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Ischemic Preconditioning of the Kidney
1A. N. Belozersky Research Institute of Physico-Chemical Biology, M. V. Lomonosov Moscow State University, Moscow, Russia. plotnikov@belozersky.msu.ru.
Abstract:
The phenomenon of ischemic preconditioning was discovered in 1986 in experiments with the heart, and then it was observed in almost all organs, the kidneys included. This phenomenon is underlain by conditioning of the tissues with short ischemia/reperfusion cycles intended for subsequent exposure to pathological ischemia. Despite the kidneys are not viewed as so vital organs as the brain or the heart, the acute ischemic injury to kidneys is a widespread pathology responsible for the yearly death of almost 2 million patients, while the number of patients with chronic kidney disease is estimated as hundreds of millions or nearly 10% adult population the world over. Currently, it is believed that adaptation of the kidneys to ischemia by preconditioning is the most effective way to prevent the development of acute kidney injury, so deep insight into its molecular mechanisms will be a launch pad for creating the nephroprotective therapy by elevating renal tolerance to oxygen deficiency. This review focuses on the key signaling pathways of kidney ischemic preconditioning, the potential pharmacological mimetics of its key elements, and the limitations of this therapeutic avenue associated with age-related decline of ischemic tolerance of the kidneys.
Insights
Ischemic preconditioning protects kidneys from injury by brief oxygen deprivation cycles. Understanding its molecular pathways could lead to new therapies for acute kidney injury and chronic kidney disease.
Area of Science:
- Nephrology
- Cardiovascular Physiology
- Molecular Biology
Background:
- Ischemic preconditioning (IP) is a protective phenomenon observed in various organs, including the kidneys, involving brief cycles of ischemia/reperfusion.
- Acute kidney injury (AKI) affects millions globally, leading to significant mortality, while chronic kidney disease (CKD) impacts nearly 10% of the adult population.
- Kidney IP is considered a highly effective strategy for preventing AKI, highlighting the need to understand its underlying molecular mechanisms for therapeutic development.
Purpose of the Study:
- To review the key signaling pathways involved in kidney ischemic preconditioning.
- To explore potential pharmacological agents that mimic key elements of kidney IP.
- To discuss limitations of IP-based therapies, particularly age-related decreases in renal ischemic tolerance.
Main Methods:
- Literature review of studies on kidney ischemic preconditioning.
- Analysis of molecular signaling pathways implicated in renal IP.
- Evaluation of pharmacological approaches and age-related effects on kidney IP.
Main Results:
- Identified key signaling pathways crucial for kidney ischemic preconditioning.
- Discussed pharmacological mimetics that could replicate IP's protective effects.
- Highlighted age-related decline in renal ischemic tolerance as a significant limitation.
Conclusions:
- Understanding kidney IP molecular mechanisms is vital for developing nephroprotective therapies.
- Pharmacological mimetics offer potential for enhancing renal tolerance to oxygen deficiency.
- Age-dependent alterations in IP necessitate further research for effective clinical translation.
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