doi:10.1369/jhc.5A6623.2005
Volume 53 (12): 1459-1468, 2005 Copyright ©The Histochemical Society, Inc. Provinol Prevents CsA-induced Nephrotoxicity by Reducing Reactive Oxygen Species, iNOS, and NF-kB Expression
Division of Human Anatomy, Department of Biomedical Sciences and Biotechnology, University of Brescia, Brescia, Italy (BB,LG,RB,RR); Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic (OP,SK); and Pharmacologie et Physico-Chimie des Interactions Cellulaires et Moléculaires, Université Louis Pasteur de Strasbourg, Illkirch, France (RA) Correspondence to: Prof. Rita Rezzani, Department of Biomedical Sciences and Biotechnology, Division of Human Anatomy, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy. E-mail: rezzani{at}med.unibs.it
Cyclosporine A (CsA) use is associated with several side effects, the most important of which is nephrotoxicity that includes, as we previously showed, tubular injury and interstitial fibrosis. Recently, many researchers have been interested in minimizing these effects by pharmacological interventions. To do this, we tested whether the administration of a red wine polyphenol, Provinol (PV), prevents the development of CsA-induced nephrotoxicity. Rats were treated for 21 days and divided into four groups: control; group treated with PV (40 mg/kg/day by oral administration in tap water); group treated with CsA (15 mg/kg/day by subcutaneous injection); group treated with CsA plus PV. CsA produced a significant increase of systolic blood pressure; it did not affect urinary output, but caused a significant decrease in creatinine clearance. These side effects were associated with an increase in conjugated dienes, which are lipid peroxidation products, inducible NO-synthase (iNOS), and nuclear factor (NF)-kB, which are involved in antioxidant damage. However, PV prevented these negative effects through a protective mechanism that involved reduction of both oxidative stress and increased iNOS and NF-kB expression induced by CsA. These results provide a pharmacological basis for the beneficial effects of plant-derived polyphenols against CsA-induced renal damage associated with CsA. (J Histochem Cytochem 53:14591468, 2005)
Key Words: fibrosis kidney Provinol ROS
CYCLOSPORINE A (CSA), a fungal undecapeptide, is the most common immunosuppressive drug used in organ transplantation and autoimmune diseases. However, clinical use is often limited by nephrotoxicity, which remains a major problem. Our previous articles showed that nephrotoxicity was related to tubulointerstitial fibrosis and glomerular vasoconstriction. In fact, tubulointerstitial fibrosis was mainly observed in proximal tubules with respect to distal tubules, suggesting that the proximal tubules were involved in CsA-induced nephrotoxicity (Rezzani 2004 The present study was designed to test whether the administration PV might prevent the development of nephrotoxicity induced by chronic treatment of rats with CsA. Moreover, we evaluated by: (1) morphological method, picrosirius staining, the CsA-induced alterations in renal cytoarchitecture underlying the increase of interstitial fibrosis induced by the drug; (2) immunohistochemical and biochemical analysis, the iNOS and nuclear factor (NF)-kB expression, as markers of oxidative damage; and (3) biochemical assay, the lipid peroxidation products, such as conjugated dienes.
Animal and Experimental Design Forty adult male Wistar rats weighing 200300 g were obtained from Harlan Laboratories (Udine, Italy). They were housed in individual cages at a constant temperature with a 12-hour dark/light cycle and fed with a standard diet. All experiments were performed in accordance with Institutional guidelines for the ethical care of animals. An adaptation period of 2 weeks was allowed before the treatments. The rats were randomly divided into four groups (n=10 in each group) and treated for 21 days. Group I (control rats) received olive oil, the CsA vehicle, with SC injections; group II rats were treated with oral administration of PV alone (40 mg/kg/day diluted in tap water); group III rats were treated with CsA (15 mg/kg/day in olive oil, SC); group IV rats were treated simultaneously with PV and CsA at the same dose previously reported. PV, dry powder from red wine, was provided by Mr. D. Ageron (Société Francaise de Distillerie; Vallont Pont d'Arc, France). The composition of PV has been determined as follows: (in mg/g of dry powder): proanthocyanidins 480, total anthocyanins 61, free anthocyanins 19, catechin 38, hydroxycinnamic acid 18, and flavonols 14. The administration of CsA (purchased from Novartis, Basel, Switzerland) was made considering the weight of the animal. To make sure that each animal received the complete dose of PV, the calculated amount of PV was given to each rat in the appropriate volume of water (0.2 mg/ml). Daily water consumption was estimated individually for every animal 1 week before the experiment. During the experiment, water consumption was controlled, with graduated Richter tubes, and PV concentration in the drinking fluid was adjusted, if necessary.
Body weight and systolic blood pressure (SBP), measured an average of 35 times by the noninvasive method of tail-cuff plethysmography in each conscious rats, were recorded before and after the treatments. The animals were placed in individual metabolic cages after the last dose of drug(s) to collect urine output for 24 hours. The urine output were expressed in milliliters, according to Padi and Chopra (2002)
Renal function was assessed by colorimetric assay of urinary creatinine. Creatinine clearance was calculated using standard formulae according to Shi et al. (2004)
Morphology
Findings ascribed to tubular injury included cellular vacuolization and tubular distension. For tubular injury, the quantitative scorings used were similar to those reported by Shi et al. (2004)
The findings of interstitial fibrosis consisted of matrix-rich expansion of the interstitium with distortion and collapse of the tubules. Interstitial fibrosis was estimated by counting the percentage of injured areas per field and was scored quantitatively (Shi et al. 2004
Immunohistochemistry
Western Blot Analysis
Determination of Conjugated Diene Concentration
Statistical Analysis
Effect of PV on Body Weight, SBS, and Urine Output in CsA-treated Rats Body weight and SBP were not significantly different in rats before the beginning of the treatment. CsA treatment reduced the gain of body weight compared with either control or PV-treated rats (p<0.05). Interestingly, PV treatment prevented this effect of CsA (Table 1). CsA treatment produced a significant increase of SBP compared with control and PV-treated rats. SBP rise was prevented by concomitant treatment of the rat with CsA plus PV. In contrast to body weight and SBP, CsA treatment did not affect urinary output in rats that drank the same amount of water or water plus PV. However, CsA caused a significant decrease in creatinine clearance that was markedly improved by concomitant treatment with PV.
Effect of PV on CsA-induced Renal Morphological Changes Morphological data obtained from control and PV-treated rats were not significantly different. Thus only pictures taken from control rats are shown in Figure 1. Kidneys from control rat displayed normal cortex and medulla features. The cortex showed a number of proximal and distal tubules located around the glomerula (Figure 1A). The medulla showed the different portions of Henle loops and a number of peritubular capillaries (vasa recta) (Figure 1B). Both cortex and medulla showed very little amount of collagen, stained by Sirius red method, distributed throughout anatomical structures (Figures 1C and 1D). Under a polarized light microscope, these fibers appeared as green color because of the presence of type III collagen (Figures 1E and 1F).
In contrast, animals treated with CsA showed characteristic renal morphological changes such as those described for chronic human lesion (Rezzani 2004
Coadministration of CsA and PV greatly improved the alterations of renal morphology both in cortex and medulla; in fact, the observed structures were not significantly different from those seen in kidney from either control or PV-treated rats. Figure 3A shows glomeruli with normal Bowman's capsule and tubular structures. In the medulla, some damaged structures could still be observed around the vasa recta (Figure 3B). In conjunction with the former data, fibrosis was not present in the cortex and a little fibrosis persisted around the damaged vasa recta in the medulla (Figures 3C and 3D). Under polarized light microscope, type III collagen, indicated by green fibers, was observed in the cortex, whereas a number of yellow/red spots of type I collagen were seen in the medulla (Figures 3E and 3F). As reported in Table 2, both tubular injury and interstitial fibrosis scoring were greatly improved in kidney of CsA plus PV-treated rats.
Effect of PV on Expression of iNOS and NF-kB Proteins in CsA-treated Animals Immunohistochemical studies showed that no detectable iNOS and NF-kB was observed both in cortical and medullar structures of kidney taken from control rats (Figures 4A, 4B, 5A, and 5B). In the renal cortex of CsA treated animals, diffuse, moderate and strong iNOS and NF-kB staining was seen in all the proximal and distal tubules. Low iNOS and NF-kB staining was observed in the glomeruli (Figures 4C and 5C). It should be noted that the staining was mainly distributed in the basal part of the tubular cells where numerous mitochondria are distributed. The Henle loops and vasa recta in outer medulla from CsA-treated rat showed marked iNOS and NF-kB labeling (Figures 4D and 5D).
The iNOS and NF-kB labeling was undetectable both in cortical and medullar areas after CsA plus PV treatment (data not shown). Western blot of iNOS showed enhanced expression of the enzyme in kidney taken from CsA-treated rats that was significantly reduced by concomitant treatment with PV (Figure 6). In conjunction with iNOS, CsA treatment produced an increase of NF-kB expression that was significantly reduced in kidney taken from PV plus CsA-treated rats (Figure 7).
Effect of PV on CsA-induced Increase on CD Concentration The concentration of CD was significantly increased by CsA treatment in comparison with the control group (238 ± 16 nmol/g tissue vs 170 ± 11 nmol/g tissue, p<0.05, n=5). On the other hand, the concomitant treatment with CsA plus PV prevented the increase of CD concentration and showed values similar to those observed in control group (195 ± 13 nmol/g tissue vs 170 ± 11 nmol/g tissue, n=5) (Table 3).
The present study provides evidence that PV prevents the increase of systolic blood pressure as well as structural and functional injuries of the kidney induced by CsA treatment. The immunosuppressor CsA has been associated to human endothelial dysfunction, accelerated atherosclerosis, and hypertension (Navarro-Antolin et al. 2002 PV treatment was associated with a decreased tubular injury and interstitial fibrosis and was more pronounced in the glomeruli. Our data suggest that PV completely restored the alterations caused by CsA treatment in renal cortex but not in the medulla, in which we still observed fibrosis, especially around the vasa recta. Reduction of both oxidative stress and increased iNOS expression via the NF-kB pathway may be responsible for the protective effect of PV on CsA-induced nephrotoxicity.
The introduction of CsA to the transplant community had great importance primarily because of the improved cadaveric graft survival rates with corresponding decrease in rate of rejection episodes. However, the most serious and limiting effect associated with CsA is nephrotoxicity (Kahan 1989
The mechanisms of CsA-induced nephrotoxicity are not fully elucidated, but several lines of evidence suggest an increased oxidative stress (Suleymanlar et al. 1994
In our previous study, PV accelerated blood pressure lowering or prevented the development of hypertension in a NO-deficient model of hypertension (Bernatova et al. 2002
In the literature, there are few data reporting the importance of a reinforced and improved antioxidant system in the reduction of CsA-induced renal oxidative stress (Fryer 1997
In the present study, it was shown that PV minimized oxidative stress induced by CsA in the kidney, as illustrated by the reduced CD concentration. In our previous studies, reduced oxidative stress contributes to the antihypertensive effect of PV and to the protection against cardiovascular remodeling in several models of experimental hypertension (Bernatova et al. 2002
Very recently, we have reported that one of the mechanisms involved in the reduction of oxidative stress by PV results from increased NO production by endothelial NO-synthase that could contribute to the anti-inflammatory and antiremodeling in vivo properties of PV. The activation of endothelial NO pathway may be involved in the regulation of inflammatory cytokines, adhesion molecules, and chemokine production by inhibition of either transcription NF-kB (Kitamoto et al. 2000
NF-kB activation is upstream of the synthesis of inflammatory mediators. Among the genes positively regulated by NF-kB, there is iNOS. iNOS can produce a huge amount of NO that can combine with superoxide anions to release the cytotoxic compound peroxynitrite responsible for lipid peroxidation and interstitial fibrosis. In the present study, PV treatment reduced the increase of iNOS expression in the kidney of CsA-treated rats; this effect probably results from the reduction of NF-kB expression. The mechanism by which PV affects the NF-kB and iNOS pathways remains to be determined, but it may act either by decreasing the level of ROS or by acting on different intracellular kinases that alter their expression or activity. Nevertheless, it was reported that CsA-induced nephrotoxicity at least partially involved changes in iNOS in several experimental models (Amore et al. 1995 In summary, PV protects against CsA-induced increase of systolic blood pressure and nephrotoxicity in the rat. Reduction of both oxidative stress and iNOS expression via the NF-kB pathway may be responsible for the protective effect of PV on CsA-induced structural and functional alterations of the kidney. The present data support the assumption about the beneficial effect of PV on blood pressure and renal damage associated with immunosuppressive agents.
This work was in part supported by the research grants VEGA - 2/3185/24, APVT - 51-017902. The authors wish to thank Miss Stefania Castrezzati for technical assistance.
Received for publication January 14, 2005; accepted May 4, 2005
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