# Neuromodulation of long-term sequelae of ischemic acute kidney injury

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2022 · $454,321

## Abstract

Project Summary
Acute kidney injury (AKI) is recognized as a major risk for progressive chronic kidney disease (CKD). However, the
mechanism by which AKI leads to fibrogenesis and ultimately to end-stage renal disease (ESRD)2 is not well defined, Due
to limited knowledge of the primary signals that drive fibrogenesis, effective therapy for CKD is a major unmet medical
need. Our data indicate the novel paradigm that renal denervation can prevent renal fibrosis and inflammation in three
renal fibrogenesis models: 5/6 nephrectomy (5/6Nx), unilateral ureteral obstruction (UUO) and ischemic renal injury (IRI).
Our data indicate that the renal nerve-derived factor, norepinephrine (NE), signaling via α2-adrenergic receptor (α2-AR)
plays a key role in initiating fibrogenesis and inflammation and its inhibition pre-or post-injury can reduce fibrosis by about
70% in these CKD models. This finding is striking, as most experimental strategies targeting a single molecule or a pathway
rarely achieve a reduction of fibrosis of more than 50%. Our overall goal of this study is to delineate the mechanisms by
which NE signaling via α2-AR induces fibrosis and determine the therapeutic potential of inhibition of the α2-AR subtype
or its downstream signaling pathways in preventing renal fibrogenesis and inflammation in the IRI model. Our preliminary
studies indicate that NE signaling via α2-AR induces the expression of angiotensinogen (AGT) in renal proximal tubular cell
(RPTC) via activation of cAMP-response element-binding protein (CREB). Further, simultaneous inhibition of α2AR
subtypes A and C additively protected from inflammation and fibrosis, suggesting activation of subtype specific signaling
pathways, parallel to CREB-AGT axis, that may promote interstitial fibrosis and CKD. Based on these data, our central
hypothesis is that NE activates α2AR-subtypes specific-signaling pathways to induce interstitial fibrosis and their inhibition
can prevent long term sequelae of IRI. Further, α2AR activation regulates parallel pathways including, fibroblast activation
and Mφ infiltration, activation and Mφ phenotypic switching, and activates Renin-Angiotensin II Signaling (RAS) signaling
pathways to promote fibrogenesis. In specific aim 1, using genetic and pharmacological approaches, we will delineate the
functional and mechanistic role of the three α2-AR subtypes (A, B and C), and the effect of their inhibition on renal
fibrogenesis in the IRI-model. Using transcriptomic profile, we will identify overlapping versus specific pathways between
the α2AR subtypes and identify the signaling molecules that provides added protection after combinatorial inhibition. In
specific aim 2, we will dissect out the distinct role of of α2-AR subtype(s) cell-specific role (PTC vs. Mφ vs fibroblasts) in
cytokine secretion in fibroblast differentiation, Mφ behavior or Mφ switching and tubular injury. In specific aim 3, we will
identify the α2-AR subtype/s that activates CREB and AGT signalin...

## Key facts

- **NIH application ID:** 10410562
- **Project number:** 5R01DK120846-03
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** BABU Joseph PADANILAM
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $454,321
- **Award type:** 5
- **Project period:** 2021-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10410562

## Citation

> US National Institutes of Health, RePORTER application 10410562, Neuromodulation of long-term sequelae of ischemic acute kidney injury (5R01DK120846-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10410562. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*