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

> **NIH VA I01** · RALPH H JOHNSON VA MEDICAL CENTER · 2024 · —

## 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 organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** JOSHUA H LIPSCHUTZ
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10795640

## Citation

> US National Institutes of Health, RePORTER application 10795640, The role of beta agonists in the treatment of chronic kidney disease (5I01CX002391-02). Retrieved via AI Analytics 2026-06-25 from https://api.ai-analytics.org/grant/nih/10795640. Licensed CC0.

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