Hypoxia-inducible factor signaling in the development of tissue fibrosis

Metallothionein: a new soldier in the fight against chronic renal hypoxia?

Sustained hypoxia appears to be an early and pivotal condition in the pathogenesis of chronic kidney disease, and may induce a number of adaptive/protective or harmful cellular responses. Kojima and colleagues found an upregulation of metallothioneins (MTs) among dozens of altered expression patterns. They demonstrated the astonishing properties of MTs within major intracellular signaling pathways beyond their notorious functions in heavy metal metabolism, detoxification, and ROS scavenging-HRE stimulation during normoxia and hypoxia together with ERK phosphorylation and mTOR activation.

Adipocyte metabolism and obesity

Adipose tissue metabolism exerts a profound impact on whole-body metabolism. We review how fuel partitioning between adipocytes and other tissues affects insulin signaling pathways. We discuss the role of adipose tissue inflammation in adipocyte metabolism and whole-body insulin sensitivity. Finally, we mention the role of adipokines in autocrine and paracrine signaling.

The adipocyte as an endocrine cell

Adipose tissue contains many cell types. Among the more abundant are adipocytes, preadipocytes, immune cells, and endothelial cells. During times of excess caloric intake, these cells have to adjust and remodel to accommodate the increased demand for triglyceride storage. Based on a comprehensive analysis of the total adipose tissue secretome, this article focuses on three areas of adipokine biology: (1) How does the adipocyte interact with the extracellular matrix over the course of obesity? (2) Does the adipocyte, per se, play a role in the innate immune response? (3) How is the angiogenic profile of adipose tissue linked to the development of insulin resistance? The authors present a comprehensive overview of all of the currently available secreted adipose tissue products that have been identified at the protein level.

EMT and proteinuria as progression factors

Tubulointerstitial fibrosis is an integral part of the structural changes of the kidney in chronic progressive renal failure. The accumulation of the extracellular matrix in the tubulointerstitial space is mediated mainly by myofibroblasts. These are derived from resident interstitial fibroblasts, tubular epithelial cells, periadventitial cells, and possibly also mesenchymal stem cells and endothelial cells. Fibrosis is usually preceded by tubulointerstitial infiltration of mononuclear inflammatory cells. Proteinuria is one of several mechanisms of primary glomerular or vascular disease to transmit the disease process to the interstitial space. Increased protein filtration may have direct toxic effects on tubular epithelial cells, induce chemokine and cytokine secretion and result in increased expression of adhesion molecules, all contributing to the influx of mononuclear cells. Inflammatory cells in return secrete cytokines, which stimulate resident fibroblasts and tubular epithelial cells to differentiate into matrix-producing cells. The phenotypic conversion of primary epithelial cells into mesenchymal cells, termed epithelial-mesenchymal transition (EMT), has been studied in great detail in recent years. Several signal transduction pathways of this process have been clarified and may eventually result in novel therapeutic approaches. The severity of proteinuria and the extent of EMT have both been associated with the decline in renal function in clinical studies. Limiting proteinuria results in a slower decline of renal function deterioration, whereas reducing EMT has had beneficial effects in a number of animal studies, including those indicating reversal of fibrotic lesions. However, the association between proteinuria and EMT and vice versa is far from clear and has not been carefully studied.