All-Trans Retinoic Acid Has a Potential Therapeutic Role for Diabetic Nephropathy

Single-cell RNA sequencing data locate ALDH1A2-mediated retinoic acid synthetic pathway to glomerular parietal epithelial cells

Aldehyde dehydrogenase 1, family member A2, is a retinoic acid-synthesizing enzyme encoded by Aldh1a2 in mice and ALDH1A2 in humans. This enzyme is indispensable for kidney development, but its role in kidney physiology and pathophysiology remains to be fully defined. In this review, we mined single-cell and single-nucleus RNA sequencing databases of mouse and human kidneys and found that glomerular parietal epithelial cells (PECs) express a full set of genes encoding proteins needed for cellular vitamin A uptake, intracellular transport, and metabolism into retinoic acid. In particular, Aldh1a2/ALDH1A2 mRNAs are selectively enriched in mouse and human PECs. Aldh1a2 expression in PECs is greatly increased in a mouse model of anti-glomerular basement membrane glomerulonephritis and moderately induced in a mouse model of ischemia-reperfusion acute kidney injury. Aldh1a2 expression in PECs is substantially repressed in a chronic kidney disease mouse model combining diabetes, hypertension, and partial nephrectomy and is moderately repressed in mouse models of focal segmental glomerulosclerosis and diabetic nephropathy. Single-nucleus RNA sequencing data show that ALDH1A2 mRNA expression in PECs is diminished in patients with chronic kidney disease associated with diabetes, hypertension and polycystic kidney disease. In addition to data mining, we also performed Spearman's rank correlation coefficient analyses and identified gene transcripts correlated with Aldh1a2/ALDH1A2 transcripts in mouse PECs and PEC subtypes, and in human PECs of healthy subjects and patients with AKI or CKD. Furthermore, we conducted Gene Ontology pathway analyses and identified the biological pathways enriched among these Aldh1a2/ALDH1A2-correlated genes. Our data mining and analyses led us to hypothesize that ALDH1A2-mediated retinoic acid synthesis in PECs plays a yet-undefined role in the kidney and that its dysregulation mediates injury. Conditional, PEC-selective Aldh1a2 knockout, RNA silencing and transgenic mouse models will be useful tools to test this hypothesis. Clinical studies on genetics, epigenetics, expression and functions of ALDH1A2 and other genes needed for retinoic acid biosynthesis and signaling are also warranted.

A New Prospect for the Treatment of Nephrotic Syndrome Based on Network Pharmacology Analysis

Network pharmacology is an emerging field which is currently capturing interest in drug discovery and development. Chronic kidney conditions have become a threat globally due to its associated lifelong therapies. Nephrotic syndrome (NS) is a common glomerular disease that is seen in paediatric and adult population with characteristic manifestation of proteinuria, oedema, hypoalbuminemia, and hyperlipidemia. It involves podocyte damage with tubulointerstitial fibrosis and glomerulosclerosis. Till date there has been no specific treatment available for this condition that provides complete remission. Repurposing of drugs can thus be a potential strategy for the treatment of NS. Recently, epigenetic mechanisms were identified that promote progression of many renal diseases. Therefore, in the present study, we investigated two epigenetic drugs valproic acid (VPA) and all-trans retinoic acid (ATRA). Epigenetic drugs act by binging about changes in gene expression without altering the DNA sequence. The changes include DNA methylation or histone modifications. The targets for the two drugs ATRA and VPA were collated from ChEMBL and Binding DB. All the genes associated with NS were collected from DisGeNET and KEGG database. Interacting proteins for the target genes were acquired from STRING database. The genes were then subjected to gene ontology and pathway enrichment analysis using a functional enrichment software tool. A drug-target and drug-potential target-protein interaction network was constructed using the Cytoscape software. Our results revealed that the two drugs VPA and ATRA had 65 common targets that contributed to kidney diseases. Out of which, 25 targets were specifically NS associated. Further, our work exhibited that ATRA and VPA were synergistically involved in pathways of inflammation, renal fibrosis, glomerulosclerosis and possibly mitochondrial biogenesis and endoplasmic reticulum stress. We thus propose a synergistic potential of the two drugs for treating chronic kidney diseases, specifically NS. The outcomes will undoubtedly invigorate further preclinical and clinical explorative studies. We identify network pharmacology as an initial inherent approach in identifying drug candidates for repurposing and synergism.

Vitamin A and Diabetes

Recently, research data have shown that vitamin A (VA, retinol) as a micronutrient participates in the regulation of glucose and lipid metabolism. Since diabetes is a metabolic disease, it is imperative to reveal the relationship of VA and diabetes. This review was aimed to summarize the current understanding of VA and its metabolites in diabetes. Since April of 2020, the authors have searched the PubMed using key words and retrieved articles that focused on diabetes and VA or its metabolites. Based on the published data, it appears that the development of type 1 diabetes leads to reduction of blood VA level in human and animals, and increase of hepatic VA store in experimental animals. On the other hand, the mutual impacts of type 2 diabetes and VA intake and blood VA level on each other appear to be uncertain. Retinoic acid, the active metabolite of VA, has been studied extensively for the treatment of diabetic complications. The current data appear to indicate that the development of diabetes is associated with changes of VA metabolism. More carefully designed clinical and laboratory experiments are needed to reveal the impacts of diabetes on VA metabolism and the role of VA in the development and treatment of diabetes.

Effects of ATRA on diabetic rats with renal ischemia-reperfusion injury

Purpose

To explore the role of all-trans retinoic acid (ATRA) in renal ischemia/reperfusion injury of diabetic rats.

Methods

Sixty adult male rats were randomly divided into 6 groups, including sham group (S group), ischemia-reperfusion group (I/R group), ischemia-reperfusion+ATRA group (A group), diabetic group (D group), diabetic ischemia-reperfusion group (DI/R group), diabetic ischemia-reperfusion +ATRA group (DA group). The levels of creatinine (Cr), cystatin C (Cys-C) and β2-microglobulin (β2-MG) were measured. Morphology of renal tissue was observed under light microscope.

Results

DJ-1, Nrf2, HO-1 and caspase-3 were detected by western blot. DJ-1, Nrf2, HO-1 and caspase-3 in I/R group, D group and DI/R group was higher than that in S group. Compared with I/R group, Nrf2 and HO-1 in A group was decreased, but caspase-3 was increased. However, Nrf2 in DA group was higher than that in DI/R group, HO-1 and caspase-3 in DA group were lower than that in DI/R group. Compared with group S, Cr, Cys-C and β2-MG in I/R group, A group, D group, and DI/R group were higher. Whereas the levels of Cr, Cys-C, β2-MG and renal injury score in DA group were lower than those in DI/R group.

Conclusion

ATRA has a protective effect on renal ischemia-reperfusion injury in diabetic rats, maybe relating to DJ/Nrf2 pathway.

All-trans retinoic acid prevents cisplatin-induced nephrotoxicity in rats

The aim of this study is to investigate the effects of all-trans retinoic acid (ATRA) use on cisplatin (CP)-induced nephrotoxicty. Twenty-eight rats were randomly divided into four groups. The rats in the control group were injected a single dose of 1 ml/kg saline intra-peritoneally (IP) during 10 days. The rats in the ATRA group were injected a single dose of ATRA during 10 days. The rats in the ATRA+CP group were injected a single dose of CP on the fourth day of the 10 days of ATRA treatment. The rats in the CP group were injected a single dose of CP on the fourth day of 10 days without administering a treatment. After treatment, the groups were compared with regard to total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels in renal tissue and renal histopathology. The serum creatinine and urea values were statistically significantly higher in the CP group compared to the other groups. The serum creatinine and urea values were statistically significantly lower in the ATRA+CP group when compared to the CP group. Although the TOS and OSI levels were found to be lower in the ATRA+CP group compared to the CP group, the difference was not statistically significant. Administration of ATRA together with CP was observed to reduce the histopathologic destruction in the kidney and lead to mild tubular degeneration, vacuolization, and necrosis (57.1% grade 1; 28.6% grade2, and 14.3% grade 3 necrosis). The results of the present study have revealed that ATRA administration ameliorates CP-induced nephrotoxicity; however, further studies are required to identify this issue before clinical application.

Amelioration of Diabetic Nephropathy Using a Retinoic Acid Receptor β2 Agonist

Vitamin A (VA) and its derivatives, known as retinoids, play critical roles in renal development through retinoic acid receptor β2 (RARβ2). Disruptions in VA signaling pathways are associated with the onset of diabetic nephropathy (DN). Despite the known role of RARβ2 in renal development, the effects of selective agonists for RARβ2 in a high-fat diet (HFD) model of DN are unknown. Here we examined whether AC261066 (AC261), a highly selective agonist for RARβ2, exhibited therapeutic effects in a HFD model of DN in C57BL/6 mice. Twelve weeks of AC261 administration to HFD-fed mice was well tolerated with no observable side effects. Compared with HFD-fed mice, HFD + AC261-treated mice had improved glycemic control and reductions in proteinuria and urine albumin-to-creatinine ratio. Several cellular hallmarks of DN were mitigated in HFD + AC261-treated mice, including reductions in tubule lipid droplets, podocyte (POD) effacement, endothelial cell collapse, mesangial expansion, and glomerular basement membrane thickening. Mesangial and tubule interstitial expression of the myofibroblast markers α-smooth muscle actin (α-SMA) and type IV collagen (Col-IV) was lower in HFD + AC261-treated mice compared with HFD alone. Ultrastructural and immunohistochemistry analyses showed that, compared with HFD-fed mice, HFD + AC261-treated mice showed preservation of POD foot process and slit-diaphragm morphology, an increase in the levels of slit-diagram protein podocin, and the transcription factor Wilms tumor-suppressor gene 1 in PODs. Given the need for novel DN therapies, our results warrant further studies of the therapeutic properties of AC261 in DN.