Low density lipoprotein metabolism in rats with puromycin aminonucleoside-induced nephrotic syndrome

A scrutiny of circulating microRNA biomarkers for drug-induced tubular and glomerular injury in rats

Drug-induced acute kidney injury (AKI) is a frequent cause of adverse drug reaction. Serum creatinine (CRE) and blood urea nitrogen (BUN) are widely used as standard biomarkers for kidney injury; however, the sensitivity and specificity are considered to be low. In recent years, circulating microRNA (miRNAs) have been attracting considerable attention as novel biomarkers for organ injury, but there are currently no established miRNA biomarkers for drug-induced AKI. The present study aimed to identify plasma miRNAs that may enable early and specific detection of drug-induced tubular and glomerular injury through next-generation sequencing analysis. Six-week old male Sprague-Dawley (SD) rats were intravenously administered cisplatin (CSP, 6 mg/kg) and gentamicin (GEN, 120 mg/kg) to induce tubular injury. To create glomerular injury models, puromycin (PUR, 120 mg/kg) and doxorubicin (DOX, 7.5 mg/kg) were intravenously administered, and these models were always accompanied by tubular damage. Small RNA-sequencing was performed to analyze time-dependent changes in the plasma miRNA profiles. The cluster analyses showed that there were distinct plasma miRNA profiles according to the types of injury, and the changes reflected the progress of renal damages. In the differential analysis, miR-3473 was specifically up-regulated in the glomerular injury models. miR-143-3p and miR-122-5p were commonly down-regulated in all models, and the changes were earlier than the traditional biomarkers, such as plasma CRE and BUN. These data indicated that changes in the specific miRNAs in plasma may enable the early and sensitive detection of tubular and glomerular injuries. The present study suggests the potential utility of plasma miRNAs in the early and type-specific detection of drug-induced AKI.

LDL size and susceptibility to oxidation in experimental nephrosis

The aim of this study was to investigate the relationship between endothelial dysfunction and low density lipoprotein (LDL) size and susceptibility to oxidation in nephrotic rats with or without deficiency of vitamin E and selenium. Four groups of male Wistar rats were studied: control (C), vitamin E and selenium deficient control (DefC), nephrotic (NS), and vitamin E and selenium deficient NS (DefNS). Nephrotic syndrome was induced by puromycin aminonucleoside. The molar ratio of vitamin E/LDL-cholesterol was significantly lower in DefNS, DefC rats, and NS vs. C rats. In comparison with control animals, vasodilation and LDL oxidability were significantly lower in nephrotic animals. LDL size was similar in all groups. Abnormal endothelial function in response to acetylcholine and carbachol was observed in NS animals compared to control rats. Relaxation response was inversely associated with an increase in LDL susceptibility to oxidation and with a lower molar ratio of vitamin E/LDL-c. LDL oxidability and LDL-c were the only variables independently associated with vasodilation. These results suggest that endothelial dysfunction of NS may be a consequence of the increased LDL susceptibility to oxidation, secondary to antioxidant deficiency.

Hepatic cholesterol metabolism in experimental nephrotic syndrome

Hypercholesterolemia is a consistent feature of the nephrotic syndrome. However, the mechanisms underlying this perturbation are unclear. In the present work, we have investigated different factors that influence hepatic cholesterol metabolism using the nephrotic rat as a model. The induction of nephrosis resulted in a severe and sustained hypercholesterolemia. However, no effect on the rate-limiting enzyme in cholesterol synthesis, 3-hydroxy-3-methylglutaryl CoA reductase, could be detected. Further, plasma lathosterol/cholesterol ratio, a measure of cholesterol synthesis, was not altered. Also, plasma levels of mevalonate, both a substrate for cholesterogenesis beyond the rate-limiting step and a marker for cholesterol synthesis, did not differ between control rats and those with established hypercholesterolemia. There was no detectable change in the expression of low density lipoprotein (LDL) receptor between the two experimental groups. We conclude that the early increase in cholesterol synthesis reported after the induction of nephrosis is not necessary for the maintenance of hypercholesterolemia. Established hypercholesterolemia of the nephrotic syndrome seems to represent a steady state in which neither enhanced hepatic cholesterol synthesis nor retarded LDL cholesterol clearance is of major importance.

Dietary antioxidant inhibits lipoprotein oxidation and renal injury in experimental focal segmental glomerulosclerosis

Lipid peroxidation may be involved in the pathogenesis of focal segmental glomerulosclerosis (FSGS). In the present study we examined whether lipid-soluble antioxidants, probucol and vitamin E, could inhibit renal injury in rats with chronic puromycin aminonucleoside (PA) nephrosis and dietary hypercholesterolemia by protecting lipoproteins from oxidation. Male Sprague-Dawley rats received six intraperitoneal injections of PA over a 10 week period and were fed a high cholesterol (HC) diet (PA-HC) or the same diet supplemented with either 1% probucol or vitamin E (100 IU/kg) for 32 weeks. For comparison, a group of rats received PA injections and a normal diet (PA-normal) with or without probucol or vitamin E. Another group rats received saline injections instead of PA and were fed a HC diet (Sal-HC) with or without probucol or vitamin E. At the end of the experiment, proteinuria, FSGS and tubulointerstitial lesions were present in the untreated rats with PA-HC or PA-normal. The magnitude of these lesions was significantly greater in the PA-HC rats than the PA-normal. In contrast to the PA-HC group with hypercholesterolemia, the PA-normal group did not show hypercholesterolemia from week 16 onwards. The rats with PA-HC alone showed significantly higher renal cortical malondialdehyde (MDA) levels and greater susceptibility of plasma very low density lipoprotein (VLDL) + low density lipoprotein (LDL) to the copper-mediated oxidation than the rats with PA-normal or Sal-HC alone. The administration of probucol or vitamin E in the rats with PA-HC significantly reduced the susceptibility of plasma VLDL + LDL to in vitro oxidation, renal cortical MDA level, proteinuria, mesangial volume density and magnitude of FSGS and interstitial lesions. Immunohistochemical staining of renal tissue showed focal segmental distribution of oxidized LDL (Ox-LDL) in the glomeruli of rats with PA-HC. Administration of probucol or vitamin E reduced the intensity of Ox-LDL staining. The staining with ED1 demonstrated that infiltrating glomerular macrophages were significantly more prevalent in the untreated rats with PA-HC than PA-normal or Sal-HC. Treatment with probucol or vitamin E significantly reduced the number of glomerular macrophages in the rats with PA-HC. These results suggest that alimentary hypercholesterolemia aggravates the renal damage in association with increased renal lipid peroxides in chronic PA nephrosis, and that dietary probucol or vitamin E attenuates renal injury in rats with PA-HC possibly by making lipoproteins resistant to oxidation and by inhibiting intraglomerular macrophage infiltration.

Lipoprotein phospholipid composition and LCAT activity in nephrotic and analbuminemic rats

Albumin is an acceptor of lysophosphatidylcholine (LPC), product of the lecithin:cholesterol acyl transferase (LCAT) reaction, and it has been suggested that low LCAT activity and reduced cholesterol esterification rate in patients with the nephrotic syndrome may be linked to depletion of albumin. Effects of low plasma albumin levels on LCAT activity, cholesterol esterification rates and LPC-binding were therefore studied in hyperlipidemic nephrotic (NS) and analbuminemic (NAR) rats. LPC-binding was also measured in normoalbuminemic rats with dietary hypercholesterolemia. Remarkably, LCAT activity, measured with excess exogenous substrate, was not decreased but increased in both NAR and NS rats. Molar esterification rates with endogenous substrate were increased in NAR but normal in NS rats. In normoalbuminemic rats, with or without hypercholesterolemia, LPC was primarily found in the lipoprotein-deficient plasma and the HDL3 fraction. In NAR and NS rats LPC levels were increased in lipoproteins (notably in LDL and HDL2), but, in marked contrast to normoalbuminemic rats, decreased in lipoprotein-deficient plasma. Phosphatidylcholine, quantitatively the major phospholipid, was distributed proportionally over the lipoproteins in NS, NAR and control rats. Therefore, in hypoalbuminemia and analbuminemia LPC is mainly bound to lipoproteins, which is in contrast to the paucity of LPC in these particles in normoalbuminemic rats. Cholesterol esterification in nephrotic plasma is thus not impaired by lack of an acceptor for LPC-binding. The absence of an increase in molar cholesterol esterification in conjunction with increased LCAT activity points to a possible defect of the substrate for this reaction in nephrotic plasma. Increased LPC levels in LDL, a characteristic of oxidized LDL, may be a hitherto unrecognized atherosclerotic risk factor in the nephrotic syndrome.

Receptor-mediated uptake of IDL and LDL from nephrotic patients by glomerular epithelial cells

Although hyperlipidemia is a well-recognized complication of the nephrotic syndrome, the precise interaction of human glomerular cells and human lipoproteins, abnormal in lipid and protein composition, has not been clearly defined. This study examines receptor mediated binding, internalization and degradation as well as intracellular cholesterol metabolism of apoB-100 containing LDL and apoB,E containing IDL, isolated from patients with the nephrotic syndrome (N = 6), in human glomerular epithelial cells and skin fibroblasts. In the patients, serum LDL cholesterol level was increased threefold and IDL elevenfold as compared to healthy subjects. IDL of nephrotic patients contained 72% more cholesterol than IDL of healthy controls. No difference in lipid/protein composition was found in the LDL density range. Therefore, nephrotic and control LDL showed identical affinities for receptor mediated binding, internalization and degradation. Furthermore, inhibition of intracellular sterol synthesis and cholesteryl ester formation after incubation with LDL was comparable. In contrast, cholesterol-rich IDL of nephrotic patients was taken up by glomerular epithelial cells with higher affinity than LDL and control IDL, as well as intracellular sterol synthesis was suppressed more effectively than by control IDL. The cholesterol esterification rate of IDL from patients was enhanced 3.5-fold as compared to control IDL. In comparison to fibroblasts, glomerular epithelial cells showed about 15% of the maximal capacity for LDL uptake, but 31% for IDL from nephrotic patients. The data indicate that hypercholesterolemia of nephrotic origin cannot be explained by reduced ligand binding for LDL. ApoE containing IDL, which accumulate in nephrotic patients, were avidly taken up by glomerular epithelial cells via receptor dependent pathway. These lipoproteins could therefore play the predominant role in glomerular lipid accumulation and development of glomerulosclerosis.

Compensatory increase in intestinal apolipoprotein A-IV mRNA levels in the experimental nephrotic rat

Using experimental nephrotic rats, we investigated the potential feedback regulation of apolipoproteins (apos) at their hepatic and intestinal synthetic sites. Nephrotic syndrome (NS) was induced in rats by puromycin aminonucleoside (PAN) with a single intraperitoneal injection (120 mg/kg). In nephrotic rats, we observed a 60% reduction in serum apo A-IV levels despite a 3.4-fold increase in jejunum and a 1.5-fold increase in ileum apo A-IV mRNA levels, although hepatic apo A-IV levels were unchanged compared with those in pair-fed control rats. A strikingly positive correlation was observed between daily urinary excretion of apo A-IV and its mRNA levels in jejunum (r = .856, P < .01; n = 10) and ileum (r = .710, P < .05; n = 10). On the other hand, nephrotic rats had an 8.2-fold increase in serum apo A-I level associated with a 4.6-fold increase in hepatic and a small but significant increase in jejunum apo A-I mRNA levels. Compared with the fractional catabolic loss of albumin or apo A-IV, that of apo A-I was small and suggests a diminished level of glomerular filtration, leading to a further elevation in serum apo A-I level. Barring nonspecific effects of PAN, these data suggest that reduction of serum apo A-IV level due to urinary loss may directly upregulate mRNA levels in the small intestine. Alternatively, it may be the result of an effective filtration of a serum component unassociated with lipoproteins that normally and site-specifically reduces apo A-I and apo A-IV mRNA transcription.

Abnormalities of lipoprotein metabolism in patients with the nephrotic syndrome

BACKGROUND AND METHODS

Patients with the nephrotic syndrome characteristically have multiple abnormalities of lipoprotein metabolism, but the cause and exact nature of these abnormalities are uncertain. In this study, we measured serum lipids and apoproteins in 57 patients with the nephrotic syndrome. We also determined the kinetic indexes of low-density lipoprotein (LDL) metabolism in six patients, and again in three of the six after recovery.

RESULTS

The patients with the nephrotic syndrome had elevated serum concentrations of cholesterol, triglycerides, and phospholipids, which were confined to the lipoproteins containing apoprotein B. The serum concentrations of high-density lipoproteins and the associated A-I and A-II apoproteins were similar in the patients with the nephrotic syndrome and normal subjects. The relative proportions of lipids and their positive association with the increased serum concentrations of apoproteins B, C-II, C-III, and E suggest quantitative rather than qualitative differences in the lipoproteins. All the patients had lipiduria, which probably reflected the excretion of high-density lipoproteins, although no intact immunoreactive apoprotein A-I was found in urine. Serum albumin concentrations were inversely related to serum lipid concentrations in the patients, the severity of the hypoalbuminemia corresponding to the degree of change in serum lipoprotein concentrations. The kinetic studies of lipoprotein metabolism revealed an overproduction of LDL apoprotein B that returned to normal after recovery.

CONCLUSIONS

The elevated serum concentrations of LDL cholesterol, other lipids, and apoprotein B in patients with uncomplicated nephrotic syndrome are due to reversible increases in lipoprotein production.