The role of beta agonists in the treatment of chronic kidney disease

NIH RePORTER · VA · I01 · · view on reporter.nih.gov ↗

Abstract

Diseases affecting podocytes and the glomerulus, such as diabetes, are the leading cause of end stage kidney disease (ESKD). Eleven percent of Veterans meet the established criteria for chronic kidney disease (CKD), which leads to ESKD and premature death from cardiovascular disease. The vast majority of research in the field of CKD has focused on the initiating events and causes of CKD; unfortunately, this approach does not represent what is seen clinically where CKD is identified after the injury occurs. Because therapeutic options for recovery from CKD are either severely limited or non-existent, there is a critical need for novel targets and therapeutics. The goal here is to validate a novel therapeutic target, the beta 2 adrenergic receptor (β2-AR), that we recently showed accelerates recovery of glomerular function following injury. Glomerular function is highly dependent on specialized cells known as podocytes, which are critical components of glomeruli. While podocyte injury is a common denominator in many glomerular diseases, there are no specific drugs that restore injury-induced loss of podocyte structure and function. Bioinformatics analysis following injury revealed induction of genes related to mitochondrial function. Mutations in mitochondrial genes are known to result in mitochondrial dysfunction and have been implicated in the loss of podocyte function. Since mitochondria are known to play a critical role in maintaining podocyte energy homeostasis, we hypothesized that podocytes could recover from injury by increasing mitochondrial biogenesis, and therapeutics that increase mitochondrial biogenesis would promote recovery from glomerular injury. To test this hypothesis, we investigated whether stimulation of the β2-AR by an agonist would induce mitochondrial biogenesis and restore glomerular filtration function in injured mice. Our recently published studies and preliminary data show a potent induction of mitochondrial biogenesis in podocytes by the long-acting β2-AR agonist formoterol. Importantly, using mouse models of podocyte injury, we demonstrated that oral and intraperitoneal administration of formoterol six hours following injury, when glomerular dysfunction is already established, restored glomerular structures, significantly reduced proteinuria, and accelerated recovery of glomerular function. We also show preliminary data indicating that Veterans with CKD and chronic obstructive pulmonary disease (COPD), who use β2-AR agonists, have a significantly slower decline of renal function. Since diabetes is the leading cause of CKD and ESKD, these clinical findings are most likely due to the effect of β2-AR agonists on diabetic nephropathy. Indeed, we have new data showing that formoterol use results in recovery from diabetic nephropathy in a mouse model of type II diabetes. Thus, we further hypothesize that treatment with formoterol accelerates the recovery of glomerular function following injury through the induction of podoc...

Key facts

NIH application ID
10795640
Project number
5I01CX002391-02
Recipient
RALPH H JOHNSON VA MEDICAL CENTER
Principal Investigator
JOSHUA H LIPSCHUTZ
Activity code
I01
Funding institute
VA
Fiscal year
2024
Award amount
Award type
5
Project period
2022-10-01 → 2026-09-30