Rôle du système rénine-angiotensine intrarénal dans l’hypertension et les dommages rénaux chez les souris
transgéniques diabétiques

Experimental and clinical studies have shown that renin-angiotensin system (RAS)activation may lead to hypertension, a major cardiovascular and renal risk factor. Angiotensinogen (Agt) is the sole substrate of the RAS. However, it is unclear whether intrarenal RAS activation alone could induce kidney injury independently of systemic hypertension and play an important role in the progression of diabetic nephropathy (DN). To explore the role of intrarenal RAS in kidney injury, transgenic (Tg) mice overexpressing rat Agt in their renal proximal tubular cells (RPTCs) were rendered diabetic by streptozotocin (STZ). Diabetic Tg mice were treated with RAS blockers (perindopril and losartan), insulin or a combination of both and then euthanized after 4 weeks of treatment.  In a separate study, non-diabetic Tg mice were treated with RAS blockers or hydralazine (a vasodilator) or apocynin (an NADPH oxidase inhibitor) and then euthanized after 8 weeks of treatment. Non-Tg littermates served as controls in both studies. Immortalized rat proximal tubule cells (IRPTCs) stably transfected with Agt cDNA or control plasmid were used in the experiments as an in vitro model. Our results showed that non-diabetic Tg mice displayed a significant increase in systolic blood pressure (SBP), albuminuria, RPTC apoptosis, and proapoptotic gene expression. Diabetic Tg mice had a further increase of albuminuria, RPTC apoptosis, and proapoptotic gene expression, though the SBP of the diabetic Tg mice was similar to that of non-diabetic Tg mice. RAS blockers and/or insulin treatments markedly attenuated these changes, except that insulin had no impact on hypertension. In vitro, high-glucose melieu significantly increased apoptosis and caspase-3 activity in Agt stable transfectants compared to control cells, and these changes were attenuated by insulin and/or RAS blockers. Furthermore, non-diabetic Tg mice showed significantly elevated reactive oxygen species (ROS) production and NADPH oxidase activity, as well as enhanced expression of transforming growth factor-beta 1 (TGF-β1), plasminogen activator inhibitor-1 (PAI-1), extracellular matrix proteins, collagen type IV, and NADPH oxidase subunit p47 in their RPTC. Treatment with apocynin and perindopril ameliorated these changes, but apocynin had no effect on SBP. In contrast, hydralazine prevented hypertension but not albuminuria, RPTC apoptosis, or proapoptotic gene expression. These data indicate that intrarenal RAS activation and hyperglycemia act in concert to induce albuminuria and RPTC apoptosis independent of systemic hypertension. ROS generation via NADPH oxidase activation mediates, at least in part, intrarenal RAS action on RPTC apoptosis, tubulointerstitial fibrosis and albuminuria in Tg mice. On the other hand, in an on-going experiment, to avoid the nephro-toxic effects of STZ and further delineate the effects of intrarenal RAS activation, Tg mice overexpressing rat Agt in their RPTCs were crossbred with Ins2Akita mice, a  spontaneous type I diabetes model, to generate Akita-rAgt-Tg mice. Preliminary data indicated that hyperglycaemia and intrarenal RAS activation induced  endoplasmic reticulum (ER) stress in RPTC in vivo, and the ER stress pathway contributed to RPTC apoptosis in diabetes, at least in the Akita model. RAS blockade was effective in attenuating some parameters of renal injury in AkitarAgt-Tg mice.

Keyphrases: hypertension, ROS, NADPH oxidase, kidney, diabetic nephropathy, apoptosis, tubulo-interstitial fibrosis, ER stress, Ins2Akita mouse model