The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets

Diabetic kidney disease (DKD) is recognized worldwide as a leading cause of end-stage renal failure. Although therapies that target glomerular hemodynamics and can inhibit disease progression have been developed, there is currently no fundamental cure for the disease. Mitochondria play an important...

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Main Authors: Masanobu Takasu, Seiji Kishi, Hajime Nagasu, Kengo Kidokoro, Craig R. Brooks, Naoki Kashihara
Format: Article
Language:English
Published: Elsevier 2025-02-01
Series:Kidney International Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2468024924020035
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author Masanobu Takasu
Seiji Kishi
Hajime Nagasu
Kengo Kidokoro
Craig R. Brooks
Naoki Kashihara
author_facet Masanobu Takasu
Seiji Kishi
Hajime Nagasu
Kengo Kidokoro
Craig R. Brooks
Naoki Kashihara
author_sort Masanobu Takasu
collection DOAJ
description Diabetic kidney disease (DKD) is recognized worldwide as a leading cause of end-stage renal failure. Although therapies that target glomerular hemodynamics and can inhibit disease progression have been developed, there is currently no fundamental cure for the disease. Mitochondria play an important role in cellular respiration, producing adenosine triphosphate (ATP) by oxidative phosphorylation, and are essential for renal function, especially in proximal tubular cells (PTCs). In diabetic conditions, maintaining mitochondrial health is vital for preserving renal function. Under diabetic conditions, excessive reactive oxygen species (ROS) can damage mitochondrial DNA (mtDNA), leading to renal dysfunction. Strategies targeting mitochondrial function, such as AMP-activated protein kinase (AMPK) activation and modulation of nitric oxide (NO) availability, are promising for suppressing diabetic nephropathy. The immune response to DKD, initiated by detecting damage- and pathogen-associated molecular patterns, has a significant impact on the progression of DKD, including leakage of mtDNA and RNA, leading to inflammation through various pathways. This contributes to renal impairment characterized by hyperfiltration, endothelial dysfunction, and albuminuria. Mitochondrial energy metabolism and dynamics induced by hyperglycemia precede the onset of albuminuria and histological changes in the kidneys. The increased mitochondrial fission and decreased fusion that occur under diabetic conditions result in ATP depletion and exacerbate cellular dysfunction. Therapeutic strategies focused on restoring mitochondrial function are promising for slowing the progression of DKD and reduce the adverse effects on renal function. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 (GLP-1) receptor agonists, already in clinical use, have been shown to be protective for mitochondria, and nuclear factor erythroid 2-related factor 2 (Nrf2) activation and mitochondrial dynamics are promising drug discovery targets for further research.
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spelling doaj-art-a3a5dc8d8d62435190a7986e58113d102025-08-20T02:33:34ZengElsevierKidney International Reports2468-02492025-02-0110232834210.1016/j.ekir.2024.10.035The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic TargetsMasanobu Takasu0Seiji Kishi1Hajime Nagasu2Kengo Kidokoro3Craig R. Brooks4Naoki Kashihara5Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, JapanDepartment of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan; Correspondence: Seiji Kishi, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, 7010192, Japan.Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, JapanDepartment of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, JapanDivision of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USADepartment of Medical Science, Kawasaki Medical School, Kurashiki, Japan; Kawasaki Geriatric Medical Center, Kawasaki Medical School, Okayama, JapanDiabetic kidney disease (DKD) is recognized worldwide as a leading cause of end-stage renal failure. Although therapies that target glomerular hemodynamics and can inhibit disease progression have been developed, there is currently no fundamental cure for the disease. Mitochondria play an important role in cellular respiration, producing adenosine triphosphate (ATP) by oxidative phosphorylation, and are essential for renal function, especially in proximal tubular cells (PTCs). In diabetic conditions, maintaining mitochondrial health is vital for preserving renal function. Under diabetic conditions, excessive reactive oxygen species (ROS) can damage mitochondrial DNA (mtDNA), leading to renal dysfunction. Strategies targeting mitochondrial function, such as AMP-activated protein kinase (AMPK) activation and modulation of nitric oxide (NO) availability, are promising for suppressing diabetic nephropathy. The immune response to DKD, initiated by detecting damage- and pathogen-associated molecular patterns, has a significant impact on the progression of DKD, including leakage of mtDNA and RNA, leading to inflammation through various pathways. This contributes to renal impairment characterized by hyperfiltration, endothelial dysfunction, and albuminuria. Mitochondrial energy metabolism and dynamics induced by hyperglycemia precede the onset of albuminuria and histological changes in the kidneys. The increased mitochondrial fission and decreased fusion that occur under diabetic conditions result in ATP depletion and exacerbate cellular dysfunction. Therapeutic strategies focused on restoring mitochondrial function are promising for slowing the progression of DKD and reduce the adverse effects on renal function. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 (GLP-1) receptor agonists, already in clinical use, have been shown to be protective for mitochondria, and nuclear factor erythroid 2-related factor 2 (Nrf2) activation and mitochondrial dynamics are promising drug discovery targets for further research.http://www.sciencedirect.com/science/article/pii/S2468024924020035diabetic kidney diseasemitochondriaoxidative stress
spellingShingle Masanobu Takasu
Seiji Kishi
Hajime Nagasu
Kengo Kidokoro
Craig R. Brooks
Naoki Kashihara
The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
Kidney International Reports
diabetic kidney disease
mitochondria
oxidative stress
title The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
title_full The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
title_fullStr The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
title_full_unstemmed The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
title_short The Role of Mitochondria in Diabetic Kidney Disease and Potential Therapeutic Targets
title_sort role of mitochondria in diabetic kidney disease and potential therapeutic targets
topic diabetic kidney disease
mitochondria
oxidative stress
url http://www.sciencedirect.com/science/article/pii/S2468024924020035
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