Increased density of renal amylin binding sites in experimental hypertension

The association between renal accumulation of pancreatic amyloid-forming amylin and renal hypoxia

Chronic kidney disease (CKD) is increasing worldwide and is associated with diabetic states (obesity, prediabetes and type-2 diabetes mellitus). The kidney is intrinsically susceptible to low oxygen (hypoxia) and renal hypoxia plays a vital role in the progression of CKD. Recent studies suggest an association between CKD and renal deposition of amyloid-forming amylin secreted from the pancreas. Renal accumulation of amyloid-forming amylin is associated with hypertension, mitochondrial dysfunction, increased production of reactive oxygen species (ROS) and activation of hypoxia signaling in the kidney. In this review we will discuss potential associations between renal amylin amyloid accumulation, hypertension, and mechanism of hypoxia-induced kidney dysfunction, including activation of hypoxia-inducible factors (HIFs) and mitochondrial dysfunction.

Amylin: Pharmacology, Physiology, and Clinical Potential

Amylin is a pancreatic β-cell hormone that produces effects in several different organ systems. Here, we review the literature in rodents and in humans on amylin research since its discovery as a hormone about 25 years ago. Amylin is a 37-amino-acid peptide that activates its specific receptors, which are multisubunit G protein-coupled receptors resulting from the coexpression of a core receptor protein with receptor activity-modifying proteins, resulting in multiple receptor subtypes. Amylin's major role is as a glucoregulatory hormone, and it is an important regulator of energy metabolism in health and disease. Other amylin actions have also been reported, such as on the cardiovascular system or on bone. Amylin acts principally in the circumventricular organs of the central nervous system and functionally interacts with other metabolically active hormones such as cholecystokinin, leptin, and estradiol. The amylin-based peptide, pramlintide, is used clinically to treat type 1 and type 2 diabetes. Clinical studies in obesity have shown that amylin agonists could also be useful for weight loss, especially in combination with other agents.

Amylin deposition in the kidney of patients with diabetic nephropathy

Amylin (islet amyloid peptide) plays a critical role in islet amyloidosis and in the development of beta-cell dysfunction in patients with diabetes; however, the involvement of amylin in renal amyloidosis has not been studied. For this reason, we surveyed 149 patients with biopsy-proven diabetic nephropathy (DN). The results were compared to 95 renal disease control patients, which included membranoproliferative glomerulonephritis, light-chain deposition, IgA nephropathy, and obesity-related glomerulopathy (ORG). Seventy-two of the 149 patients with DN showed amylin deposition in their renal tissue. Amylin was mainly distributed in the expanded mesangial area, Kimmelstiel-Wilson nodules, Bowman's capsule, and in blood vessels. The frequencies of mesangial proliferation, glomerular nodule lesions, and glomerular sclerosis were higher in DN patients with amylin deposits. Furthermore, the tubular interstitial lesions were more severe in these patients. Of the 95 disease-control patients, four with ORG were positive for renal amylin deposits. Our study has found renal amylin deposition in patients with DN and that the deposition was associated with disease severity. We suggest that strict metabolic control and reversing insulin resistance in patients with diabetes may blunt the process of amylin deposition in the kidney and possibly protect renal function in these patients.

Renal Effects

Amylin bound to kidney cortex in a distinctive pattern. Binding appeared specific in that it was displaceable with amylin antagonists. It was associated with activation of cyclic AMP (cAMP), and was thereby likely to represent receptor binding and activation. Amylin's principal effects at the kidney included a stimulation of plasma renin activity, reflected in aldosterone increases at quasi-physiological amylin concentrations. It was unclear whether this was a local or a systemic effect. Other renal effects in rats included a diuretic effect and a natriuretic effect. The latter was mainly driven by the diuresis, since urinary sodium concentration did not change. Amylin had a transient effect to lower plasma potassium concentration. This effect was likely to be a consequence of activation of Na+/K+-ATPase, an action shared with insulin and catecholamines. Amylin lowered plasma calcium, particularly ionized calcium, likely due to an antiresorptive effect at osteoclasts. Immunoreactive amylin was detected in the developing kidney. It appeared to have a trophic effect in kidney, and its absence resulted in renal dysgenesis. Neurons in the subfornical organ (SFO), which has a role in fluid/electrolyte homeostasis, were potently activated by amylin. The dipsogenic and renal effects of amylin may be related to effects at the SFO.

Receptor pharmacology

Despite clear evidence for a distinct amylin pharmacology and localization of such pharmacology to sites such as the nucleus accumbens,efforts to clone an amylin receptor were fruitless for over a decade. This enigma led many to doubt the status of amylin as a bona fide hormone. Yet it became apparent during those cloning efforts that, whatever the amylin receptor was, it was somehow similar to a calcitonin receptor. The enigma of the amylin receptor was solved following the identification of receptor activity modifying proteins (RAMPs). These single transmembrane spanning molecules, when associated with a calcitonin receptor, altered its pharmacology from calcitonin-preferring to amylin-preferring. With at least two forms of the calcitonin receptor and three forms of RAMP, there is the potential for six subtypes of amylin receptors. Of these, two appear to predominate. The CTa (shorter form) calcitonin receptor, dimerized with RAMP1 [amylin 1 (a) receptor], appears to represent binding sites at the nucleus accumbens and the subfornical organ. Binding sites at area postrema appear to be composed of CTa + RAMP3 [amylin3 (a) receptors]. Thus far, RAMP proteins have been associated in vivo only with the CT/CLR receptor system. It is presently unknown whether RAMPs are more general modulators of receptor function, dynamically modifying responsivity with time or across other receptor classes. The largest and first identified amylin-binding field was in the nucleus accumbens. The function of these receptors is yet undetermined, but because the nucleus accumbens is within the blood-brain barrier, the cognate ligand is unlikely to be circulating amylin. Dense amylin binding is present at the circumventricular organs, including the subfornical organ, the organum vasculosum lateralis terminalis (OVLT), and the area postrema. There is no diffusional (blood-brain) barrier at these structures, so they most likely respond to circulating (beta-cell-derived) amylin. Despite pharmacological evidence of amylin sensitivity in several peripheral tissues, selective amylin binding outside of the brain is observed only in the renal cortex. The newly designated amylinomimetic drug class was defined on the basis of its unique pharmacology prior to the molecular characterization of amylin receptors. Currently, the class includes any agent that acts as antagonist at characterized amylin receptors. Several peptides, typically analogs of truncated salmon calcitonin, have been developed as potent and selective amylin antagonists and have been useful in identifying amylinergic responses. Of these, AC187 (30Asn32Tyr[8-32]sCT; Amylin Pharmaceuticals Inc.) is particularly selective and potent, and has been most often cited in studies using amylin antagonists. Antagonism of a response with an order of potency of AC187> AC66 > CGRP[8-37] is suggestive that it is mediated via amylin receptors. Activation of a response with salmon calcitonin (sCT) > amylin >calcitonin gene-related peptide (CGRP) > mammalian CT suggests activation via the amylinl (a) receptor, while sCT = amylin >> CGRP >mammalian CT suggests activation via amylin3 (a) receptors. Absence of response to other ligands (e.g., adrenomedullin) is useful for excluding certain pharmacologies.

Amylin fasting plasma levels are decreased in patients with osteoporosis

Amylin is a polypeptide hormone produced in pancreatic beta-cells that belongs to the family of calcitonin gene-related peptides. There is a 20% sequence homology between amylin and calcitonin and 44% homology with calcitonin gene-related peptide. Amylin and its fragments stimulate the proliferation of osteoblasts, inhibit bone resorption, and increase bone density and the amount of bone mass. We measured amylin total and unreduced amylin fasting plasma levels in patients with osteoporosis ( n=28; 3 men, 25 women; mean age 65 years), type 2 diabetes mellitus ( n=10; 5 men, 5 women; 64 years), and in the control group ( n=24; 11 men, 13 women; 53 years) using an ELISA kit with immunofluorescent detection (Linco). Amylin total plasma levels in patients with osteoporosis were 3.33+/-0.46 pmol/l (mean+/-SEM), in patients with type 2 diabetes 6.29+/-1.47 pmol/l (mean+/-SEM), and in the control group 8.48+/-3.12 pmol/l (mean+/-SEM). Mean plasma levels were lower in patients with osteoporosis than in patients with type 2 diabetes and in the control group. Unreduced amylin plasma levels in patients with osteoporosis ( n=28) were 2.51+/-0.87 pmol/l (mean+/-SEM), in patients with type 2 diabetes ( n=10) 4.15+/-0.95 pmol/l (mean+/-SEM) and in the control group ( n=5) 13.50+/-3.94 pmol/l (mean+/-SEM). Plasma levels were significantly lower in patients with osteoporosis than in patients with type 2 diabetes ( P<0.01) and in the control group ( P<0.001). Amylin plasma levels are decreased in patients with osteoporosis. Amylin deficiency in these patients may contribute to the development of osteoporosis. Amylin should be investigated in relation to the pharmacological treatment of osteoporosis.

Calcitonin receptor isoforms expressed in the developing rat kidney

BACKGROUND

Development in the metanephric-kidney transition period involves the precise expression of paracrine and autocrine events in an ordered spatio-temporal manner. Expression of these molecular events is tightly controlled and includes positive and negative growth factors and cognate receptors within close proximity in developing structures in the expanding renal cortex and medulla. The expression of calcitonin receptor (CTR) isoforms C1a and C1b in this context has not previously been described. Our current study also explored the relationship between the expression of CTR isoforms and amylin binding sites.

METHODS

Techniques included immunohistochemistry with novel antibodies that detect CTR isoforms, real time PCR for the quantification of CTR isoforms, Western blot and in vitro autoradiography, on tissues from embryo day 18 to postnatal day 30.

RESULTS

The CTR C1a isoform is expressed in the ureteric ducts of the metanephros and both isoforms are expressed in the developing distal convoluted tubules, ascending limbs of the loop of Henle and collecting ducts in the postnatal rat kidney. There was a 60-fold excess of C1a versus C1b isoforms. An apparent molecular weight of 63 kD was found. In vitro autoradiography demonstrated that while amylin binding sites were predominantly in the cortex, CTR expression was largely localized in the medulla in an earlier event, followed by cortical expression.

CONCLUSIONS

CTR C1a protein expression has been identified in the ureteric ducts in the metanephros and both isoforms expressed in the distal portions of the developing nephrons and collecting ducts. Since amylin binding sites have been localized on the proximal tubules of the cortex, it is unlikely that amylin receptors can be represented by modification of CTR affinity with receptor activity modifying proteins in the kidney.

Angiotensin type 2 receptor is expressed in the adult rat kidney and promotes cellular proliferation and apoptosis

BACKGROUND

Angiotensin II (Ang II) is associated with cell proliferation and apoptosis. The role of the angiotensin type 2 receptor (AT2R) in these processes remains controversial. Conventional radioligand binding of 125I-Sar1, Ile8 Ang II in adult kidney has failed to demonstrate the binding for the AT2R.

METHODS

The presence of the AT2R was explored in adult rat kidney by in vitro and in vivo autoradiography using the selective AT2R radioligand 125I-CGP 42112B. The roles of the angiotensin type 1 receptor (AT1R) and the AT2R in mediating cellular proliferation and apoptosis were assessed using selective AT1R or AT2R antagonists in Ang II-infused Sprague-Dawley (SD) rats.

RESULTS

125I-CGP 42112B binding was demonstrated by in vitro and in vivo autoradiography techniques in the glomeruli and proximal tubules of SD rats. This binding could be displaced by Ang II and the AT2R antagonist PD123319 but not by the AT1R antagonist valsartan. Subcutaneous infusion of Ang II for 14 days in eight-week-old SD rats induced proliferation of proximal tubular epithelial cells, as assessed by a twofold increase in proliferating cell nuclear antigen (PCNA)-positive cells and apoptosis, as assessed by a threefold increase in terminal dUTP nick end labeling (TUNEL)-positive cells. The administration of the AT2R antagonist PD123319 or the AT1R antagonist valsartan was associated with attenuation of the increases in both PCNA- and TUNEL-positive cells following Ang II infusion. Ang II infusion was associated with increased osteopontin gene and protein expression, which could be reduced by treatment with either valsartan or PD123319.

CONCLUSION

These findings indicate that there is significant expression of the AT2R in the adult kidney, and that the AT2R has a role in mediating Ang II-induced proliferation and apoptosis in proximal tubular epithelial cells and expression of osteopontin.

Circulating amylin in human essential hypertension: heritability and early increase in individuals at genetic risk

BACKGROUND

Human essential hypertension is a complex trait with poorly understood genetic determination. Insulin resistance is frequently associated with this trait.

OBJECTIVE

To determine whether a potentially pathogenic feature of the insulin-resistant state, circulating amylin (islet amyloid polypeptide, co-released with insulin from pancreatic islet beta-cells), is already increased in prehypertensive individuals (normotensive persons at genetic risk of hypertension because of family history), whether such individuals already differ in their amylin response to beta-cell stimulation, and whether plasma amylin concentration is heritable. Such features could establish increased circulating amylin as a hereditary 'intermediate phenotype' useful in genetic analyses of hypertension.

METHODS

Plasma amylin and insulin were measured in 283 medication-free individuals stratified by blood pressure status (82 hypertensive and 201 normotensive), and genetic risk (family history) of hypertension. Differences in means were tested by ANOVA, variances by F test, and frequency distributions by maximum likelihood analysis. Co-release of amylin and insulin was provoked by intravenous infusion of mixed amino acids. The effect of antihypertensive treatment was evaluated after monotherapy with either angiotensin converting enzyme inhibition or calcium-channel blockade in hypertension.

RESULTS

Plasma amylin was increased in hypertension (P= 0.027), and body mass index was a strong predictor of increased circulating amylin (P = 0.0001). Plasma amylin and plasma renin activity were not correlated (P = 0.395), and effective antihypertensive monotherapy with either angiotensin converting enzyme inhibition or calcium-channel blockade did not affect either amylin (P = 0.87-0.97) or insulin (P= 0.55-0.59). Among normotensive individuals, those at genetic risk of hypertension (with positive family history) already had increased concentrations of amylin (P< 0.001), despite exhibiting no difference in blood pressure or body mass index compared with the family-history-negative group; however, among normotensive individuals, both family history (P = 0.043) and body mass index (P= 0.0059) were significant predictors of increased concentrations of amylin. By maximum likelihood analysis, plasma amylin was distributed heterogeneously in the normotensive individuals, with two modes best explaining the distribution (chi2 = 77.4, P< 0.001), and family-history-positive individuals completely accounting for the upper mode (chi2 = 4.63, P = 0.031). Family-history-positive normotensive individuals showed greater plasma amylin concentrations both before and during beta-cell stimulation by amino acid infusion (P = 0.014). Black (n = 111) and white (n = 172) individuals did not differ in mean (P = 0.946) or variance (P = 0.172) of plasma amylin concentrations.

CONCLUSIONS

These results suggest that plasma amylin concentration is in part determined by heredity. Both basal and stimulated plasma amylin excess may identify a subgroup of individuals bearing an inherited predisposition to hypertension. Measurement of amylin might identify a useful 'intermediate phenotype' in the genetic analysis of essential hypertension and its relationship to insulin resistance.

Amylin: physiological roles in the kidney and a hypothesis for its role in hypertension

1. There are high-affinity binding sites for amylin in the renal cortex associated with proximal tubules. These appear to represent seven transmembrane (heptatopic) receptors that are known to form ternary complexes with G-proteins and activate second messenger systems. 2. Amylin stimulates sodium/water reabsorption from the basolateral side of the proximal tubules and plays a role in sodium homeostasis. 3. The transient expression of amylin-like mRNA has been detected perinatally, using in situ hybridization, in the subnephrogenic zone of the metanephros and is associated with proximal tubules of the developing nephron. There it is thought to play a role as a growth factor for brush border epithelial cells in the developing kidney and in renal regrowth in the adult kidney. 4. In two models of hypertension, the spontaneously hypertensive rat (SHR) and one created surgically by subtotal nephrectomy, renal amylin receptors are activated. In the SHR, activation precedes the rise in blood pressure and suggests that activation of the amylin system may be an important event in the development of hypertension.

Renal amylin binding in normotensive and hypertensive rats: effects of angiotensin converting enzyme inhibition with perindopril

OBJECTIVES

To investigate the effect of angiotensin converting enzyme inhibition with perindopril on the binding density of [125I]-rat amylin in the renal cortex in normotensive Sprague-Dawley rats, renally ablated hypertensive rats and spontaneously hypertensive rats.

DESIGN

Sprague-Dawley rats, renally ablated hypertensive rats and spontaneously hypertensive rats were administered either the angiotensin converting enzyme inhibitor perindopril or no treatment.

METHODS

The density of [125I]-rat amylin binding was measured in the renal cortex using autoradiography in vitro. The systolic blood pressure was measured by indirect tail-cuff plethysmography. The plasma renin activity was measured by radioimmunoassay.

RESULTS

The density of [125I]-amylin binding was reduced by approximately 50% in Sprague-Dawley and subtotally nephrectomized Sprague-Dawley rats after treatment with perindopril. These changes were associated with a reduction in systolic blood pressure and an increase in plasma renin activity. In contrast, amylin binding in the perindopril-treated spontaneously hypertensive rats was not reduced, despite the prevention of a rise in systolic blood pressure and an increase in plasma renin activity.

CONCLUSIONS

These findings provide further evidence for the hypothesis that there is an association among renal amylin binding, the renin-angiotensin system and blood pressure for rats of the Sprague-Dawley strain. In contrast, the lack of an effect of angiotensin converting enzyme inhibition on renal amylin binding for rats of the spontaneously hypertensive rat strain is consistent with previous findings that the changes in amylin binding in rats of this strain are not linked directly to the prevailing systemic blood pressure but may be associated with a developmental abnormality in the kidney of these rats.