title: Bardoxolone methyl decreases megalin and activates nrf2 in the kidney.
abstract: Inflammation and oxidative stress are hallmarks and mediators of the progression of CKD. Bardoxolone methyl, a potent activator of the nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated antioxidant and anti-inflammatory response, increases estimated GFR and decreases BUN, serum phosphorus, and uric acid concentrations in patients with moderate to severe CKD. However, it also increases albuminuria, which is associated with inflammation and disease progression. Therefore, we investigated whether this bardoxolone methyl-induced albuminuria may result from the downregulation of megalin, a protein involved in the tubular reabsorption of albumin and lipid-bound proteins. Administration of bardoxolone methyl to cynomolgus monkeys significantly decreased the protein expression of renal tubular megalin, which inversely correlated with the urine albumin-to-creatinine ratio. Moreover, daily oral administration of bardoxolone methyl to monkeys for 1 year did not lead to any adverse effects on renal histopathologic findings but did reduce serum creatinine and BUN, as observed in patients with CKD. Finally, the bardoxolone methyl-induced decrease in megalin corresponded with pharmacologic induction of renal Nrf2 targets, including NAD(P)H:quinone oxidoreductase 1 enzyme activity and glutathione content. This result indicates that Nrf2 may have a role in megalin regulation. In conclusion, these data suggest that the increase in albuminuria that accompanies bardoxolone methyl administration may result, at least in part, from reduced expression of megalin, which seems to occur without adverse effects and with strong induction of Nrf2 targets.
authors.affiliation: Reata Pharmaceuticals Inc., 2801 Gateway Drive, Irving, TX 75063, USA. scott.reisman@reatapharma.com
authors.forename: Scott A
authors.initials: SA
authors.lastname: Reisman
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Hebbar
authors.forename: Nosratola D
authors.initials: ND
authors.lastname: Vaziri
authors.forename: Keith W
authors.initials: KW
authors.lastname: Ward
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Meyer
mesh_terms: D000419:Albuminuria / Q000209:etiology / Q000378:metabolism; D000818:Animals; D000975:Antioxidants / Q000009:adverse effects / Q000494:pharmacology; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005980:Glutathione Reductase / Q000235:genetics; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism*; D026561:Low Density Lipoprotein Receptor-Related Protein-2 / Q000378:metabolism*; D008252:Macaca fascicularis; D008297:Male; D016660:NAD(P)H Dehydrogenase (Quinone) / Q000235:genetics / Q000378:metabolism; D051267:NF-E2-Related Factor 2 / Q000378:metabolism*; D009828:Oleanolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D011956:Receptors, Cell Surface / Q000378:metabolism; D015854:Up-Regulation / Q000187:drug effects
chemical_list: D000975:Antioxidants; D026561:Low Density Lipoprotein Receptor-Related Protein-2; D051267:NF-E2-Related Factor 2; D012333:RNA, Messenger; D011956:Receptors, Cell Surface; C029486:intrinsic factor-cobalamin receptor; D009828:Oleanolic Acid; D003404:Creatinine; C445068:bardoxolone methyl; D016660:NAD(P)H Dehydrogenase (Quinone); D005980:Glutathione Reductase