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Updated: Mar 25, 2026

Modeling Hypoxia/Reoxygenation Injury in Proximal Tubular Epithelial Cells
Published on: November 21, 2025
Heme Oxygenase-1 in Kidney Health and Disease
Jeremie M Lever1, Ravindra Boddu1, James F George2
11 Nephrology Research and Training Center, Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama.
Insights
The heme oxygenase (HO) system shows promise for treating kidney diseases like acute kidney injury (AKI) and chronic kidney disease (CKD). Further research into HO
Area of Science:
- Biochemistry and Molecular Biology
- Nephrology
- Oxidative Stress Research
Background:
- The heme oxygenase (HO) system is crucial for regulating oxidative stress and has demonstrated protective effects in various kidney disease models.
- Iron regulation proteins, including HO and ferritin, offer insights into acute kidney injury (AKI) mechanisms.
- HO-1 expression is implicated in the development of hypertension, diabetic kidney disease, and progression to end-stage renal disease.
Purpose of the Study:
- To explore the role of the heme oxygenase (HO) system in kidney homeostasis and disease.
- To identify potential therapeutic targets within the HO system for kidney diseases.
- To address the challenges hindering clinical translation of HO-targeting therapies.
Main Methods:
- Review of preclinical studies on the HO system in kidney disease models.
- Analysis of the connection between HO, ferritin, and iron regulation in AKI.
- Examination of HO-1 expression in the pathogenesis of hypertension and diabetic kidney disease.
Main Results:
- Preclinical studies indicate the protective role of the HO system in kidney disease.
- HO system components are linked to mechanisms of damage in AKI and disease progression.
- Despite promising preclinical data, no HO-targeting drugs have reached clinical application.
Conclusions:
- The HO system presents a promising therapeutic avenue for kidney diseases.
- Challenges in clinical translation include model variations and disease complexity.
- Future research should focus on tissue-specific gene modulation and expanded animal studies to advance HO-based therapies.
Significance:
Acute kidney injury (AKI) and chronic kidney disease (CKD) represent a considerable burden in healthcare. The heme oxygenase (HO) system plays an important role in regulating oxidative stress and is protective in a variety of human and animal models of kidney disease. Preclinical studies of the HO system have led to the development of several clinical trials targeting the enzyme or its products.
Recent Advances:
Connection of HO, ferritin, and other proteins involved in iron regulation has provided important insight into mechanisms of damage in AKI. Also, HO-1 expression is important in the pathogenesis of hypertension, diabetic kidney disease, and progression to end-stage renal disease.
Critical Issues:
Despite intriguing discoveries, no drugs targeting the HO system have been translated to the clinic. Meanwhile, treatments for AKI and CKD are urgently needed. Many factors have likely contributed to challenges in clinical translation, including variation in animal models, difficulties in obtaining human tissue, and complexity of the disease processes being studied.
Future Directions:
The HO system represents a promising avenue of investigation that may lead to targeted therapeutics. Tissue-specific gene modulation, widening the scope of animal studies, and continued clinical research will provide valuable insight into the role HO plays in kidney homeostasis and disease. Antioxid. Redox Signal. 25, 165-183.
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