Identification and dissection of the Nrf2 mediated oxidative stress pathway in human renal proximal tubule toxicity
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Updated: Jun 5, 2026

Modeling Hypoxia/Reoxygenation Injury in Proximal Tubular Epithelial Cells
Published on: November 21, 2025
Anja Wilmes1, Daniel Crean, Sonia Aydin
1Division of Physiology, Department of Physiology and Medical Physics, Innsbruck Medical University, Innsbruck, Austria.
Abstract:
The identification and dissection of cellular stress mechanisms is fundamental to understanding the susceptibility of the kidney to chemicals and pharmaceuticals and for the development of renal biomarkers indicative of sub lethal injury. Here, we utilised whole genome DNA microarrays in an attempt to uncover molecular mechanisms of response to nephrotoxin exposure. Human renal proximal tubular cells (HK-2) were treated for 12h and 48 h with 5 μM Cadmium (Cd), 30 μM Diquat Dibromide (Diq), and 5 μM Cyclosporine A (CsA). Nephrotoxin treatment resulted in an alteration of a total of 4608 transcripts. Ingenuity Pathways Analysis™ revealed the anti-oxidant and detoxification Nrf2 pathway as the most significantly enriched signaling pathway in the selected dataset. Activation of this transcription factor was confirmed as nuclear translocation and paralleled the temporal alterations of compound induced H(2)O(2) production. Transcriptomics, western blot and immunofluorescence showed an induction of both HO-1 and NQO1 with Cd and Diq exposure, but not with CsA treatment. Knockdown of Nrf2 by siRNA, reduced compound induced NQO1 mRNA to basal levels and attenuated toxin induced HO-1 mRNA expression. siRNA knock down of HO-1, but not NQO1, enhanced Cd induced H(2)O(2) production and Cd induced toxicity. Using an un-biased transcriptomic approach we have identified the Nrf2 pathway as the most significant signaling response in renal epithelial cells challenged with nephrotoxin. This study highlights the importance of this pathway and particularly HO-1 in renal epithelial adaptation to oxidative stress.
Insights
The Nrf2 pathway is key for kidney cells responding to toxins. This study shows Heme oxygenase-1 (HO-1) is crucial for adapting to oxidative stress from nephrotoxins.
Area of Science:
- Cellular and Molecular Toxicology
- Renal Physiology
- Biomarker Discovery
Background:
- Understanding kidney susceptibility to chemicals and pharmaceuticals is vital.
- Identifying cellular stress mechanisms aids in developing biomarkers for sub-lethal kidney injury.
- Nephrotoxins pose a significant threat to kidney health.
Purpose of the Study:
- To uncover molecular mechanisms of kidney cell response to nephrotoxin exposure.
- To identify key signaling pathways involved in the cellular stress response.
- To investigate the role of the Nrf2 pathway and its downstream targets in nephrotoxicity.
Main Methods:
- Utilized whole genome DNA microarrays to analyze transcriptomic changes in human renal proximal tubular cells (HK-2).
- Treated HK-2 cells with Cadmium (Cd), Diquat Dibromide (Diq), and Cyclosporine A (CsA).
- Confirmed Nrf2 pathway activation via western blot, immunofluorescence, and siRNA-mediated knockdown of Nrf2 and HO-1.
Main Results:
- Nephrotoxin treatment altered 4608 transcripts, with the Nrf2 pathway identified as the most significantly enriched.
- Nrf2 activation, indicated by nuclear translocation, correlated with increased H(2)O(2) production.
- HO-1 and NQO1 were induced by Cd and Diq but not CsA; HO-1 knockdown exacerbated Cd-induced toxicity.
Conclusions:
- The Nrf2 pathway is a primary signaling response in renal epithelial cells exposed to nephrotoxins.
- Heme oxygenase-1 (HO-1) plays a critical role in renal epithelial adaptation to oxidative stress.
- This study highlights the importance of the Nrf2-HO-1 axis in mitigating nephrotoxicity.
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