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Review
. 2019 Oct 8:10:1192.
doi: 10.3389/fphar.2019.01192. eCollection 2019.

Inflammation in Renal Diseases: New and Old Players

Affiliations
Review

Inflammation in Renal Diseases: New and Old Players

Vinicius Andrade-Oliveira et al. Front Pharmacol. .

Abstract

Inflammation, a process intimately linked to renal disease, can be defined as a complex network of interactions between renal parenchymal cells and resident immune cells, such as macrophages and dendritic cells, coupled with recruitment of circulating monocytes, lymphocytes, and neutrophils. Once stimulated, these cells activate specialized structures such as Toll-like receptor and Nod-like receptor (NLR). By detecting danger-associated molecules, these receptors can set in motion major innate immunity pathways such as nuclear factor ĸB (NF-ĸB) and NLRP3 inflammasome, causing metabolic reprogramming and phenotype changes of immune and parenchymal cells and triggering the secretion of a number of inflammatory mediators that can cause irreversible tissue damage and functional loss. Growing evidence suggests that this response can be deeply impacted by the crosstalk between the kidneys and other organs, such as the gut. Changes in the composition and/or metabolite production of the gut microbiota can influence inflammation, oxidative stress, and fibrosis, thus offering opportunities to positively manipulate the composition and/or functionality of gut microbiota and, consequentially, ameliorate deleterious consequences of renal diseases. In this review, we summarize the most recent evidence that renal inflammation can be ameliorated by interfering with the gut microbiota through the administration of probiotics, prebiotics, and postbiotics. In addition to these innovative approaches, we address the recent discovery of new targets for drugs long in use in clinical practice. Angiotensin II receptor antagonists, NF-ĸB inhibitors, thiazide diuretics, and antimetabolic drugs can reduce renal macrophage infiltration and slow down the progression of renal disease by mechanisms independent of those usually attributed to these compounds. Allopurinol, an inhibitor of uric acid production, has been shown to decrease renal inflammation by limiting activation of the NLRP3 inflammasome. So far, these protective effects have been shown in experimental studies only. Clinical studies will establish whether these novel strategies can be incorporated into the arsenal of treatments intended to prevent the progression of human disease.

Keywords: NF- kappa B; acute kidney injury (AKI); chronic kidney disease (CKD); gut microbiota; inflammation.

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Figures

Figure 1
Figure 1
Inflammation in acute kidney diseases. Under physiologic conditions, endothelial, epithelial, and immune cells (around parenchymal structures and/or vessels) interact harmonically within the kidney (left side). Upon an insult by bacteria or bacterial products, drug toxicity, or following nonsterile stimulation, epithelial and endothelial cells undergo necrosis or apoptosis, releasing products that can activate Toll-like receptors (TLR), NOD-like receptors (NLR), and NLPR3 inflammasome in immune and kidney cells. This activation leads to the production of chemokines and proinflammatory cytokines, which recruit monocytes and neutrophils to the organ. Concomitantly, resident immune cells (mainly dendritic cells) get activated and induce the proliferation of T cells (TH1, TH17, and CD8 cytotoxic cells), which in turn produce cytokines, exacerbating the inflammation process (right).
Figure 2
Figure 2
Actors in the transition from acute kidney injury (AKI) to chronic kidney disease (CKD). Inflammation is a common link between AKI and CKD, and increased expression and/or activation of TLR, NLRP3 inflammasome, and NF-ĸB are present in both scenarios. The composition of the immune cell population depends on the context. In AKI, a large number of TH1/TH17 lymphocytes and neutrophils concentrate around parenchymal structures and/or vessels, whereas in CKD TH2 lymphocytes and M2 macrophages predominate. M1 macrophages, dendritic cells, and CD8+ T cells are seen in both processes. In CKD, epithelial– and/or endothelial–mesenchymal transition, with fibroblast proliferation, may contribute substantially to the development of inflammation and fibrosis. Gut microbiota composition, along with its subproducts, can have an important role in both AKI and CKD. Short-chain fatty acid (SCFA) can inhibit inflammation in different models of AKI, whereas in CKD there is a reciprocal relationship, with gut microbiota modulating the development of CKD, and, conversely, uremic toxins (e.g., p-cresol and indol) promoting changes in the composition of gut microbiota. Repurposed drugs and compounds that limit lymphocyte proliferation, M1 infiltration, and specific inflammatory pathways can exert renoprotective and anti-inflammatory effects. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers inhibit the NF-ĸB system, whereas the experimental compounds pyrrolidine dithiocarbamate and parthenolide provide more specific inhibition. Allopurinol reduces activation of the NLRP3 inflammasome.

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