Abstract
There are diverse pathophysiological mechanisms involved in acute kidney injury (AKI). Among them, overactivity of the renin-angiotensin system (RAS) has been described. Angiotensin-converting enzyme 2 (ACE2) is a tissue RAS enzyme expressed in the apical border of proximal tubules. Given the important role of ACE2 in the metabolism of angiotensin II, this study aimed to characterize kidney and urinary ACE2 in a mouse model of AKI. Ischemia-reperfusion injury (IRI) was induced in C57BL/6 mice by clamping of the left renal artery followed by removal of the right kidney. In kidneys harvested 48 h after IRI, immunostaining revealed a striking maldistribution of ACE2 including spillage into the tubular lumen and the presence of ACE2-positive luminal casts in the medulla. In cortical membranes, ACE2 protein and enzymatic activity were both markedly reduced (37 ± 4 vs. 100 ± 6 ACE2/b-actin, P = 0.0004, and 96 ± 14 vs. 152 ± 6 RFU/μg protein/h, P = 0.006). In urine, full-length membrane-bound ACE2 protein (100 kDa) was markedly increased (1,120 ± 405 vs. 100 ± 46 ACE2/lg creatinine, P = 0.04), and casts stained for ACE2 were recovered in the urine sediment. In conclusion, in AKI caused by IRI, there is a marked loss of ACE2 from the apical tubular border with deposition of ACE2-positive material in the medulla and increased urinary excretion of full-length membrane-bound ACE2 protein. The deficiency of tubular ACE2 in AKI suggests that provision of this enzyme could have therapeutic applications and that its excretion in the urine may also serve as a diagnostic marker of severe proximal tubular injury. NEW & NOTEWORTHY This study provides novel insights into the distribution of kidney ACE2 in a model of AKI by IRI showing a striking detachment of apical ACE2 from proximal tubules and its loss in urine and urine sediment. The observed deficiency of kidney ACE2 protein and enzymatic activity in severe AKI suggests that administration of forms of this enzyme may mitigate AKI and that urinary ACE2 may serve as a potential biomarker for tubular injury.
| Original language | English (US) |
|---|---|
| Pages (from-to) | F412-F425 |
| Journal | American Journal of Physiology - Renal Physiology |
| Volume | 327 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2024 |
Funding
The authors acknowledge the careful evaluation of some of the kidney slides by Dr. Yashpal Kanwar. This work was supported by National Institutes of Health Grant R21AI166940 (to D.B.). C.C. was supported by the Biomedical Education Program during part of his stay in Chicago. M.S. received an award from the National Kidney Foundation of Illinois. D.B. and J.W. are coinventors of patents entitled \u201CActive Low Molecular Weight Variants of Angiotensin Converting Enzyme 2 (ACE2)\u201D and \u201CSoluble ACE2 Variants and Uses Therefor.\u201D D.B. is founder of Angiotensin Therapeutics Inc. D.B. has received consulting fees from Advicenne unrelated to this work and received unrelated research support from a grant from AstraZeneca. J.W. reports scientific advisor capacity for Angiotensin Therapeutics Inc. None of the other authors has any conflicts of interest, financial or otherwise, to disclose. This work was supported by National Institutes of Health Grant R21AI166940 (to D.B.). C.C. was supported by the Biomedical Education Program during part of his stay in Chicago. M.S. received an award from the National Kidney Foundation of Illinois.
Keywords
- ACE2
- acute kidney injury
- angiotensin II
- renin-angiotensin system
- reperfusion injury
ASJC Scopus subject areas
- Physiology