Mutação na proteína <font face = \"symbol\">b-glucuronidase Klotho tem sido associada com envelhecimento prematuro e disfunção cognitiva. Embora altamente expressa em regiões específicas do encéfalo, as funções da proteína Klotho no sistema nervoso central ainda são desconhecidas. Aqui, mostramos que animais com gene mutado e hipomórfico para a proteína Klotho possuem regulação glicêmica alterada, sugerindo maior sensibilidade à insulina. No sistema nervoso central, vias relacionadas à sinalização intracelular de insulina apresentam-se mais ativadas no hipocampo, com maior ativação de AKT e mTOR e inativação dos fatores de transcrição FOXO. Neurônios hipocampais em cultura parecem responder à estimulação por insulina e glutamato aumentando os níveis de Klotho. De forma coerente, antagonismo de receptor AMPA ou NMDA suprime a expressão neuronal de Klotho. Também mostramos aqui que a forma solúvel da Klotho é capaz de induzir a glicólise aeróbica de astrócitos impedindo a metabolização do piruvato pela mitocôndria, e estimulando seu processamento pela lactato desidrogenase. Inibição farmacológica de FGFR1, fosforilação da ERK e de transportadores de ácidos monocarboxílicos previne a liberação de lactato induzida por Klotho em astrócitos. Inibição da AKT pelo tratamento com Klotho induz a atividade transcricional dos fatores de transcrição FOXO e promove proteção antioxidante em astrócitos pelo aumento de expressão de catalase. De forma similar, tratamento com a Klotho apresentou propriedades antiinflamatórias em astrócitos, impedindo ativação do fator de transcrição NF-<font face = \"symbol\">kB após estímulo com LPS. Em neurônios, tratamento com a proteína Klotho induz ubiquitiniação e degradação proteassomal de PFKFB3. Por fim, provamos que a quantidade de Klotho diminui em hipocampo de animais envelhecidos. Genes e proteínas relacionados ao metabolismo energético e ao acoplamento metabólico de neurônios e astrócitos tem padrão de expressão alterados no hipocampo com o envelhecimento, mostrando que essa pode ser uma característica importante para explicar o declínio cognitivo comum ao processo de envelhecimento. Em conjunto, esses dados sugerem que a Klotho pode ser um novo participante do acoplamento metabólico entre neurônios e astrócitos. / Mutations in the <font face = \"symbol\">b-glucuronidase protein Klotho have been associated with premature aging and cognitive dysfunction. Although highly expressed in specific regions of the brain, Klotho actions in the central nervous system are still largely unknown. Here we show that animals with a mutated hypomorphic Klotho gene have altered glycemia regulation, suggestive of a higher insulin sensitivity. In the central nervous system, pathways related to insulin intracellular signaling were shown to be up-regulated in the hippocampus, with higher AKT and mTOR activation, and inactivation of transcription factor FOXO. Here, we show that cultured hippocampal neurons respond to insulin and glutamate stimulation by elevating Klotho protein levels. Conversely, APA and NMDA antagonism suppress neuronal Klotho expression. We also provide evidence that soluble Klotho enhances astrocytic aerobic glycolysis by hindering pyruvate metabolism through the mitochondria, and stimulating its processing by lactate dehydrogenase. Pharmacological inhibition of FGFR1, ERK phosphorylation, and monocarboxylic acid transporters prevents Klotho-induced lactate release from astrocytes. AKT inhibition by Klotho treatment induces transcriptional activity of FOXO transcription factors and promote antioxidant defense in astrocytes by inducing catalase expression. Similarly, Klotho treatment has anti-inflammatory properties, as shown by its ability to hinder NF-<font face = \"symbol\">kB activation in astrocytes after LPS stimulation. In neurons, Klotho treatment induces PFKFB3 ubiquitination and degradation through the proteasome. Lastly, in the hippocampus, we show that Klotho is less present in hippocampi of aged mice. Genes and proteins related to energy metabolism and metabolic coupling between neurons and astrocytes show an altered expression pattern with aging, suggesting that this could be a crucial characteristic that explains cognitive decline commonly seen during the aging process. Taken together these data suggest Klotho as a potential new player in the metabolic coupling between neurons and astrocytes.

Τα επίπεδα φωσφόρου αλλάζουν με την ηλικία. Ο αυξητικός παράγοντας των ινοβλαστών 23 (FGF23) είναι μία φωσφατουρική ορμόνη που παίζει σημαντικό ρόλο στην ομοιόσταση φωσφόρου. Η πρωτεΐνη Klotho είναι ο συμπαράγοντας του FGF23 που μεσολαβεί τη σύνδεση του FGF23 στον υποδοχέα του. Στη βιβλιογραφία για τα υγιή παιδιά υπάρχουν λίγα δεδομένα για τον FGF23 και ακόμη λιγότερα για το Klotho. Σκοπός μελέτης: Nα διερευνήσουμε την ύπαρξη πιθανής συσχέτισης μεταξύ των κυκλοφορούντων επιπέδων FGF23 και Klotho με την ηλικία και το ρυθμό μέγιστης σωληναριακής επαναρρόφησης φωσφόρου (TmP/GFR) και να μελετήσουμε τις παραμέτρους που τυχόν επηρεάζουν τα επίπεδα FGF23 και Klotho. Μέθοδοι: Σε 159 υγιή παιδιά (82 αγόρια) με μέση ± SD ηλικία 8.78 ± 3.47 έτη μετρήθηκε ο FGF23 (τόσο ο iFGF23 όσο και ο cFGF23) και το κυκλοφορούν Klotho (sKlotho) με τεχνικές ELISA. Υπολογίσαμε επίσης τα επίπεδα του TmP/GFR. Αποτελέσματα: Η μέση τιμή ± SD του cFGF23 ήταν 51.14 ± 12.79 RU/ml ενώ η διάμεσος (εύρος) του iFGF23 και του Klotho ήταν 35 (8.8, 120) pg/ml and 1945 (372, 5866) pg/ml αντιστοίχως. Ούτε ο FGF23 αλλά ούτε και το Klotho δε σχετίζονταν με την ηλικία. Τα παιδιά που είχαν μπει στην εφηβεία είχαν υψηλότερα επίπεδα Klotho (p < 0.05). Τα κορίτσια είχαν υψηλότερα επίπεδα cFGF23 (p < 0.05) και Klotho (p < 0.001). Τα επίπεδα του κυκλοφορούντος φωσφόρου και TmP/GFR ήταν θετικώς συσχετιζόμενα με τον cFGF23 (p < 0.01 και p < 0.001), iFGF23 (p < 0.05 και p < 0.001) και Klotho (p < 0.05 και p < 0.01). Το Klotho ήταν θετικώς συσχετιζόμενο με τον IGF-I (p < 0.0001) και 1,25 (OH)2 βιταμίνη D (p < 0.05). Συμπεράσματα: Στην παρούσα μελέτη παρουσιάζουμε δεδομένα για τα επίπεδα cFGF23, iFGF23, και Klotho που μετρήθηκαν ταυτόχρονα σε υγιή παιδιά. Η θετική συσχέτιση μεταξύ κυκλοφορούντος φωσφόρου και TmP/GFR με τον FGF23 και το Klotho υποδηλώνει ότι έχουν έναν αντισταθμιστικό ρόλο στην ομοιόσταση φωσφόρου. Η ισχυρή συσχέτιση μεταξύ Klotho και IGF-I μπορεί να σημαίνει ότι το Klotho έχει κάποιο ρόλο στην κατά μήκος ανάπτυξη κατά την παιδική ηλικία μέσω ρύθμισης της ομοιόστασης του φωσφόρου αλλά περισσότερες μελέτες χρειάζονται για να διευκρινιστεί αυτό περαιτέρω. / Phosphate serum levels in children vary with age. Fibroblast Growth Factor 23 (FGF23) is a phosphaturic hormone that plays an important role in phosphate homeostasis. Klotho is the essential co-player of FGF23 that mediates the binding of FGF23 to its receptor. Data for fibroblast growth factor 23 (FGF23) and particularly for Klotho in healthy children are limited. Objective and hypotheses: We aimed to investigate the relationship between FGF23 and Klotho serum levels with age and TmP/GFR and to evaluate parameters that might affect FGF23 and Klotho. Methods: In 159 healthy children (82 boys) with a mean ± SD age of 8.78 ± 3.47 years we measured FGF23 (intact FGF23/ iFGF23 and C-terminal FGF23/ cFGF23) and soluble Klotho (sKlotho) serum levels by ELISA. We also determined the TmP/GFR. Results: Mean ± SD value for cFGF23 was 51.14 ±12.79 RU/ml whereas median (range) values for iFGF23 and Klotho were 35 (8.8, 120) pg/ml and 1945 (372, 5866) pg/ml respectively. Neither FGF23 nor Klotho were significantly associated with age. Pubertal children had higher Klotho (p < 0.05). Girls had higher levels of cFGF23 (p < 0.05) and Klotho (p < 0.001). Serum phosphate and TmP/GFR were positively associated with cFGF23 (p < 0.01 and p < 0.001), iFGF23 (p < 0.05 and p < 0.001) and sKlotho (p < 0.05 and p < 0.01). Klotho was positively correlated with IGF-I (p < 0.0001) and 1,25 (OH)2 vitamin D (p < 0.05). Conclusions: We provide data on FGF23, and Klotho measured simultaneously in healthy children. The positive association of serum phosphate and TmP/GFR with FGF23 and Klotho suggests that they have a counterregulatory effect on phosphate homeostasis. The strong association of Klotho with IGF-I could indicate a role of Klotho in linear growth through regulation of phosphate homeostasis, but further studies are required.

La protéine Klotho (KL) possède des propriétés anti-vieillissement et anti-cancer. Les données cliniques montrent que l’expression de KL est associée à une meilleure survie des patients atteints de liposarcome. De plus, elle est réduite par rapport au tissu sain dans les liposarcomes dédifférenciés (DDLPS), un type de tumeur maligne rare mais de mauvais pronostic. Nos résultats montrent que KL sensibilise les DDLPS aux chimiothérapies (gemcitabine, navitoclax). L’abondance de KL dans les tumeurs pourrait donc servir de biomarqueur pour prédire l’efficacité des chimiothérapies et mettre en place une médecine plus personnalisée. De plus, des médicaments utilisés pour d’autres pathologies et connus pour stimuler l’expression de KL (Cozaar) pourraient être testés en association avec la chimiothérapie. Enfin, inspirés par le mode d’action de KL, nous avons testé la combinaison de la gemcitabine avec le navitoclax, qui s’est révélée très efficace sur les DDLPS. / Klotho (KL) is both an anti-ageing and anti-cancer protein. Analysis of clinical data highlights that high expression of KL is associated with a better overall survival of liposarcoma patients. Moreover, its expression in downregulated in dedifferentiated liposarcomas (DDLPS), a rare type of tumor associated with a poor prognosis due to high chemoresistance. Our results show that KL sensitizes DDLPS cells to chemotherapeutic agents (gemcitabine, navitoclax). So, abundance of KL in tumoral tissues could serve as a biomarker for predicting gemcitabine efficacy and so, could help for establishing personalized therapy. Moreover, drugs increasing KL expression could be tested in combination with chemotherapy. Based on KL mechanism of action, we also highlight that the combination between gemcitabine and navitoclax is very effective for killing DDLPS cells.

Fibroblast Growth Factor 19 (FGF19 chez l’humain ; FGF15 chez la souris) est un régulateur central du métabolisme hépatique. Cette molécule a un impact important au niveau de la différentiation neurologique et de l’oreille interne au stade foetal. À l’âge adulte, le patron d’expression est restreint au système gastro-intestinal. Contrairement aux autres membres de la superfamille des FGFs, FGF19/15 agit de manière endocrine car il n’est pas retenu par la matrice extracellulaire et peut rejoindre la circulation sanguine. L’expression de FGF19/15 est induite par les acides biliaires au niveau de l’intestin grêle, plus précisément l’iléon. Les acides biliaires lient le récepteur nucléaire Farnesoid-XReceptor (FXR) qui peut ensuite s’hétérodimériser avec Retinoid-X-Receptor (RXR) pour se lier au promoteur de FGF19/15, ce qui enclenche son expression. Une fois dans le sang, l’hormone rejoint le foie et son action est médiée par le complexe de récepteur Fibroblast Growth Factor Receptor 4 (FGFR4) et β-Klotho (BKL). Une fois les récepteurs activés, FGF19/15 module la glycémie en inhibant la néoglucogenèse hépatique et en activant la synthèse du glycogène, le flux protéique en activant eIF4B et la lipémie en inhibant les enzymes clefs de la lipogénèse. FGF19/15 joue aussi un rôle majeur au niveau du métabolisme biliaire. Ce dernier permet de réduire la production d’acide biliaire en inhibant la Cholesterol 7-α oxygenase (CYP7A1). Les travaux présentés dans ce mémoire portent dans un premier temps sur la caractérisation des conséquences amenées par l’infection sur l’axe endocrine FGF15/FGFR4. Un premier manuscrit traite de l’expression des différents gênes clefs du système et de leur perte lors d’une infection à Salmonella typhimurium, l’agent pathogène causant la fièvre typhoïde chez la souris, et des conséquences sur l’homéostasie biliaire. Il est possible de remarquer une perte de l’expression de FGF15 au niveau de l’intestin et de FGFR4 et β-Klotho au niveau du foie, en plus de plusieurs transporteurs responsables d’amener différents composants clefs de la bile à la vésicule biliaire ou à la circulation sanguine. Le deuxième volet du travail consistait à déterminer le mécanisme derrière la perte du complexe de récepteurs FGFR4/β-Klotho. Les résultats préliminaires démontrent que la perte de β-Klotho semble être médiée seulement par le processus inflammatoire normal et la perte de FGFR4 semble être Salmonella dépendante, par le biais de la voie c- Jun N-terminal kinases (JNK) et le facteur de transcription Hepatic Nuclear Factor 1 alpha (HNF1α)

Indiana University-Purdue University Indianapolis (IUPUI) / Fibroblast growth factor-23 (FGF23) is a hormone produced in bone that acts upon the kidney to control blood phosphate and 1,25-(OH)2 vitamin D concentrations. Chronic kidney disease-mineral bone disorder (CKD-MBD) is a major public health problem, affecting 1 in 8 individuals. These patients can have markedly elevated FGF23 at end stage disease which is associated with metabolic bone anomalies, left ventricular hypertrophy, as well as increased mortality (>6-fold). The FGF23 co-receptor αKlotho (αKL) is a membrane-bound protein (mKL) that forms heteromeric complexes with FGF receptors (FGFRs) to initiate intracellular signaling. It also circulates as a cleavage product of mKL (‘cleaved’, or cKL). Previously, a patient with increased plasma cKL from a balanced translocation between chromosomes 9 and 13 in the KLOTHO gene presented with metabolic bone disease and a complex endocrine profile, despite hypophosphatemia. The lack of a reliable cell model in which to study potential FGF23-cKL interactions is a major hurdle for the field of phosphate metabolism. The goal of the present studies was to test and characterize bone cell lines that may respond to FGF23 and/or cKL, permitting study of novel aspects of phosphate handling and control of FGF23 expression. It was confirmed that stable delivery of cKL via AAV2/8 to wild type (WT) and KL-KO mice resulted in highly elevated bone FGF23 mRNA. MC3T3 (mouse) and ROS (rat) osteoblastic cell lines were tested for p-ERK1/2 responses to control FGFs, as well as FGF23 and cKL, alone or in combination. Importantly, both cell lines demonstrated responsiveness to FGF23+cKL only, and not the individual factors. To test responsiveness at the cell level, EGR1 mRNA was tested as an index of FGFR activity and showed modest increases with the same treatments, supporting that other factors may be required for full transcriptional effects. The present studies show that MC3T3 have FGF-dependent signaling capabilities, and that the combination of FGF23+cKL is required for efficient MAPK signaling. These results demonstrated that cKL provision is permissive for efficient FGF23 signaling in bone, and revealed important implications for the regulation of FGF23 and cKL in Mendelian, and common, genetic disorders of phosphate handling and biomineralization.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19580号 / 医博第4087号 / 新制||医||1013(附属図書館) / 32616 / 京都大学大学院医学研究科医学専攻 / (主査)教授 妹尾 浩, 教授 木村 剛, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

O hiperparatireoidismo secundário à doença renal crônica (HPS) acomete inúmeros pacientes. Não existe consenso sobre qual tipo de paratireoidectomia (PTx) se associa com melhores resultados. Na PTx total com autoimplante (PTx-AI) especula-se se o número de fragmentos implantados melhora desfechos clínicos. Trinta e seis (36) pacientes com HPS foram randomizados para PTx-AI com 45 ou 90 fragmentos de paratireoide. Prospectivamente, avaliamos os fatores clínicos, bioquímicos e anatomopatológicos que influenciaram a função do AI. No início do estudo (t0), o Grupo-45 (N = 28) e Grupo-90 (N = 8) eram semelhantes, com exceção dos níveis séricos de fosfato. Após 12 meses (t12), os níveis séricos de PTH do enxerto e sistêmico correlacionaram-se com o cálcio iônico (Cai)-t0 (r2 = 0,442, p = 0,016; r2= 0,450, p = 0,008, respectivamente). A duração da fome óssea correlacionou-se com fosfatase alcalina (FA)-t0 (r2 = 0,593, p = 0,001). Nas células paratireoideanas, a expressão de PCNA correlacionou-se com o tempo em hemodiálise (r2 = 0,437, p = 0,016); a expressão do receptor-1 do fator de crescimento de fibroblastos (FGFR1) com FA-t0 (r2 = -0,758; p = 0,0001); o receptor de vitamina-D (VDR) com Cai-t0 (r2 = -0,464, p = 0,007) e carga cumulativa de Ca elemento (r2 = - 0,359, p = 0,04); o receptor sensível ao Ca (CaSR) com menor uso de calcitriol (r2 = -0,445, p = 0,049); e o Klotho com a dose de vitamina D pré- PTx (r2 = 0,811, p = 0,027) e com fosfato-t0 (r2= -0,528, p = 0,017). Houve progressão do escore de calcificação vascular [0,53 (0 - 4) vs. 1,1 (0 - 8); p = 0,04], que se correlacionou com a carga cumulativa de Ca elemento (r2 = 0,605, p = 0,006) e com o fosfato-t0 (r2 = 0,503; p = 0,028). Em conclusão, a PTx independentemente do número de AI controlou o HPS; porém parece piorar a calcificação vascular. Os níveis séricos de PTH pós-PTx ou evolução para hipo- ou normoparatireoidismo não foram influenciados pelo número de AI, nem por outros parâmetros bioquímicos e tão pouco pela densidade de expressão de PCNA, CaSR, VDR, FGFR1 ou Klotho nas células paratireoideanas / Hyperparathyroidism secondary to chronic kidney disease (SHP) affects many patients. There is no consensus about what kind of parathyroidectomy (PTx) is associated with better results. In total PTx with auto transplant (PTx- AT) it is speculated that the number of implanted fragments improves clinical outcomes. Third six (36) patients with refractory SHP were randomized to PTx-AT with 45 or 90 parathyroid fragments. We prospectively evaluated the clinical, biochemical and pathological factors influencing AT function. At baseline (t0) Group-45 (N = 28) and Group-90 (N = 8) were similar, except for serum phosphate levels. After 12 months (t12), PTH levels of graft and systemic correlated with ionic calcium (Cai) t0 (r2 = 0.442, p = 0.016; r2 = 0.450, p = 0.008, respectively). The duration of hungry bone syndrome correlated with alkaline phosphatase (AP) -t0 (r2 = 0.593, p = 0.001). In parathyroid cells, PCNA expression correlated with time on hemodialysis (r2 = 0.437, p = 0.016), expression of receptor-1 of fibroblast growth factor (FGFR1) with AP-t0 (r2 = -0.758; p = 0.0001), vitamin D receptor (VDR) with Cai t0 (r2 = -0.464, p = 0.007) and cumulative elemental Ca load (r2 = -0.359, p = 0.04), Ca sensing receptor (CaSR) with less use of calcitriol (r2 = -0.445, p = 0.049), and Klotho with the dose of vitamin D pre-PTx (r2 = 0.811, p = 0.027) and phophate-t0 (r2 = -0.528, p = 0.017). There was progression of vascular calcification score [0.53 (0 to 4) vs. 1.1 (0 to 8); p = 0.04] which correlated with cumulative elemental Ca load (r2 = 0.605, p = 0.006) and with phosphate-t0 (r2 = 0.503; p = 0.028). In conclusion, PTx controlled refractory SHP regardless of the number of AT; however, it seems to worsening vascular calcification. Serum levels of PTH or post-PTx evolution of hypo- or normoparathyroidism were not influenced by the number of AT or other biochemical parameters, nor by the density of PCNA expression, CaSR, VDR, FGFR1 or Klotho in parathyroid cells

A sepse relacionada à disfunção de múltiplos órgãos é caracterizada por uma intensa resposta inflamatória e um aumento do estresse oxidativo. A lesão renal aguda (LRA) é uma complicação grave e ocorre em aproximadamente metade dos pacientes com choque séptico. Apesar dos avanços no entendimento e tratamento da sepse, as taxas de mortalidade da LRA séptica chegam a 75%, valores ainda inaceitáveis. Mais de 60% dos casos de sepse ocorrem em idosos. A sepse, a lesão renal aguda e a idade avançada são em conjunto uma condição altamente fatal. O Klotho é uma proteína supressora do envelhecimento, com propriedades antioxidantes e que já demonstrou ser nefro-protetora no modelo de lesão renal aguda por iquemia e reperfusão. O papel do Klotho na sepse e na LRA da sepse permanece ainda desconhecido. O objetivo desse estudo foi avaliar se a redução da expressão de Klotho poderia piorar a evolução da sepse e das suas disfunções orgânicas, em especial a LRA. Para isso utilizamos camundongos heterozigotos haploinsuficientes para gene Klotho (Kl+/-) e seus irmãos de linhagem wild type (WT) divididos em 4 grupos: 1. Grupo Sham-WT: animais WT submetidos à cirurgia com apenas localização ceco; 2. Grupo LPC-WT: animais WT submetidos à cirurgia com ligação e punção do ceco (LPC); 3. Sham-Kl+/-: animais haploinsuficientes para o gene Klotho submetidos à cirurgia com apenas localização ceco; 4. LPC-Kl+/-: animais haploinsuficientes para o gene Klotho submetidos à cirurgia LPC. Inicialmente foi demonstrado que a sepse é um estado de deficiência de Klotho, já que a expressão renal de Klotho diminuiu após a realização da LPC tanto nos animais WT quanto nos Kl+/-comparados com seus respectivos grupos Sham. Os animais LPC-Kl+/- apresentaram uma significativa menor sobrevida quando comparados aos LPC-WT. O grupo LPC-Kl+/- evoluiu com uma LRA mais severa demonstrada por redução do débito urinário, aumento da ureia plasmática e um pior escore de dano tubular renal. Os animais LPC-Kl+/- apresentavam ainda uma piora da perfusão tecidual, evidenciada por um aumento mais significativo do lactato, e também uma maior lesão hepática. A deficiência de Klotho também esteve associada a um aumento do estresse oxidativo, um aumento das citocinas inflamatórias sistêmicas e no tecido renal, bem como a uma maior ativação do NF-kB. Na avaliação hemodinâmica, curiosamente, os camundongos LPC-Kl+/- também apresentaram uma menor variabilidade da frequência cardíaca com menor atividade simpática, um prejuízo na resposta barorreflexa e uma resposta deficiente da pressão arterial à droga vasopressora. Podemos concluir, com os achados desse estudo, que a baixa expressão de Klotho reduz a sobrevida, agrava a sepse e suas disfunções orgânicas por aumentar o estresse oxidativo e a resposta inflamatória. A utilização da proteína Klotho no tratamento da sepse e da lesão renal aguda pode constituir-se uma nova perspectiva terapêutica a ser tentada na prática clínica / Sepsis-related multiple organ dysfunction is characterized by an intense inflammatory response and increased oxidative stress. Acute renal injury (AKI) is a serious complication that occurs in approximately half of all patients with septic shock. Despite advances in treatment, sepsis mortality can still be unacceptably high (<= 75%). More than 60% of all cases of sepsis occur in the elderly. Sepsis, AKI, and advanced age appear to be closely related, making for a highly lethal combination. Klotho is an antioxidant-suppressing protein that is known to protect the kidneys in experimental ischemia. The role of Klotho in sepsis and sepsis-induced AKI remains unknown. The aim of this study was to determine whether reduced Klotho expression could worsen the evolution of sepsis and the associated organic dysfunction, especially AKI. To that end, we used Klotho gene (Kl+/-) haploinsufficient heterozygous mice and their wild-type (WT) littermates, divided into 4 groups: CLP-WT, WT mice submitted to cecal ligation and puncture (CLP) to induce sepsis; Sham-WT, WT mice submitted to surgery with cecum localization only (sham-operated); CLP-Kl+/-, Klotho haploinsufficient mice submitted to CLP; and Sham-Kl+/-, sham-operated Klotho haploinsufficient mice. Initially, sepsis was shown to be a Klotho deficient state, because post-procedure renal expression of Klotho was lower in the CLP-WT and CLP-Kl+/- groups than in the respective control groups. The CLP-Kl+/- group showed significantly lower survival than did the CLP-WT group. Sepsis-induced AKI was more severe in the CLP-Kl+/- group than in the CLP-WT group, the former showing lower urine output, higher plasma urea, and higher renal tubular damage scores. The CLP-Kl+/- mice also showed decreased tissue perfusion, as evidenced by a more significant increase in lactate, together with greater hepatic injury. Klotho deficiency was also associated with increased oxidative stress, increased systemic/renal tissue inflammatory cytokine production, and greater NF-?B activation. We find it curious that, in the hemodynamic evaluation, the CLP-Kl+/- mice had lower heart rate variability with lower sympathetic activity, a poorer baroreflex response, and a lower blood pressure response to vasopressor agents than did the CLP-WT mice. Our findings suggest that low Klotho expression reduces survival and aggravates sepsis, as well as the associated organic dysfunction, by increasing oxidative stress and the inflammatory response. The use of Klotho protein in the treatment of sepsis and sepsis-induced AKI might constitute a new therapeutic strategy to be evaluated in clinical practice

Alterações no receptor N-metil-D-aspartato(NMDAR) marcam o envelhecimento. Um dos efeitos desta via é a ativação da óxido nítrico sintase (NOS) e a produção GMP cíclico (GMPc), promovendo modulação da Na+,K+-ATPase. A proteína &#945;Klotho tem função anti-envelhecimento, e os animais hipomórficos para klotho (kl-/-) são caracterizados por danos periféricos e no Sistema Nervoso Central (SNC). O objetivo deste trabalho é verificar possíveis alterações na via NMDAR-NOS-GMPc e na Na+,K+-ATPase no SNC de camundongos kl-/-. Os dados obtidos apontam para um aumento da fosforilação do NMDAR , atividade da NOS, e redução de GMPc em hipocampo. Em cerebelo ocorre uma redução na fosforilação do NMDAR, atividade da NOS, sem alterações nos níveis de GMPc. Diferenças na expressão das subunidades GluN2 do NMDAR ocorrem em ambas estruturas. Também, observamos uma redução na atividade da &#945;2/&#945;3-Na+,K+-ATPase em cerebelo, e alterações na expressão de &#945;2 e &#945;3 em hipocampo e de &#945;2 em cerebelo. Os dados reforçam a participação destas vias nas alterações em SNC dos animais kl-/-. / Alterations in N-Methyl-D-Aspartate receptor (NMDAR) are typical features of aging. Nitric oxide synthase (NOS) activation and cyclic GMP (cGMP) production, promoting Na+,K+-ATPase modulation are key events in NMDAR signaling. &#945;Klotho protein has anti-aging function, and mice carrying hypomorph allele for klotho gene (kl-/-) are characterized by systemic and central nervous system (CNS) damage. The aim of this work is to verify whether alterations in NMDAR-NOS-cGMP pathway and in Na+,K+-ATPase occur in the CNS of kl-/- mice. Present data point for an increase in NMDAR phosphorylation, NOS activity and reduction in cGMP levels. In cerebellum, a decrease in NMDAR phosphorylation and NOS activity occur, with no changes in cGMP levels. Both situations are followed by changes in GluN2 subunity expression. Furthermore, we saw a reduction in &#945;2/&#945;3-Na+,K+-ATPase activity in cerebellum, and alterations in &#945;2 and &#945;3 in hippocampus and in cerebellar &#945;2. Data presented support these pathways participation in age related conditions, using kl-/- mice as a model to study CNS damage.

A nicotina é o principal componente do tabaco e dos cigarros eletrônicos. A exposição crônica a nicotina, em quantidades semelhantes às atingidas pelo tabagismo humano, é responsável por piora da lesão renal aguda e da doença renal crônica. O gene klotho, predominantemente expresso no rim, foi descoberto após uma mutação insercional, com o surgimento de um fenótipo semelhante ao envelhecimento humano nos camundongos homozigotos para esse transgene. A proteína Klotho transmembrana tem ação de co-receptor do fator de crescimento fibroblástico 23 (FGF-23) e sua forma secretada atua em diversas vias intracelulares e em órgãos a distância. A deficiência de Klotho ocorre no envelhecimento, em situações que levam a lesão renal aguda e na doença renal crônica. A expressão reduzida de Klotho também agrava lesão renal aguda e participa da progressão da doença renal crônica, enquanto o seu aumento, ou a sua reposição, protegem dos processos inflamatórios e do estresse oxidativo. Neste estudo, objetivamos avaliar os efeitos renais, hemodinâmicos e sobre a expressão de Klotho da exposição crônica a nicotina e quais os efeitos dessa exposição nos animais haploinsuficientes para o transgene klotho (Kl+/-). Utilizamos para estas avaliações camundongos Kl+/- e seus controles wild type (Kl+/+), que foram expostos a nicotina (200 mcg/mL) ou veículo (sacarina 2%) diluídos em água por 28 dias. Ao final do estudo foram avaliados diurese, eletrólitos plasmáticos e urinários, ureia, aldosterona, ADH, FGF-23 e PTH intactos plasmáticos, expressão protéica renal de Klotho, alfa7-nAchR, NHE3, ENaC, NKCC2, AQP2, e-NOS, VEGF, MnSOD e renina, expressão genica renal de klotho, interleucinas, TBARS e GSH em tecido renal, taxa de filtração glomerular por FITC-inulina, pressão arterial e frequência cardíaca invasivas, sensibilidade baroreflexa e modulação autonômica cardíaca e periférica por análise espectral. Após a exposição a nicotina, os animais Kl+/+ apresentaram redução da expressão renal da proteína e do RNAm de Klotho e uma tendência a aumento dos níveis plasmáticos de FGF-23, associados a uma queda da diurese e da taxa de filtração glomerular, sem alteração dos níveis de ADH. Esses animais Kl+/+ também apresentaram aumento da sensibilidade barorreflexa em resposta ao nitroprussiato e um predomínio da modulação simpática cardíaca, com redução da expressão renal dos alfa7-nAchR. Os animais Kl+/- tiveram níveis renais ainda menores de Klotho após a exposição a nicotina, com aumento de TBARS, IL-6, uréia e aldosterona em relação aos Kl+/- não expostos. A diurese, a taxa de filtração glomerular e a expressão dos alfa7-nAchR não se reduziram e não houve aumento da sensibilidade barorreflexa após exposição a nicotina, com um predomínio da modulação parassimpática cardíaca, nesses animais Kl+/-. A ingesta hídrica, a pressão arterial e a frequência cardíaca foram semelhantes entre os 4 grupos. A proteinúria foi maior nos animais Kl+/- do que nos animais Kl+/+ após a exposição a nicotina. Podemos concluir que a exposição crônica à nicotina reduz a expressão renal de Klotho, estimula vias de inflamação, fibrose e estresse oxidativo renais e tem efeitos renais e sistêmicos diferentes de acordo com os níveis basais de Klotho / Nicotine is a major compound of tobacco and electronic cigarettes. Chronic exposure to nicotine concentrations that are similar to human smoke worsens acute kidney injury and chronic kidney disease. The klotho (Kl) gene is expressed predominantly by the kidney and was discovered after an unintentional insertional mutation that resulted, in transgenic homozygous mice, in a phenotype similar to human aging. Klotho transmembrane protein acts as a co-receptor to fibroblastic growth factor 23 (FGF-23) and the secreted form interacts in multiple intracellular pathways, with effects in distant organs. Klotho deficiency occurs in aging and in multiple acute kidney injury and chronic kidney disease etiologies, whereas klotho upregulation and replacement protect from inflammation and oxidative stress. Here, we investigated renal and hemodynamic effects of chronic nicotine exposure, its effects over renal expression of Kl, and compared wild type (Kl+/+) and Kl haploinsufficient mice (Kl+/-) in terms of the effects of that exposure. Kl+/- and Kl+/+ mice received nicotine (200 ?g/ml) or vehicle (saccharine 2%) in drinking water for 28 days. We evaluated diuresis, ions in serum and urine, urea, plasma and urinary levels of cotinine, aldosterone, plasma antidiuretic and parathyroid hormone, plasma FGF-23, protein expression of (immunoblotting for) Klotho and ?7 nicotinic acetylcholine receptor, NHE3, NKCC2, ENaC, aquaporin-2, e-NOS, VEGF and renin, klotho mRNA, kidney interleukines, TBARS and GSH, glomerular filtration rate by fluorescein isothiocyanate-inulin clearance, mean arterial pressure, heart rate, baroreflex sensitivity and autonomic cardiac and peripheral modulation by spectral analysis. After nicotine exposure, Kl+/+ mice showed decreased Klotho protein and mRNA and a tendency towards an elevation in plasma FGF-23, which were associated with both diuresis and glomerular filtration rate reductions, without modifications in ADH levels. Besides that, Kl+/+ animals increased baroreflex sensitivity after nitroprusside, a predominant sympathetic cardiac modulation and lower alfa7-nAchR kidney expression. Kl+/- mice reduced even more Klotho renal expression, with higher levels of TBARS, IL-6, urea and aldosterone. Diuresis, glomerular filtration rate, alfa7-nAchR expression and baroreflex sensitivity were the same of their controls. Cardiac parasympathetic modulation predominated in Kl+/- mice. Fluid intake, mean arterial pressure and heart rate were similar across the 4 groups. Renal protein excretion was higher in Kl+/- than in their controls after nicotine exposure. We can conclude that chronic nicotine exposure downregulates Klotho kidney expression induces inflammation and oxidative stress and stimulates fibrosis, with different renal and systemic responses according to basal Klotho levels