QIAGEN). Total and phosphorylated protein expression was assessed by Western blot (WB). Transcription factor activity was assessed by luciferase reporter assay. Bioinformatic analysis using differentially expressed genes according to RNASeq (7834 for NRK-52E and 3197 for NRK-49F) predicted the antioxidant and cell-protective Nrf2 pathway as acidosis-induced in NRK-52E and NRK-49F cells. Activation of Nrf2 comprises enhanced Nrf2 phosphorylation, nuclear translocation, DNA binding and initiation of a cell protective transcriptional program. Our data show that acidosis enhances chromatin-associated Nrf2 expression and the abundance of phosphorylated Nrf2 in the chromatin fraction of NRK-52E cells in co-culture but not in monoculture. Furthermore, acidosis enhances the activity of a reporter for Nrf2 (ARE-luciferase). Despite the bioinformatics prediction, NRK-49F cells did not respond with Nrf2 activation. Transketolase (TKT) is an important regulator of antioxidant and homeostatic responses in the kidney and a canonical Nrf2 target gene. We show that protein and mRNA expression of TKT is increased in NRK-52E cells under co-culture but not under monoculture conditions. In conclusion, our data show that extracellular acidosis activates the cytoprotective transcription factor Nrf2 in renal epithelial cells co-cultivated with renal fibroblasts, thereby enhancing the expression of cytoprotective TKT. This protective response is not observed in monoculture. Activation of the Nrf2 pathway represents a co-operative cellular strategy of protection against acidosis. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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19 pages, 4465 KiB  
Article
Suppression of NRF2 Activity by HIF-1α Promotes Fibrosis after Ischemic Acute Kidney Injury
by Corry D. Bondi, Brittney M. Rush, Hannah L. Hartman, Jiaxuan Wang, Mohammad M. Al-Bataineh, Rebecca P. Hughey and Roderick J. Tan
Antioxidants 2022, 11(9), 1810; https://doi.org/10.3390/antiox11091810 - 14 Sep 2022
Cited by 6 | Viewed by 1997
Abstract
Acute kidney injury (AKI) is a rapid decline in renal function and can occur after ischemia/reperfusion injury (IRI) to the tubular epithelia. The nuclear factor erythroid-2-related factor 2 (NRF2) pathway protects against AKI and AKI-to-chronic kidney disease (CKD) progression, but we previously demonstrated [...] Read more.
Acute kidney injury (AKI) is a rapid decline in renal function and can occur after ischemia/reperfusion injury (IRI) to the tubular epithelia. The nuclear factor erythroid-2-related factor 2 (NRF2) pathway protects against AKI and AKI-to-chronic kidney disease (CKD) progression, but we previously demonstrated that severe IRI maladaptively reduced NRF2 activity in mice. To understand the mechanism of this response, we subjected C57BL/6J mice to unilateral kidney IRI with ischemia times that were titrated to induce mild to severe injury. Mild IRI increased NRF2 activity and was associated with renal recovery, whereas severe IRI decreased NRF2 activity and led to progressive CKD. Due to these effects of ischemia, we tested the hypothesis that hypoxia-inducible factor-1α (HIF-1α) mediates NRF2 activity. To mimic mild and severe ischemia, we activated HIF-1α in HK-2 cells in nutrient-replete or nutrient-deficient conditions. HIF-1α activation in nutrient-replete conditions enhanced NRF2 nuclear localization and activity. However, in nutrient-deficient conditions, HIF-1α activation suppressed NRF2 nuclear localization and activity. Nuclear localization was rescued with HIF-1α siRNA knockdown. Our results suggest that severe ischemic AKI leads to HIF-1α-mediated suppression of NRF2, leading to AKI-to-CKD progression. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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Review

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17 pages, 1055 KiB  
Review
Redox Regulation of Nrf2 in Cisplatin-Induced Kidney Injury
by Kranti A. Mapuskar, Casey F. Pulliam, Diana Zepeda-Orozco, Benjamin R. Griffin, Muhammad Furqan, Douglas R. Spitz and Bryan G. Allen
Antioxidants 2023, 12(9), 1728; https://doi.org/10.3390/antiox12091728 - 06 Sep 2023
Cited by 2 | Viewed by 1335
Abstract
Cisplatin, a potent chemotherapeutic agent, is marred by severe nephrotoxicity that is governed by mechanisms involving oxidative stress, inflammation, and apoptosis pathways. The transcription factor Nrf2, pivotal in cellular defense against oxidative stress and inflammation, is the master regulator of the antioxidant response, [...] Read more.
Cisplatin, a potent chemotherapeutic agent, is marred by severe nephrotoxicity that is governed by mechanisms involving oxidative stress, inflammation, and apoptosis pathways. The transcription factor Nrf2, pivotal in cellular defense against oxidative stress and inflammation, is the master regulator of the antioxidant response, upregulating antioxidants and cytoprotective genes under oxidative stress. This review discusses the mechanisms underlying chemotherapy-induced kidney injury, focusing on the role of Nrf2 in cancer therapy and its redox regulation in cisplatin-induced kidney injury. We also explore Nrf2's signaling pathways, post-translational modifications, and its involvement in autophagy, as well as examine redox-based strategies for modulating Nrf2 in cisplatin-induced kidney injury while considering the limitations and potential off-target effects of Nrf2 modulation. Understanding the redox regulation of Nrf2 in cisplatin-induced kidney injury holds significant promise for developing novel therapeutic interventions. This knowledge could provide valuable insights into potential strategies for mitigating the nephrotoxicity associated with cisplatin, ultimately enhancing the safety and efficacy of cancer treatment. Full article
(This article belongs to the Special Issue Nrf2 in Kidney Injury and Physiology)
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