Diabetic nephropathy is the leading cause of end-stage renal disease, yet the mechanisms responsible for hyperglycemia-induced kidney injury have not been fully elucidated. Activation of the renin-angiotensin system and NADPH oxidase-dependent generation of reactive oxygen species are important mediators of chronic kidney disease. I first studied the effect of ACE2, an important enzyme in the renin-angiotensin system, in diabetic kidney injury in the Akita mouse and related the effect to angiotensin peptide and NADPH oxidase. I then demonstrated the interaction between Angiotensin II, the main substrate, and angiotensin-(1-7), the main product of ACE2, respectively, on cell signaling in mesangial cells to better understand the in vitro effect of ACE2. Finally I studied the effect of deletion of p47phox, a regulatory subunit of the NADPH oxidase, on initiation and progression of diabetic nephropathy in the Akita mouse and mesangial cell. Administration of human recombinant ACE2 decreased angiotensin II levels, increased angiotensin-(1-7) levels, normalized NADPH oxidase activity in the Akita mice, and ameliorated diabetes-induced kidney injury. In vitro, hrACE2 attenuated both high glucose and ANG II–induced oxidative stress and NADPH oxidase activity in mesangial cells. Ang-(1–7)-induced ERK1/2 phosphorylation in mesangial cells in a mas receptor-cAMP-PKA-dependent manner. This effect of ang-(1-7) on ERK1/2 phosphorylation is not mediated by AT1R, AT2R, epidermal growth factor or NADPH oxidase. Pre-treatment with Ang-(1-7) attenuated Ang II-induced NADPH oxidase activity and ERK1/2 activation also in a cAMP-PKA-dependent manner. Deletion of p47phox not only reduced diabetes-induced kidney injury but also reduced hyperglycemia by increasing pancreatic and circulating insulin concentrations. p47phox-/- mice exhibited improved glucose tolerance but modestly decreased insulin sensitivity. Deletion of p47phox attenuated high glucose-induced activation of NADPH oxidase and pro-fibrotic gene expression in mesangial cells. There was a positive correlation between p47phox and collagen Iα1 mRNA levels in renal biopsy samples from control subjects and subjects with diabetic nephropathy. The data generated in this thesis strongly suggest a protective role of ACE2, via Ang-(1-7), and a deleterious role of p47phox in diabetic nephropathy. Future therapeutic strategies should include enhancing ACE2 activity in the kidney and inhibiting p47phox-dependent activation of NADPH oxidase in both the kidney and the pancreas.

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Diabetic nephropathy is the leading cause of end-stage renal disease, yet the mechanisms responsible for hyperglycemia-induced kidney injury have not been fully elucidated. Activation of the renin-angiotensin system and NADPH oxidase-dependent generation of reactive oxygen species are important mediators of chronic kidney disease. I first studied the effect of ACE2, an important enzyme in the renin-angiotensin system, in diabetic kidney injury in the Akita mouse and related the effect to angiotensin peptide and NADPH oxidase. I then demonstrated the interaction between Angiotensin II, the main substrate, and angiotensin-(1-7), the main product of ACE2, respectively, on cell signaling in mesangial cells to better understand the in vitro effect of ACE2. Finally I studied the effect of deletion of p47phox, a regulatory subunit of the NADPH oxidase, on initiation and progression of diabetic nephropathy in the Akita mouse and mesangial cell. Administration of human recombinant ACE2 decreased angiotensin II levels, increased angiotensin-(1-7) levels, normalized NADPH oxidase activity in the Akita mice, and ameliorated diabetes-induced kidney injury. In vitro, hrACE2 attenuated both high glucose and ANG II–induced oxidative stress and NADPH oxidase activity in mesangial cells. Ang-(1–7)-induced ERK1/2 phosphorylation in mesangial cells in a mas receptor-cAMP-PKA-dependent manner. This effect of ang-(1-7) on ERK1/2 phosphorylation is not mediated by AT1R, AT2R, epidermal growth factor or NADPH oxidase. Pre-treatment with Ang-(1-7) attenuated Ang II-induced NADPH oxidase activity and ERK1/2 activation also in a cAMP-PKA-dependent manner. Deletion of p47phox not only reduced diabetes-induced kidney injury but also reduced hyperglycemia by increasing pancreatic and circulating insulin concentrations. p47phox-/- mice exhibited improved glucose tolerance but modestly decreased insulin sensitivity. Deletion of p47phox attenuated high glucose-induced activation of NADPH oxidase and pro-fibrotic gene expression in mesangial cells. There was a positive correlation between p47phox and collagen Iα1 mRNA levels in renal biopsy samples from control subjects and subjects with diabetic nephropathy. The data generated in this thesis strongly suggest a protective role of ACE2, via Ang-(1-7), and a deleterious role of p47phox in diabetic nephropathy. Future therapeutic strategies should include enhancing ACE2 activity in the kidney and inhibiting p47phox-dependent activation of NADPH oxidase in both the kidney and the pancreas.

Constitutive secretion is responsible for the targeting of transmembrane proteins to the plasma membrane, and for the secretion of extracellular matrix proteins, hormones, and other cellular products. The basic steps of secretion are well understood – proteins synthesized in the endoplasmic reticulum are transported in lipid-bound intermediates to the Golgi, and from the Golgi to the plasma membrane or cell exterior. Dysfunction of the secretory pathway – either constitutive or regulated – is involved in many disease states. One such state is diabetic nephropathy (DN). DN is characterized by renal hypertrophy and fibrosis, and is the leading cause of renal failure worldwide. Our lab had previously shown that munc13 is both upregulated and activated in the diabetic kidney, and that munc13 is an effector of rab34. Study of rab34 in HeLa cells revealed that rab34 is localized to the Golgi, and that it is required for the secretion of the Vesicular Stomatitis Virus glycoprotein. Colocalization experiments, as well as the use of Brefeldin A, localized the effect of rab34 to intra-Golgi transport. Further experiments indicated that glucose-induced upregulation of munc13 in rat mesangial cells increased the rate of constitutive secretion to the plasma membrane, and that this effect depended on its interaction with rab34. Finally, munc13 and rab34 were found to be required for the high glucose-mediated stimulation of Transforming Growth Factor-β secretion from mesangial cells, placing these two proteins at a key point in a pathway of physiological significance in the pathology of DN.

Constitutive secretion is responsible for the targeting of transmembrane proteins to the plasma membrane, and for the secretion of extracellular matrix proteins, hormones, and other cellular products. The basic steps of secretion are well understood – proteins synthesized in the endoplasmic reticulum are transported in lipid-bound intermediates to the Golgi, and from the Golgi to the plasma membrane or cell exterior. Dysfunction of the secretory pathway – either constitutive or regulated – is involved in many disease states. One such state is diabetic nephropathy (DN). DN is characterized by renal hypertrophy and fibrosis, and is the leading cause of renal failure worldwide. Our lab had previously shown that munc13 is both upregulated and activated in the diabetic kidney, and that munc13 is an effector of rab34. Study of rab34 in HeLa cells revealed that rab34 is localized to the Golgi, and that it is required for the secretion of the Vesicular Stomatitis Virus glycoprotein. Colocalization experiments, as well as the use of Brefeldin A, localized the effect of rab34 to intra-Golgi transport. Further experiments indicated that glucose-induced upregulation of munc13 in rat mesangial cells increased the rate of constitutive secretion to the plasma membrane, and that this effect depended on its interaction with rab34. Finally, munc13 and rab34 were found to be required for the high glucose-mediated stimulation of Transforming Growth Factor-β secretion from mesangial cells, placing these two proteins at a key point in a pathway of physiological significance in the pathology of DN.

Diabetic nephropathy (DN) is a complication associated with diabetes and is characterized by proteinuria and a progressive loss of kidney function. The disease morphologically manifests as an increase in the extracellular matrix (ECM) produced by kidney cells including specialized mesangial cells found in the kidney glomeruli. The mesangial cells undergo increased proliferation and hypertrophy, produce ECM components at an elevated rate and in turn the ECM itself is broken down at a reduced rate. This leads to fibrosis, or the scarring of the glomeruli. The process of fibrosis is known to be promoted by pro-fibrotic factors such as transforming growth factor beta-1 (TGF-β1), which is activated by various proteins including thrombospondin-1 (TSP-1). Both of these proteins are known to have an increased rate of expression and activation in a high glucose environment and in the kidneys of diabetic patients. Glucose-regulate protein 78 (GRP78) is another protein altered by high glucose, as it is translocated to cell surface in DN (cell surface GRP78, csGRP78). In this study, we investigate the role csGRP78 has in the regulation of TSP-1 and downstream signaling by high glucose, using primary rat mesangial cell cultures. Our results confirm that TSP-1 protein levels are increased in the cell lysate and in the ECM of cells treated with high glucose. We further show that inhibitors of csGRP78 and downstream PI3K/Akt reduce the high glucose-induced increase in TSP1 at both protein and transcript levels, and attenuate TGF-β1 signaling. / Thesis / Master of Science (MSc) / Diabetic nephropathy is a condition that is associated with a gradual loss of kidney function as well as the presence of protein in the urine. As the name implies, diabetic nephropathy occurs as a result of diabetes mellitus. The disease causes the mesangial cells in the kidney to produce excess extracellular matrix leading to scarring in the kidney, a process called fibrosis. One of the key fibrotic proteins is called transforming growth factor beta-1 (TGF-β1), stored in a latent form. A major activator of TGF-β1 is thrombospondin-1 (TSP-1). Our results demonstrate that the cell surface localization of glucose regulated protein 78 (GRP78) is required for the upregulation of TSP-1 in a high glucose environment, leading to activation of profibrotic pathways that are well known to perpetuate the fibrotic phenotype seen in diabetic nephropathy.

The pathogenesis of diabetic nephropathy (DN) remains incompletely understood. In previous studies, we observed the activation of Tyr kinase Src by high glucose (HG) and showed that Src is required for MAPK activation and synthesis of collagen IV in cultured rat mesangial cells (MCs). Reactive oxygen species (ROS) are also important mediators of DN, and our present study aimed to investigate the role of Src in HG-induced ROS generation. In MCs, we found that HG led to ROS accumulation that was blocked by Src inhibitors or Src-specific siRNA. Downstream of Src, Vav2 was phosphorylated/activated leading to Rac1-dependent NADPH oxidase activation. Long-term HG exposure resulted in Src-dependent Nox4 protein induction. Nox2-specific siRNA abrogated ROS production only in short-term HG, while Nox4-specific siRNA blocked ROS production only in long-term HG. Taken together, our data indicate Src to be important in mediating ROS generation from both Nox2- and Nox4-containing NADPH oxidases.

The pathogenesis of diabetic nephropathy (DN) remains incompletely understood. In previous studies, we observed the activation of Tyr kinase Src by high glucose (HG) and showed that Src is required for MAPK activation and synthesis of collagen IV in cultured rat mesangial cells (MCs). Reactive oxygen species (ROS) are also important mediators of DN, and our present study aimed to investigate the role of Src in HG-induced ROS generation. In MCs, we found that HG led to ROS accumulation that was blocked by Src inhibitors or Src-specific siRNA. Downstream of Src, Vav2 was phosphorylated/activated leading to Rac1-dependent NADPH oxidase activation. Long-term HG exposure resulted in Src-dependent Nox4 protein induction. Nox2-specific siRNA abrogated ROS production only in short-term HG, while Nox4-specific siRNA blocked ROS production only in long-term HG. Taken together, our data indicate Src to be important in mediating ROS generation from both Nox2- and Nox4-containing NADPH oxidases.

Chronic kidney disease is defined as the appearance of kidney functional or structural injury. Cyclooxygenase and prostaglandin E2 have been implicated in the pathogenesis of diabetic nephropathy, the leading cause of chronic kidney disease. Beneficial in certain settings, inhibition of the cyclooxygenase pathway can however be detrimental in patients with compromised cardiac or renal function. Moreover, the quest for new therapies to treat diabetic nephropathy is hampered by the lack of appropriate rodent models. This doctoral thesis is a culmination of three studies, the first to determine the role of the prostaglandin E2 EP1 receptor in diabetic nephropathy, the second to elucidate the vascular prostaglandin E2 EP4 receptor’s role in hypertension and lastly to establish and characterise a novel mouse model of diabetic nephropathy. The goal being to uncover new therapeutic avenues for the treatment of CKD, its causes and/or complications.

Progression and regression of renal fibrosis is observed in patients with diabetic nephropathy (DN). The underlying pathways, especially those that promote regression of fibrosis, remain poorly understood in part due to the fact that most rodent DN models only mirror the early features of human DN. Another obstacle for optimizing treatment strategies is that albuminuria, the current gold standard biomarker of renal damage in DN, often lacks sensitivity and specificity for identification of those patients with diabetes who are at risk of a rapid decline in renal function. A novel DN model, in which diabetes was induced with streptozotocin in Cyp1a1mRen2 rats and hypertension was generated by inducing renin transgene expression with dietary indole-3-carbinol (I-3-C), mimicked many of the key biochemical, pathological and transcriptomic changes observed in the kidney of patients with DN. Recently, the model was extended to include a ‘reversal phase’ in which glycaemia was tightly controlled and blood pressure normalized for eight weeks after an ‘injury phase’ of 28 weeks. The present study aims to employ this novel rodent model to examine pathways activated in the kidney during and following reversal of hyperglycaemia and hypertension and to identify new biomarkers that might complement albuminuria in assessing risk of renal deterioration in patients with diabetes. Methods Tissue and urinary specimen from the Cyp1a1mRen 2 model of DN were analysed by realtime-PCR, Western-Blot, ELISA and staining techniques including immunohistochemistry, immunofluorescence and zymography. To establish in-situ zymography a model of ureteric obstruction was used. Urinary peptidomic analysis as well as measurement of urinary exosomes and microparticles was performed in the model and in patients with DN utilizing liquid chromatography/tandem mass-spectrometry, nanoparticle tracking analysis (NTA) or flow cytometry. Results Tight control of blood glucose and blood pressure during an 8 week ‘reversal phase’ did not significantly reverse the degree of renal fibrosis accrued during a 28wk ‘injury phase’. However, it did result in a reduction in expression of genes encoding myofibroblast markers and extracellular matrix (ECM) proteins. Genes that were up-regulated during both injury and reversal phases were implicated in adaptive immunity, phagocytosis, lysosomal processing and degradative metalloproteinases (MMPs). Paradoxically MMP activity was massively reduced during both injury and reversal phases. This may be due to an elevated level of tissue inhibitor of metalloproteinase-1 (TIMP-1) protein in both phases. After separating TIMP1 from MMP in renal tissue homogenates from animals of both the injury and reversal phases using gel electrophoresis, MMP activity was restored above that of controls. For biomarker discovery peptidomic analysis was performed on urine from rats at baseline and during the injury and reversal phases of the Cyp1a1mRen2 model of DN and from patients with moderately advanced DN and from normal controls. The use of two different search and analyse tools (Maxquant, Progenesis QI) resulted in the discovery of significantly altered peptides in the urine in rodent and human DN. Further studies focused on peptides derived from those proteins for which the corresponding gene was similarly regulated in the DN model and in human DN. Urinary epidermal growth factor (uEGF) matched these criteria as the reduction of excretion during the injury phase in the DN model was paralleled by reduced EGF protein expression in renal tissue. Key biomarker candidates identified in the first two chapters were measured in urinary specimens of patients from the Edinburgh Type 2 Diabetes study (ET2DS) to test translational utility. MMP7 and other candidates, such as osteopontin or vascular endothelial growth factor (VEGF) were not of value in predicting renal outcomes. Reduced uEGF was significantly associated with increased mortality rate. In a subgroup of 642 study participants who were normoalbuminuric and had a preserved renal function at baseline, a lower uEGF to creatinine ratio was a risk factor for either developing an estimated glomerular filtration rate less than 60 ml/min per 1.73m2, rapid (over 5% per annum) decline in renal function or the combination of both. The latter remained significant after correction for other covariates. Addition of uEGF resulted in a marginal improvement in a model derived from traditional risk factors for predicting rapid decline and the composite end-point. Urinary microparticle (20nm-1000nm) analysis was established in the rodent DN model and translated to patients with DN. Total urinary exosomes (20nm-100nm) or exosomes derived from specific renal cell types including podocytes and tubular cells, increased during the injury phase in the Cyp1a1mRen2 model followed by a decrease after reversal phase. In a pilot study comprising participants with advanced chronic kidney disease, the urinary exosome concentration correlated with renal function. In the ET2DS an increased exosome concentration at baseline indicated a higher risk for renal deterioration during four years follow-up even after correction for baseline eGFR. Urinary microvesicles (100nm-1000nm) concentration increased during the injury phase in the DN model though correlation with renal function in humans was only significant if kidney-specific marker (podocalyxin) positive microvesicles were measured. Conclusion Normalisation of hyperglycaemia and hypertension in the DN model allows the study of genetic and protein regulation during the injury and reversal phases. ECM-production but not ECM-degradation genes are down-regulated during the reversal phase. The lack of reduction in ECM during the reversal phase might be caused by persistently reduced MMP activity due to the presence of TIMP-1. Targeting TIMP might be a treatment strategy to promote reduction of renal fibrosis. For the first time, the analysis of urinary peptidomics was integrated with previous transcriptomic findings in the Cyp1a1mRen2 model and patients with DN for biomarker discovery. The approach was validated using different analysis tools and successfully identified candidate markers which were increased or reduced in DN. Candidates included uEGF, which identified patients with DN who were at risk of a rapid decline of renal function. Though the marker requires further confirmation in other cohorts, it might be especially useful for patients with type 2 diabetes, in whom renal decline is often uncoupled from the development of albuminuria. Finally, the DN model helped to develop the methodology of microparticle analysis. For the first time a potential prognostic value of urinary exosome analysis in patients with diabetes has been demonstrated. Future work will include further optimisation of the methodologies, including labelling of microparticles with multiple antibodies and increasing study participant numbers.