Inhibition of cytochrome P450 2E1 and activation of transcription factor Nrf2 are renoprotective in myoglobinuric acute kidney injury.
Rhabdomyolysis accounts for ∼10% of acute kidney injuries. In glycerol-induced myoglobinuric acute kidney injury, we found an increase in the nuclear factor erythroid 2-related factor 2 (Nrf2) nuclear protein, a key redox-sensitive transcription factor, and Nrf2-regulated genes and proteins including upregulation of heme oxygenase-1. In in vitro studies, pretreatment of LLC-PK1 cells with an activator of Nrf2 before myoglobin exposure significantly decreased oxidant generation and cytotoxicity, whereas Nrf2 inhibition and gene silencing exacerbated the injury. Chlormethiazole, a specific CYP2E1 transcription inhibitor, prevented an increase in catalytic iron in the kidneys, decreased oxidative stress, blocked nuclear translocation of the Nrf2 protein, decreased heme oxygenase-1 upregulation, and provided functional and histological protection against acute kidney injury. CYP2E1 inhibitors and gene silencing in renal tubular epithelial cells significantly decreased reactive oxygen species generation and provided marked protection against myoglobin-induced cytotoxicity. Thus, during CYP2E1-induced oxidative stress, the transcription factor Nrf2 has a pivotal role in the early adaptive response. Inhibition of CYP2E1 coupled with the prior induction of Nrf2 may be a valuable tool to reduce CYP2E1-mediated rhabdomyolysis-induced acute kidney injury.
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Zhe
Z
Wang
1] Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA [2] Renal Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA.
Sudhir V
SV
Shah
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Hua
H
Liu
Department of Pediatrics, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
Radhakrishna
R
Baliga
D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control*; D000818:Animals; D002719:Chlormethiazole / Q000494:pharmacology; D019392:Cytochrome P-450 CYP2E1 / Q000172:deficiency / Q000235:genetics / Q000378:metabolism; D065691:Cytochrome P-450 CYP2E1 Inhibitors / Q000494:pharmacology*; D055785:Gene Knockdown Techniques; D005990:Glycerol / Q000633:toxicity; D006419:Heme Oxygenase (Decyclizing) / Q000235:genetics / Q000378:metabolism; D018374:LLC-PK1 Cells; D008297:Male; D009212:Myoglobinuria / Q000150:complications* / Q000378:metabolism*; D051267:NF-E2-Related Factor 2 / Q000037:antagonists & inhibitors / Q000235:genetics / Q000378:metabolism*; D018384:Oxidative Stress; D051381:Rats; D017207:Rats, Sprague-Dawley; D017382:Reactive Oxygen Species / Q000378:metabolism; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000378:metabolism; D013552:Swine; D015854:Up-Regulation / Q000187:drug effects
D065691:Cytochrome P-450 CYP2E1 Inhibitors; D051267:NF-E2-Related Factor 2; C495637:Nfe2l2 protein, rat; D017382:Reactive Oxygen Species; D002719:Chlormethiazole; D019392:Cytochrome P-450 CYP2E1; D006419:Heme Oxygenase (Decyclizing); C491523:Hmox1 protein, rat; D005990:Glycerol