Bcl-xL augmentation potentially reduces ischemia/reperfusion induced proximal and distal tubular apoptosis and autophagy

BACKGROUND: Apoptosis and autophagy may contribute to cell homeostasis in the kidney subjected to ischemia/reperfusion injury via mitochondrial injury. Ischemia/reperfusion induces differential sensitivity between proximal and distal tubules via a dissociated Bcl-xL expression. We hypothesized Bcl-xL augmentation in the proximal and distal tubules may potentially reduce ischemia/reperfusion induced renal dysfunction. METHODS: We augmented Bcl-xL protein expression in the kidney with intrarenal adenoviral bcl-xL gene transfer and evaluated the potential effect of Bcl-xL augmentation on ischemia/reperfusion induced renal oxidative stress, apoptosis, and autophagy in the rat. RESULTS: Intrarenal arterial Adv-bcl-xL administration augmented maximal Bcl-xL protein expression of rat kidney after 7 days of transfection. The primary location of Bcl-xL augmentation was found in proximal and distal tubules, but not in glomeruli. Ischemia/reperfusion increased mitochondrial cytochrome C release, renal O2(-*) level and renal 3-nitrosine and 4-hydroxyneonal accumulation, potentiated tubular apoptosis and autophagy, including increase in microtubule-associated protein 1 light chain 3 (LC-3) and Beclin-1 expression, Bax/Bcl-xL ratio, caspase 3 expression and poly-(ADP-ribose)-polymerase fragments, and subsequent proximal and distal tubular apoptosis/autophagy. However, Adv-bcl-xL administration significantly reduced ischemia/reperfusion enhanced mitochondrial cytochrome C release, O2(-*) production, 3-nitrotyrosine and 4-hydroxynonenal accumulation, Beclin-1 expression, Bax/Bcl-xL ratio, and proximal and distal tubular apoptosis/autophagy, consequently improving renal dysfunction. Further study showed that Bcl-xL augmentation was more efficiently than Bcl-2 augmentation in amelioration of ischemia/reperfusion induced proximal and distal tubular apoptosis and renal dysfunction. CONCLUSIONS: Our results suggest that Adv-bcl-xL gene transfer significantly improves ischemia/reperfusion-induced renal dysfunction via the downregulation of renal tubular apoptosis and autophagy.     

Bcl-X(L) translocation in renal tubular epithelial cells in vitro protects distal cells from oxidative stress

BACKGROUND: The molecular pathogenesis of different sensitivities of the renal proximal and distal tubular cell populations to ischemic injury, including ischemia-reperfusion (IR)-induced oxidative stress, is not well-defined. An in vitro model of oxidative stress was used to compare the survival of distal [Madin-Darby canine kidney (MDCK)] and proximal [human kidney-2 (HK-2)] renal tubular epithelial cells, and to analyze for links between induced cell death and expression and localization of selected members of the Bcl-2 gene family (anti-apoptotic Bcl-2 and Bcl-X(L), pro-apoptotic Bax and Bad). METHODS: Cells were treated with 1 mmol/L hydrogen peroxide (H2O2) or were grown in control medium for 24 hours. Cell death (apoptosis) was quantitated using defined morphological criteria. DNA gel electrophoresis was used for biochemical identification. Protein expression levels and cellular localization of the selected Bcl-2 family proteins were analyzed (Western immunoblots, densitometry, immunoelectron microscopy). RESULTS: Apoptosis was minimal in control cultures and was greatest in treated proximal cell cultures (16.93 +/- 4.18% apoptosis) compared with treated distal cell cultures (2.28 +/- 0.85% apoptosis, P < 0.001). Endogenous expression of Bcl-X(L) and Bax, but not Bcl-2 or Bad, was identified in control distal cells. Bcl-X(L) and Bax had nonsignificant increases (P> 0.05) in these cells. Bcl-2, Bax, and Bcl-X(L), but not Bad, were endogenously expressed in control proximal cells. Bcl-X(L) was significantly decreased in treated proximal cultures (P < 0.05), with Bax and Bcl-2 having nonsignificant increases (P> 0.05). Immunoelectron microscopy localization indicated that control and treated but surviving proximal cells had similar cytosolic and membrane localization of the Bcl-2 proteins. In comparison, surviving cells in the treated distal cultures showed translocation of Bcl-X(L) from cytosol to the mitochondria after treatment with H2O2, a result that was confirmed using cell fractionation and analysis of Bcl-X(L) expression levels of the membrane and cytosol proteins. Bax remained distributed evenly throughout the surviving distal cells, without particular attachment to any cellular organelle. CONCLUSION: The results indicate that in this in vitro model, the increased survival of distal compared with proximal tubular cells after oxidative stress is best explained by the decreased expression of anti-apoptotic Bcl-X(L) in proximal cells, as well as translocation of Bcl-X(L) protein to mitochondria within the surviving distal cells.     

Bcl-2 protects tubular epithelial cells from ischemia reperfusion injury by inhibiting apoptosis

Ischemia followed by reperfusion leads to severe organ injury and dysfunction. Inflammation is considered to be the most important cause of graft dysfunction in kidney transplantation subjected to ischemia. The mechanism that triggers inflammation and renal injury after ischemia remains to be elucidated; however, cellular stress may induce apoptosis during the first hours and days after transplantation, which might play a crucial role in early graft dysfunction. Bcl-2 is known to inhibit apoptosis induced by the etiological factors promoting ischemia and reperfusion injury. Accordingly, we hypothesized that an augmentation of the antiapoptotic factor Bcl-2 may thus protect tubular epithelial cells by inhibiting apoptosis, thereby ameliorating the subsequent tubulointerstitial injury. We examined the effects of Bcl-2 overexpression on ischemia-reperfusion (I/R) injury using Bcl-2 transgenic mice (Bcl-2 TG) and their wild-type littermates (WT). To investigate the effects of I/R injury, the left renal artery and vein were clamped for 45 min, followed by reperfusion for 0-96 h. Bcl-2 TG exhibited decreased active caspase protein in the tubular cells, which led to a reduction in TUNEL-positive apoptotic cells. Consequently, interstitial fibrosis and phenotypic changes were ameliorated in Bcl-2 TG. In conclusion, Bcl-2 augmentation protected renal tubular epithelial cells from I/R, and subsequent interstitial injury by inhibiting tubular apoptosis.     

Administration of interleukin-1 receptor antagonist ameliorates renal ischemia-reperfusion injury.

Interleukin (IL)-1 is a major contributor to inflammation and apoptosis during ischemia/reperfusion (I/R) injury. Its deleterious effects are primarily mediated by the activation of nuclear factor-kappaB (NF-kappaB). Receptor-binding and signaling of IL-1 can be blocked by the IL-1 receptor antagonist (IL-1ra). The aim of our study was to characterize effects and mechanisms of IL-1ra administration on inflammation, apoptosis, and infiltration in renal I/R injury. Renal ischemia was induced in Lewis rats by clamping of the left renal artery for 45 min. Kidneys were removed for histological and molecular analysis 24 h or 5 days after reperfusion. IL-1ra ameliorated I/R induced renal injury and inflammation. Furthermore, the number of apoptotic tubular cells was lower in IL-1ra-treated animals 24 h after ischemia, which was paralleled by a Bax/Bcl-2 mRNA ratio towards anti-apoptotic effects. IL-1ra reduced the expression of monocyte chemoattractant protein-1 (MCP-1) mRNA at 24 h and 5 days and that of intracellular adhesion molecule-1 (ICAM-1) expression at 24 h in the ischemic reperfused kidneys. Our results indicate that IL-1ra treatment ameliorates renal I/R injury and this protective effect might be mediated by reduced induction of NF-kappaB mediated MCP-1, ICAM-1, and a decreased ratio between Bax and Bcl-2 mRNA expression.     

Augmenter of Liver Regeneration Attenuates Tubular Cell Apoptosis in Acute Kidney Injury in Rats: The Possible Mechanisms

Augmenter of liver regeneration (ALR), the expression of which increased in rat kidneys after renal ischemia/reperfusion (I/R) injury, enhances renal tubular cell regeneration in vivo and in vitro. We aimed to investigate the effects of ALR on apoptosis of renal tubular cells after renal I/R injury in vivo and consider the possible mechanisms. Rats that were subjected to bilateral renal ischemia for 60 min followed by reperfusion were administered with either vehicle or recombinant human ALR (rhALR). Renal dysfunction and histologic injury were assessed by the measurement of serum biochemical markers and histological grading. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL). Caspase-3 activity was measured using a colorimetric protease assay. Expression of Bcl-2, Bax Fas, phosphorylated-Akt (p-Akt), and phosphorylated-p53 (p-p53) was determined by western blotting. Compared with vehicle-treated rats, renal dysfunction and histologic injury were significantly attenuated by administration of rhALR. The number of TUNEL-positive tubular cells and caspase-3 activity were decreased, Bcl-2 and p-Akt expression was up-regulated, and Bax and p-p53 expression was down-regulated by administration of rhALR. However, administration of rhALR had no effect on Fas protein expression. These results indicate that the protective effect of rhALR on renal I/R injury is associated with its anti-apoptotic action in renal tubular cells. RhALR inhibits apoptosis by increasing the ratio of Bcl-2 to Bax and by decreasing the activity of caspase-3. The activation of Akt and inactivation of p53 are involved in the rhALR anti-apoptosis process.     

Augmenter of liver regeneration attenuates tubular cell apoptosis in acute kidney injury in rats: the possible mechanisms

Augmenter of liver regeneration (ALR), the expression of which increased in rat kidneys after renal ischemia/reperfusion (I/R) injury, enhances renal tubular cell regeneration in vivo and in vitro. We aimed to investigate the effects of ALR on apoptosis of renal tubular cells after renal I/R injury in vivo and consider the possible mechanisms. Rats that were subjected to bilateral renal ischemia for 60 min followed by reperfusion were administered with either vehicle or recombinant human ALR (rhALR). Renal dysfunction and histologic injury were assessed by the measurement of serum biochemical markers and histological grading. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL). Caspase-3 activity was measured using a colorimetric protease assay. Expression of Bcl-2, Bax Fas, phosphorylated-Akt (p-Akt), and phosphorylated-p53 (p-p53) was determined by western blotting. Compared with vehicle-treated rats, renal dysfunction and histologic injury were significantly attenuated by administration of rhALR. The number of TUNEL-positive tubular cells and caspase-3 activity were decreased, Bcl-2 and p-Akt expression was up-regulated, and Bax and p-p53 expression was down-regulated by administration of rhALR. However, administration of rhALR had no effect on Fas protein expression. These results indicate that the protective effect of rhALR on renal I/R injury is associated with its anti-apoptotic action in renal tubular cells. RhALR inhibits apoptosis by increasing the ratio of Bcl-2 to Bax and by decreasing the activity of caspase-3. The activation of Akt and inactivation of p53 are involved in the rhALR anti-apoptosis process.     

Involvement of the Mitochondrial Pathway in Cold Storage and Rewarming-Associated Apoptosis of Human Renal Proximal Tubular Cells

The cellular and molecular mechanisms of cold storage-ATN are not well characterized. In our earlier studies, cold storage caused necrosis of human proximal tubular epithelial (RPTE) cells, whereas apoptosis was prominent during rewarming. An intriguing finding was the pronounced swelling of the mitochondria in the cold, which promoted us to further characterize its role in rewarming-associated apoptosis. Human proximal tubular epithelial cells were cold stored in University of Wisconsin (UW) solution for 48 h followed by 24 h of rewarming in regular cell culture medium. During the cold storage, there was no significant change in the Bcl-2 to Bax protein ratio, mitochondrial location of cytochrome C or caspse-3 activity. However, during rewarming, the Bcl-2 to Bax ratio increased, cytochrome C was translocated to cytosol, and caspase-3 was activated: events and timing were consistent with the occurrence of apoptosis during rewarming. In a time-course experiment, mitochondrial swelling was discernable by electron microscopy as early as at 2 h. Cold storage of isolated-mitochondria for 2 h was attended by an increase in the opening of the permeability transition pores (PTP), suggesting PTP opening as an early mechanism for mitochondrial swelling. Addition of antioxidants (deferoxamine or 2-methyaminochroman) to the storage solution suppressed mitochondrial pore opening and swelling, Bcl-2 to Bax ratio increase, cytochrome C translocation, caspase-3 activation as well as rewarming-induced apoptosis. Our data demonstrate for the first time that apoptosis following cold storage and rewarming of human renal tubular cells is accompanied by specific mitochondrial events, and that these events and apoptosis can be suppressed by adding antioxidants to the cold storage solution.     

Segmental heterogeneity in Bcl-2, Bcl-xL and Bax expression in rat tubular epithelium after ischemia-reperfusion

Summary: Aims: Studies in rats with bilateral clamping of renal arteries showed transient Bcl‐2, Bcl‐xL and Bax expression in renal tubular epithelium following ischemia‐reperfusion. However, current data on the preferential localization of specific mRNAs or proteins are limited because gene expression was not analysed at segmental level. This study analyses the mRNA expression of Bcl‐2, Bcl‐xL and Bax in four segments of proximal and distal tubules localized in the renal cortex and outer medulla in rat kidneys with bilateral renal clamping for 30 min and seven reperfusion times versus control animals without clamp. Methods: Proximal convoluted tubule (PCT), distal convoluted tubule (DCT), proximal straight tubule (PST) and medullary thick ascending limb (MTAL) were obtained by manual microdissection. RT‐PCR was used to analyse mRNA expression at segmental level. Results: Proximal convoluted tubule and MTAL showed early, persistent and balanced up‐regulation of Bcl‐2, Bcl‐xL and Bax, while PST and DCT revealed only Bcl‐2 and Bcl‐xL, when only Bax was detected in PST. DCT expressed Bcl‐xL initially, and persistent Bcl‐2 later. Conclusion: These patterns suggest a heterogeneous apoptosis regulatory response in rat renal tubules after ischemia‐reperfusion, independently of cortical or medullary location. This heterogeneity of the expression patterns of Bcl‐2 genes could explain the different susceptibility to undergo apoptosis, the different threshold to ischemic damage and the different adaptive capacity to injury among these tubular segments.     

过度训练可通过破坏Bax/Bcl-2平衡激活caspase依赖的凋亡通路诱导大鼠肾小管上皮细胞凋亡

目的 观察过度训练大鼠肾组织Bax、Bcl-2及 caspase-3的表达及其与肾小管上皮细胞凋亡的关系,探讨caspase依赖的凋亡信号途径在其中的作用及其机制。 方法 将48只雄性Wistar大鼠按随机数字表法分为对照组（CN）、力竭运动组（ES）、旋覆花素干预组（IB）。CN组为安静对照;ES组又根据力竭后恢复时间分为力竭后即刻（ESI）、力竭后6 h（ES 6 h）和力竭后24 h（ES 24 h）组;IB组于力竭运动前24 h 给予旋覆花素25 ml/kg分3次灌胃后进行力竭运动,分为IB 6 h和IB 24 h组。采用大鼠游泳至力竭建立过度训练模型。TUNEL法检测肾小管上皮细胞凋亡。免疫组织化学法检测肾组织Bax、Bcl-2及 caspase-3的表达。Western印迹法测定肾组织caspase-3蛋白的表达。用图像分析系统测定肾小管凋亡细胞、Bax、Bcl-2及 caspase-3表达的平均吸光度并计算Bax和Bcl-2的比值。用Pearson法分析Bax和Bcl-2的比值与caspase-3之间的相关性。用非参Spearman法分析Bax/Bcl-2的比值和caspase-3与细胞凋亡之间的相关性。 结果 TUNEL法显示,过度训练大鼠肾组织凋亡细胞主要分布在肾小管上皮细胞,力竭后即刻、6 h及24 h肾小管上皮细胞凋亡数呈进行性增多（P < 0.01）;免疫组化显示,过度训练大鼠肾组织caspase-3的表达及分布与Bax/Bcl-2比值变化及凋亡细胞的分布一致。图像分析显示,大鼠肾小管上皮细胞Bax/Bcl-2比值与caspase-3的表达于力竭后即刻、力竭后6 h、力竭后24 h逐渐增高（均P < 0.05）,均显著高于对照组（均P < 0.05）。Western 印迹测定结果也显示caspase-3蛋白表达的变化趋势。过度训练大鼠肾小管上皮细胞Bax/Bcl-2比值与caspase-3的表达呈正相关（r = 0.865,P < 0.05）;Bax/Bcl-2比值和caspase-3的表达与肾小管上皮细胞凋亡之间均呈正相关（r = 0.674,r = 0.837,均P < 0.05）。用旋覆花素干预后,过度训练引起的肾小管上皮细胞Bax/Bcl-2比值增高和caspase-3的过度表达及肾小管上皮细胞的过度凋亡均被显著抑制（均P < 0.05）。 结论 过度训练可通过破坏肾小管上皮细胞Bax/Bcl-2的平衡,激活caspase依赖的凋亡信号通路,进而诱导大鼠肾小管上皮细胞凋亡。这可能是过度训练引起肾小管上皮细胞凋亡的分子机制之一。     

肾上腺髓质素对大鼠肾缺血再灌注损伤中肾小管上皮细胞凋亡的影响及机制研究

目的 观察肾上腺髓质素(adrenomedullin,AM)对大鼠肾缺血再灌注损伤(ischemia reperfusion injury,IRI)中肾小管上皮细胞凋亡的影响,并探讨其机制.方法 Wistar大鼠32只,随机分为4组:假手术组和IRI组各6只,转染空质粒组和转染AM质粒组各10只.大鼠右肾切除后1周,用超声微泡造影剂介导的基因转染方法将大鼠AM真核表达质粒转染大鼠肾脏,1周后采用免疫组织化学方法检测转染效率.转染成功后夹闭左肾动脉45 min制作肾IRI模型,于再灌注24 h后留取肾组织标本.TUNEL染色检测肾组织细胞凋亡,RT-PCR检测肾组织Bcl-2、Bax和Fas的mRNA表达,蛋白质印迹法检测caspase-3、caspase-8和caspase-9蛋白质表达.结果 转染AM质粒组的AM表达显著高于转染空质粒组(0.51±0.09和0.23±0.05,P＜0.05).与假手术组相比,IRI组肾组织细胞凋亡率明显增加[(38.79±7.52)%和(2.89±0.52)%,P＜0.05];肾组织Bax、Bcl-2、Fas、caspase-3、caspase-8和caspase-9表达上调,分别为0.72±0.18和0.23±0.04、0.80±0.12和0.38±0.06、1.24±0.25和0.39±0.09、0.76±0.13和0.38±0.08、0.92±0.14和0.32±0.06、0.89±0.12和0.42±0.09(P＜0.05),Bax/Bcl-2升高(0.91±0.18和0.61±0.08,P＜0.05).转染AM质粒组肾组织凋亡细胞数、Bax、Fas、caspase-3、caspase-8和caspase-9表达下调,分别为(19.36±6.78)%、0.48±0.11、0.62±0.07、0.53±0.08、0.46±0.08、0.51±0.12,与IRI组比较差异均有统计学意义(P＜0.05);Bcl-2表达进一步上调为1.23±0.25,Bax/Bcl-2降低为0.44±0.12,与IRI组比较差异均有统计学意义(P＜0.05).转染空质粒组和IRI组比较,上述各指标差异均无统计学意义(P＞0.05).结论 AM能减轻肾IRI引起的肾小管上皮细胞凋亡,其部分机制可能是通过抑制caspase依赖的内、外源性凋亡途径实现的.

Abstract：

Objective To investigate the effect and mechanism of adrenomedullin (AM) on apoptosis of renal tubular epithelial cell in rats induced by renal ischemia reperfusion injury. Methods Thirty-two Wistar rats were randomly divided into 4 groups: control group, IRI group, empty plasmid group and AM group. One week after removing the right kidney, eukaryotic expression vector encoding rat AM gene was transfected into the left kidney using an ultrasound-microbubble mediated system. After 1 week the transfer efficiency was detected by immunohistochemical method . Renal IRI model induced by clamping left renal arteries for 45 min followed by reperfusion for 24 h. Tubular cell apoptosis was detected by TUNEL assay. Bcl-2, Bax and Fas expressions were examined by RT-PCR. The expressions of caspase-3, caspase-8 and caspase-9 were determined by Western bolt analysis. Results The expression of AM in the AM group was significantly higher than the empty plasmid group (0.51±0.09 vs 0.23±0.05; P<0.05). Compared with the control group, the apoptosis rate of renal tubular cell in the IRI group was significantly higher [(38.79±7.52)% vs (2.89±0.52)%; P<0.05]. The expressions of Bax, Bcl-2, Fas, caspase-3, caspase-8 and caspase-9 were also significantly increased (0.72±0.18 vs 0.23±0.04, 0.80±0.12 vs 0.38±0.06, 1.24±0.25 vs 0.39±0.09, 0.76±0.13 vs 0.38±0.08, 0.92±0.14 vs 0.32±0.06, 0.89±0.12 vs 0.42±0.09; P<0.05). Bax/Bcl-2 was also significantly increased (0.91±0.18 vs 0.61±0.08; P<0.05). Compared with the IRI group, AM pretreatment significantly decreased the apoptosis rate of renal tubular cells [(19.36±6.78)% vs (38.79±7.52)%; P<0.05]. AM inhibited the up-regulation of Bax, Fas, caspase-3, caspase-8 and caspase-9, while promoting the up-regulation of Bcl-2 (0.48±0.11 vs 0.72±0.18, 0.62±0.07 vs 1.24±0.25, 0.53±0.08 vs 0.76±0.13, 0.46±0.08 vs 0.92±0.14, 0.51±0.12 vs 0.89±0.12, 1.23±0.25 vs 0.80±0.12; P<0.05). Bax/Bcl-2 significantly decreased (0.44±0.12 vs 0.91±0.18; P<0.05). The above parameters had no significant diffe-rence between the empty plasmid group and the IRI group (P>0.05). Conclusion AM can reduce apoptosis of renal tubular epithelial cell induced by renal IRI, the mechanism of which might be achieved by inhibiting caspase-dependent intrinsic and extrinsic pathways.     

Role of apoptosis in hypoxic/ischemic damage in the kidney

Cell death by hypoxia/ischemia may occur by apoptosis as well as necrosis in experimental models of renal injury both in vivo and in vitro. Necrosis can occur during hypoxia/ischemia as a result of widespread cellular degradation, and during reoxygenation/reperfusion as a consequence of the development of the mitochondrial permeability transition pore (PTP). In vitro models of hypoxia/reoxygenation suggest that apoptotic cell death may occur during reoxygenation as a consequence of mitochondrial release of cytochrome c (Cyt c) during hypoxia. In hypoxic renal cells, Bax and Bak, 2 pro-apoptotic proteins of the Bcl-2 family, collaborate to permeabilize the mitochondrial outer membrane to intermembrane proteins such as Cyt c, although Bax, per se, appears to play the dominant role. Cyt c then acts to trigger the downstream apoptotic cascade. Caspase inhibitors suppress these downstream events, but not Cyt c release. However, the anti-apoptotic Bcl-2 prevents mitochondrial permeabilization and maintains viability. Inflammation is known to play a major role in exacerbating parenchymal damage during reperfusion. Recent studies suggest that the apoptosis-related mechanisms contribute to the inflammatory process. By inhibiting tubular cell apoptosis, by suppressing an apoptotic chain reaction in accumulating inflammatory cells, and by inhibiting caspase-1 processing in injured tissue, caspase inhibitors may reduce inflammation, and thereby reduce the cascading parenchymal injury that is associated with inflammation.     

Fibrate prevents cisplatin-induced proximal tubule cell death

BACKGROUND: In previous studies we have shown that cisplatin inhibits peroxisome proliferator-activated receptor-alpha (PPAR-alpha) activity and consequently fatty acid oxidation, and these events precede proximal tubule cell death. In addition the use of fibrate class of PPAR-alpha ligands ameliorate renal function by preventing both inhibition of fatty acid oxidation and proximal tubule cell death. METHODS: LLC-PK1 cells were treated with cisplatin and apoptosis was established by the presence of nuclear fragmentation and by cell cycle analysis. Proximal tubular cells treated with cisplatin and bezafibrate were subjected to sub cellular fractionation and the presence of Bax, Bcl-2, cytochrome c, and active caspase-3 in the cytosolic and mitochondrial membrane fractions was determined by Western blot analysis. PPAR-alpha activity was measured by determining luciferase activity after transfection of LLC-PK1 cells with TK-Luc 3x PPAR response elements (PPRE), and the accumulation of nonesterified free fatty acids was measured in lysates obtained from cells treated with cisplatin and bezafibrate. RESULTS: Incubation of LLC-PK1 cells with 25 micromol/L cisplatin for 18 hours induced 41.5% apoptosis measured by cell cycle analysis. Cisplatin-induced apoptosis was significantly suppressed by bezafibrate, a fibrate class of PPAR-alpha ligand. Bezafibrate treatment of LLC-PK1 cells prevented cisplatin-induced translocation of proapoptotic Bax from the cytosol to the mitochondrial fraction, and increased the expression of antiapoptotic molecule Bcl-2. Cisplatin-induced inhibition of PPAR-alpha activity was accompanied by increased accumulation of nonesterified free fatty acids. Pretreatment with bezafibrate prevented both the inhibition of PPAR-alpha activity and the accumulation of nonesterified free fatty acids induced by cisplatin. Finally, bezafibrate prevented cisplatin-induced release of cytochrome c from the mitochondria to the cytosol, and the cleavage of procaspase-3 to active caspase-3. CONCLUSION: Bezafibrate treatment inhibits cisplatin-mediated tubular injury by preventing the activation of various cellular mechanisms that lead to proximal tubule cell death. These findings support our previous observations where the use of fibrates represents a novel strategy to ameliorate proximal tubule cell death in cisplatin-induced acute renal failure.     

Relationship between expression of Bcl-2 genes and growth factors in ischemic acute renal failure in the rat

The promotion of cell survival and regeneration in acute renal failure (ARF) is important for restitution of renal function. This study analyzes the temporal and spatial relationship between expression of pro- and anti-apoptotic members of the Bcl-2 gene family (Bcl-2, Bcl-X(L), Bax) and epidermal growth factor (EGF), insulin-like growth factor- (IGF-1), and transforming growth factor-beta (TGF-beta), growth factors that are thought to be reparative in ARF. A rat model of ischemic ARF involving 30 min of bilateral renal artery occlusion followed by reperfusion for 0 to 14 d was used. Apoptosis and mitosis were quantified and qualitative assessment was made of other cellular damage including necrosis and loss of cellular adhesion. Locality and level of expression of the Bcl-2 and growth factor proteins were determined using immunohistochemistry. Apoptosis peaked between 4 and 14 d postischemia in both proximal and distal tubules. Mitosis peaked at 2 d in proximal tubules and 4 to 14 d in the distal tubules. A spatio-temporal relationship was observed between anti-apoptotic Bcl-2 gene family members and growth factors after ischemia-reperfusion. In control kidneys, expression of Bcl-2, Bcl-X(L) was low in epithelium of distal tubules, Bax had low-to-moderate expression in the proximal tubule and had low expression in the distal tubule, EGF and IGF-1 had low-to-moderate expression in the distal tubule, and TGF-beta had low expression in the proximal tubule. In contrast, within 24 h of reperfusion, distal tubules showed a marked increase in expression of Bcl-2 and a moderate increase in Bcl-X(L) and Bax. Proximal tubules showed a marked increase in Bax expression and a moderate increase in Bcl-X(L). Twenty-four hours after expression of the Bcl-2 proteins was increased, IGF-1 and EGF protein levels were increased in the distal tubule, similar to the Bcl-2 anti-apoptotic proteins, and were also detected in the adjacent proximal tubules, suggestive of paracrine action in these tubules. TGF-beta expression was moderately increased in regenerating proximal tubules, but no relationship was seen with the pattern of expression of the Bcl-2 genes. An explanation of these results is that the distal tubule is adaptively resistant to ischemic injury via promotion of survival by anti-apoptotic Bcl-2 genes, and its survival allows expression of growth factors critical not only to the maintenance and regeneration of its own cell population (autocrine action), but also to the adjacent ischemia-sensitive proximal tubular cells (paracrine action).     

Delayed administration of darbepoetin or erythropoietin protects against ischemic acute renal injury and failure

Administration of human recombinant erythropoietin (EPO) at time of acute ischemic renal injury (IRI) inhibits apoptosis, enhances tubular epithelial regeneration, and promotes renal functional recovery. The present study aimed to determine whether darbepoetin-alfa (DPO) exhibits comparable renoprotection to that afforded by EPO, whether pro or antiapoptotic Bcl-2 proteins are involved, and whether delayed administration of EPO or DPO 6 h following IRI ameliorates renal dysfunction. The model of IRI involved bilateral renal artery occlusion for 45 min in rats (N = 4 per group), followed by reperfusion for 1-7 days. Controls were sham-operated. Rats were treated at time of ischemia or sham operation (T0), or post-treated (6 h after the onset of reperfusion, T6) with EPO (5000 IU/kg), DPO (25 mug/kg), or appropriate vehicle by intraperitoneal injection. Renal function, structure, and immunohistochemistry for Bcl-2, Bcl-XL, and Bax were analyzed. DPO or EPO at T0 significantly abrogated renal dysfunction in IRI animals (serum creatinine for IRI 0.17 +/- 0.05 mmol/l vs DPO-IRI 0.08 +/- 0.03 mmol/l vs EPO-IRI 0.04 +/- 0.01 mmol/l, P = 0.01). Delayed administration of DPO or EPO (T6) also significantly abrogated subsequent renal dysfunction (serum creatinine for IRI 0.17 +/- 0.05 mmol/l vs DPO-IRI 0.06 +/- 0.01 mmol/l vs EPO-IRI 0.03 +/- 0.03 mmol/l, P = 0.01). There was also significantly decreased tissue injury (apoptosis, P < 0.05), decreased proapoptotic Bax, and increased regenerative capacity, especially in the outer stripe of the outer medulla, with DPO or EPO at T0 or T6. These results reaffirm the potential clinical application of DPO and EPO as novel renoprotective agents for patients at risk of ischemic acute renal failure or after having sustained an ischemic renal insult.     

促红细胞生成素抑制过氧化氢诱导的肾小管细胞凋亡

目的探讨促红细胞生成素（erythropoietin,EPO）是否可以抑制过氧化氢（H2O2）诱导的氧化应激和细胞凋亡及其抑制凋亡的相关机制。方法传代培养大鼠近端肾小管上皮细胞（NRK-52E）,分为正常对照组（NC组）、H1组（1mmol／L H2O2）、H2组（5mmol／LH2O2、E组（H2U＋EPO组）。细胞免疫荧光检测NRK-52E细胞是否表达EPO受体（erythropoietin receptor,EPOR）。荧光探针氯甲基二氯二氢荧光素二乙酯（CM—H2DCFDA）标记检测细胞内活性氧（reactive oxygen species,ROS）水平。流式细胞仪AnnexinV-FITC／PI双染法检测细胞凋亡指数。RTPCR检测凋亡相关基因B细胞淋巴瘤／白血病-2（B-cell lymphoma／L eukemia-2,Bcl-2）家族中Bcl-2和BaxmRNA的表达。结果NRK52E细胞表达EPOR。H2O2引起NRK-52E细胞内ROS水平升高,上调BaxmRNA表达、下凋Bcl-2mRNA表达,诱导NRK-52E细胞凋亡。EPO可以抑制H2O2诱导的ROS水平升高、Bcl2mRNA表达下调、BaxmRNA表达上调及NRK-52E细胞凋亡。结论EPO可以缓解H2O2诱导的氧化应激、上调Bcl-2mRNA表达、下调BaxmRNA表达,抑制H2O2诱导的NRK52E细胞凋亡,发挥肾小管细胞保护效应。     

Blockade of calcium influx through L-type calcium channels attenuates mitochondrial injury and apoptosis in hypoxic renal tubular cells

In hypoxia, ATP depletion causes cellular Ca(2+) increase, mitochondrial injury, and apoptosis in renal tubular cells. However, the molecular basis of these observations is incompletely delineated. IRPTC, a rat renal proximal tubular cell line, was treated with antimycin A, and disturbances in cytoplasmic calcium ([Ca(2+)]c) and mitochondrial calcium ion concentration ([Ca(2+)]m), dissipation of mitochondrial membrane potential (DeltaPsi(m)), cytochrome c release, and resultant apoptosis were examined. Pharmacologic targeting of L-type Ca(2+) channels in vitro and in vivo was used to clarify the involvement of voltage-dependent Ca(2+) channels during this process. In vitro studies indicated that ATP depletion-induced apoptosis was preceded by increased [Ca(2+)]c and [Ca(2+)]m before activation of mitochondrial signaling. Antagonizing L-type Ca(2+) channels offset these findings, suggesting [Ca(2+)]c and [Ca(2+)]m involvement. Azelnidipine administration ameliorated cellular and mitochondrial Ca(2+) accumulation, mitochondrial permeability transition, cytochrome c release, caspase-9 activation, and resultant apoptosis (15.8 +/- 0.8% versus 8.9 +/- 0.7%; P < 0.01). Similar effects of azelnidipine were substantiated in an in vivo ischemia/reperfusion injury model. There were fewer terminal-deoxynucleotidyl transferase mediated dUTP nick-end labeling-positive cells in the azelnidipine-treated group (0.322 +/- 0.038/tubule) as compared with the vehicle-treated group (0.450 +/- 0.041; P < 0.05), although the antiapoptotic effect was smaller in vivo than in vitro, partly as a result of distinct levels of Bax expression. It is proposed that voltage-dependent Ca(2+) channels are involved in cellular and mitochondrial accumulation of Ca(2+) subsequent to ATP depletion and play an important role in regulating mitochondrial permeability transition, cytochrome c release, caspase activation, and apoptosis.     

大白鼠小肠缺血再灌注后肾脏组织中凋亡基因表达与超微结构改变

目的:探讨大白鼠小肠缺血再灌注后肾脏组织的次级损伤和改变。方法:建立小肠缺血再灌注模型,于缺血再灌注前及再灌注后03、0 min,1、2 h,1、3、7天采取静脉血并切取脏肾组织块;用化学法检测一氧化氮(NO)和超氧化物歧化酶(SOD)血中含量,用免疫组织化学SP法和透射电镜分别观察肾脏组织中Bax、Bcl-2、p53的表达及细胞超微结构的改变情况。结果:小肠缺血再灌注后NO浓度有所升高(P<0.01),而SOD浓度呈下降趋势(P<0.01)。Bax、Bcl-2及p53免疫阳性细胞率于再灌注0 min开始升高,依次为(3.35±1.43)%,(2.86±0.56)%,(1.58±0.32)%;至30 min时,三者阳性细胞率升高更为明显,依次为(13.38±3.65)%,(22.25±4.82)%,(6.31±2.24)%,但Bcl-2表达高于Bax(P<0.01)。再灌注2 h时,三种基因的表达均有所降低,其后又开始升高,7天时阳性细胞率达高峰,依次为(59.85±8.25)%,(40.75±6.27)%,(36.45±4.98)%,但Bax表达明显高于Bcl-2。电镜观察发现肾小管基底膜破裂,上皮坏死脱落等。结论:大鼠小肠缺血再灌注后可引起肾脏组织细胞的凋亡和损伤。     

Bcl-2 Protects Tubular Epithelial Cells From Ischemia/Reperfusion Injury by Dual Mechanisms

Ischemia/reperfusion (I/R) injury, which induces extensive loss of tubular epithelial cells, is associated with delayed graft function following kidney transplantation. Recent reports have suggested that cell death by I/R injury occurs by autophagy, a cellular degradation process responsible for the turnover of unnecessary or dysfunctional organelles and cytoplasmic proteins, as well as by apoptosis. Recently, we demonstrated that overexpression of the anti-apoptotic factor, Bcl-2, inhibited tubular apoptosis and subsequent tubulointerstitial damage after I/R injury. Autophagy is also observed in cells undergoing cell death in several diseases. Therefore, we hypothesized that increased Bcl-2 protein may protect tubular epithelial cells by suppressing autophagy and inhibiting apoptosis. In the present study, a transgenic mouse model (LC3-GFP TG) in which autophagosomes are labeled with LC3-GFP and Bcl-2/LC3-GFP double transgenic mice (Bcl-2/LC3-GFP TG) were used to examine the effect of Bcl-2 on I/R-induced autophagy. I/R injury, which is associated with marked disruption of normal tubular morphology, promoted the formation of LC3-GFP dots, representing extensively induced autophagosomes. On electron microscopy, the autophagosomes contained mitochondria in I/R-injured tubular epithelial cells. In contrast, Bcl-2 augmentation suppressed the formation of autophagosomes and there was less tubular damage. In conclusion, Bcl-2 augmentation protected renal tubular epithelial cells from I/R injury by suppressing autophagosomal degradation and inhibiting tubular apoptosis.     

垂体中叶素对肾脏缺血再灌注大鼠肾小管上皮细胞凋亡的影响及其机制

目的 探讨垂体中叶素（IMD）对肾脏缺血再灌注（I/R）大鼠肾小管上皮细胞凋亡的影响及相关机制。 方法 健康雄性Wistar大鼠24只随机分为假手术组、I/R组、空质粒组、IMD质粒组。动物右肾切除后,采用超声微泡法,将空质粒或IMD质粒转染入左肾,1周后制作肾脏I/R模型。TUNEL法测定细胞凋亡;半定量RT-PCR检测Bax、Bcl-2、Fas的mRNA表达水平;比色法检测caspase-8、-9的活性;Western印迹法检测caspase-3蛋白的表达水平。 结果 与假手术组相比,I/R组细胞凋亡率增高,Bax、Fas mRNA表达增加,bcl-2 mRNA表达下降,caspase-8、-9活性增强,caspase-3蛋白表达增加（均P < 0.05）。与I/R组相比,IMD转染组细胞凋亡率明显降低,Bax、Fas的mRNA表达下降,bcl-2的mRNA表达增加,caspase-8、-9活性减弱,caspase-3蛋白表达减少（均P < 0.05）。转空质粒组与I/R组比较,各指标差异均无统计学意义。 结论 IMD能上调bcl-2表达,降低bax、Fas的表达,降低caspase-8、-9活性,从而抑制肾脏I/R损伤所诱导的凋亡。     

依托咪酯后处理对大鼠脑缺血再灌注时细胞凋亡的影响

目的 评价依托咪酯后处理对大鼠脑缺血再灌注时细胞凋亡的影响.方法 清洁级健康雄性SD大鼠32只,体重250～300 g,采用随机数字表法,将大鼠随机分为4组(n=8):假手术组(S组)、缺血再灌注组(I/R组)、脂肪乳组(L组)和依托咪酯后处理组(Ep组).采用栓塞右侧大脑中动脉2h恢复灌注的方法制备大鼠脑缺血再灌注模型.Ep组于再灌注即刻腹腔注射依托咪酯乳剂20 mg/kg(1 ml/100 g),I/R组和L组分别给予等容积生理盐水和脂肪乳.于再灌注24h时处死大鼠,取缺血侧脑组织,HE染色后光镜下观察病理学结果,采用TUNEL法检测凋亡细胞,计算凋亡指数,采用免疫组化染色法测定Bcl-2和Bax的表达,计算Bcl-2与Bax表达的比值(Bcl-2/Bax).结果 与S组比较,I/R组、L组和Ep组细胞凋亡指数升高,Bcl-2和Bax表达上调,Bcl-2/Bax升高(P＜0.05);与I/R组和L组比较,Ep组细胞凋亡指数降低,Bcl-2表达上调,Bax表达下调,Bcl-2/Bax升高(P＜ 0.05);I/R组和L组上述指标差异无统计学意义(P＞0.05).Ep组脑组织病理学损伤较I/R组明显减轻.结论 依托咪酯后处理减轻大鼠脑缺血再灌注损伤的机制与调节Bcl-2和Bax的平衡表达,抑制细胞凋亡有关.