过度内质网应激在慢性环孢素A肾毒性细胞凋亡中的作用机制*

 目的：探讨过度内质网应激在慢性环孢素A(CsA)肾毒性细胞凋亡中的作用机制。方法：将Sprague-Dawley大鼠分为正常对照组和慢性CsA肾毒性组，分别给予皮下注射橄榄油(1 mg·kg-1·d-1)和CsA (15 mg·kg-1·d-1)1周或4周后处死大鼠。三色染色和TUNEL染色观察肾小管间质纤维化和细胞凋亡；免疫组织化学染色和免疫印迹检测免疫球蛋白结合蛋白(BiP)、 磷酸化的真核细胞翻译起始因子2α(eIF2α)、 生长阻滞及DNA损伤诱导蛋白153(GADD153)、caspase-12和caspase-3蛋白表达。结果：CsA注射1周观察不到肾小管间质纤维化和TUNEL阳性细胞，而给予CsA注射4周大鼠表现为明显的肾小管间质纤维化［(38.9±3.3)% vs (0.0±0.0)%, P<0.01］和大量TUNEL阳性细胞 ［(89±9)% vs (7±2)%, P<0.01］。与对照组比较，CsA组BiP和caspase-12蛋白的表达于1周达到高峰，4周后降至正常水平；反之，eIF2α和caspase-3蛋白表达呈时间依赖性增加。结论：在慢性CsA肾毒性中，过度的内质网应激耗尽分子伴侣，激活凋亡途径，从而导致肾小管上皮细胞凋亡和肾小管间质损伤。

Excessive endoplasmic reticulum stress induces apoptotic cell death in chronic cyclosporine A nephrotoxicity

AIM：To investigate the impact of excessive endoplasmic reticulum stress on apoptotic cell death in a rat model of chronic cyclosporine A (CsA) nephrotoxicity. METHODS：Male Sprague-Dawley rats on a low-salt diet were subcutaneously injected with vehicle (olive oil, 1 mL·kg-1·d-1) or CsA (15 mg/kg) daily for 1 or 4 weeks. Tubulointerstitial fibrosis and apoptotic cell death were estimated by trichrome staining and TUNEL staining. In addition, immunohistochemistry and immunoblotting were used to evaluate the expression of immunoglobulin-binding protein (BiP), eukaryotic initiation factor 2α (eIF2α), growth arrest and DNA damage-inducible protein 153 (GADD153), caspase-12 and caspase-3. RESULTS：The rats treated with CsA for 1 week did not develop tubulointerstitial fibrosis and TUNEL-positive cells, whereas 4-week treatment with CsA induced typical tubulointerstitial fibrosis and increased TUNEL-positive cells. CsA induced a significant increase in BiP and caspase-12 expression peaked at 1 week, and then returned to normal levels at 4 weeks. In contrast, the expression of eIF2α, GADD153 and caspase-3 in CsA-treated rat kidneys were significantly increased in a time-dependent manner. CONCLUSION：Excessive endoplasmic reticulum stress causes apoptotic cell death by depleting molecular chaperones and stimulating the proapoptotic pathway in chronic CsA nephrotoxicity.