title: The potential of alkaline phosphatase as a treatment for sepsis-associated acute kidney injury.
abstract: Sepsis-associated acute kidney injury (AKI) is associated with a high attributable mortality and an increased risk of developing chronic kidney failure in survivors. As a successful therapy is, as yet, unavailable, a pharmacological treatment option is clearly warranted. Recently, two small phase II clinical trials demonstrated beneficial renal effects of bovine-derived alkaline phosphatase administration in critically ill patients with sepsis-associated AKI. The rationale behind the renal protective effects remains to be fully elucidated, but is likely to be related to dephosphorylation and thereby detoxification of detrimental molecules involved in the pathogenesis of sepsis-associated AKI. A potent candidate target molecule might be endotoxin (lipopolysaccharide) from the cell wall of Gram-negative bacteria, which is associated with the development of sepsis and becomes nontoxic after being dephosphorylated by alkaline phosphatase. Another target of alkaline phosphatase could be adenosine triphosphate, a proinflammatory mediator released during cellular stress, which can be converted by alkaline phosphatase into the tissue-protective and anti-inflammatory molecule adenosine. Human recombinant alkaline phosphatase, a recently developed replacement for bovine-derived alkaline phosphatase, has shown promising results in the preclinical phase. As its safety and tolerability were recently confirmed in a phase I clinical trial, the renal protective effect of human recombinant alkaline phosphatase in sepsis-associated AKI shall be investigated in a multicenter phase II clinical trial starting at the end of this year.
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Peters
authors.forename: Rosalinde
authors.initials: R
authors.lastname: Masereeuw
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology; D000241:Adenosine / Q000627:therapeutic use; D000255:Adenosine Triphosphate / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D002417:Cattle; D017322:Clinical Trials, Phase II as Topic; D016638:Critical Illness; D004353:Drug Evaluation, Preclinical; D019446:Endotoxemia / Q000150:complications / Q000188:drug therapy; D005544:Forecasting; D006801:Humans; D007422:Intestines / Q000201:enzymology; D015337:Multicenter Studies as Topic; D018047:Receptors, Purinergic P1 / Q000172:deficiency / Q000187:drug effects / Q000502:physiology; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy
chemical_list: D018047:Receptors, Purinergic P1; D011993:Recombinant Fusion Proteins; D000255:Adenosine Triphosphate; D000469:Alkaline Phosphatase; D000241:Adenosine