title: Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase.
abstract: The pathophysiology of sepsis involves complex cytokine and inflammatory mediator networks, a mechanism to which NF-κB activation is central. Downregulation of endothelial nitric oxide synthase (eNOS) contributes to sepsis-induced endothelial dysfunction. Erythropoietin (EPO) has emerged as a major tissue-protective cytokine in the setting of stress. We investigated the role of EPO in sepsis-related acute kidney injury using a cecal ligation and puncture (CLP) model. Wistar rats were divided into three primary groups: control (sham-operated); CLP; and CLP+EPO. EPO (4,000 IU/kg body wt ip) was administered 24 and 1 h before CLP. Another group of rats received N-nitro-l-arginine methyl ester (l-NAME) simultaneously with EPO administration (CLP+EPO+l-NAME). A fifth group (CLP+EPOtreat) received EPO at 1 and 4 h after CLP. At 48 h postprocedure, CLP+EPO rats presented significantly higher inulin clearance than did CLP and CLP+EPO+l-NAME rats; hematocrit levels, mean arterial pressure, and metabolic balance remained unchanged in the CLP+EPO rats; and inulin clearance was significantly higher in CLP+EPOtreat rats than in CLP rats. At 48 h after CLP, creatinine clearance was significantly higher in the CLP+EPO rats than in the CLP rats. In renal tissue, pre-CLP EPO administration prevented the sepsis-induced increase in macrophage infiltration, as well as preserving eNOS expression, EPO receptor (EpoR) expression, IKK-α activation, NF-κB activation, and inflammatory cytokine levels, thereby increasing survival. We conclude that this protection, which appears to be dependent on EpoR activation and on eNOS expression, is attributable, in part, to inhibition of the inflammatory response via NF-κB downregulation.
authors.affiliation: Nephrology Dept., Univ. of São Paulo School of Medicine, Av. Dr. Arnaldo 455, São Paulo, Brazil. luciacan@usp.br.
authors.forename: Ana Carolina C Pessoa de
authors.initials: AC
authors.lastname: Souza
authors.forename: Rildo A
authors.initials: RA
authors.lastname: Volpini
authors.forename: Maria Heloísa
authors.initials: MH
authors.lastname: Shimizu
authors.forename: Talita Rojas
authors.initials: TR
authors.lastname: Sanches
authors.forename: Niels Olsen Saraiva
authors.initials: NO
authors.lastname: Camara
authors.forename: Patrícia
authors.initials: P
authors.lastname: Semedo
authors.forename: Camila Eleutério
authors.initials: CE
authors.lastname: Rodrigues
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Seguro
authors.forename: Lúcia
authors.initials: L
authors.lastname: Andrade
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control*; D000818:Animals; D003404:Creatinine / Q000652:urine; D016207:Cytokines / Q000032:analysis; D015536:Down-Regulation; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000494:pharmacology; D004921:Erythropoietin / Q000037:antagonists & inhibitors*; D051550:I-kappa B Kinase / Q000378:metabolism; D007249:Inflammation / Q000378:metabolism; D007444:Inulin / Q000652:urine; D008297:Male; D016328:NF-kappa B / Q000096:biosynthesis*; D019331:NG-Nitroarginine Methyl Ester / Q000494:pharmacology; D052250:Nitric Oxide Synthase Type III / Q000096:biosynthesis*; D051381:Rats; D017208:Rats, Wistar; D017467:Receptors, Erythropoietin / Q000096:biosynthesis; D018805:Sepsis / Q000188:drug therapy* / Q000378:metabolism; D015854:Up-Regulation
chemical_list: D016207:Cytokines; D004791:Enzyme Inhibitors; D016328:NF-kappa B; D017467:Receptors, Erythropoietin; D004921:Erythropoietin; D007444:Inulin; D003404:Creatinine; D052250:Nitric Oxide Synthase Type III; D051550:I-kappa B Kinase; D019331:NG-Nitroarginine Methyl Ester