#4176 ROLE OF KIDNEY FUNCTION ON NRF2 MRNA LEVELS IN TYPE-2 DIABETES
Authors: Politi Cristina , Spoto Belinda , Postorino Maurizio , Parlongo Rosa , Mannino Domenico , Testa Alessandra , Alessi Eugenio , Tripepi Giovanni Luigi , Mallamaci Francesca , Zoccali Carmine 
Published: June 2023

Abstract

Background and Aims
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor that induces the expression of genes coding for antioxidant proteins and phase II detoxifying enzymes. Repressor molecule Kelch-like ECH-associated protein 1 (Keap1) and several microRNAs (miRNA) negatively regulate Nrf2 gene expression at post-transcriptional level. Oxidative stress is a major factor for kidney damage in diabetes but the role of Nrf2 in kidney dysfunction in diabetes is still unclear.

Method
To test whether the gene expression of Nrf-2 is downregulated in type-2 diabetes and whether kidney dysfunction per se further reduces Nrf2 in diabetic patients with diabetic nephropathy, we carried out a case-control study including 99 participants divided into three independent groups: 33 patients with diabetic nephropathy (DN), 33 patients with type 2 diabetes without nephropathy (D) and 33 control subjects (C), all accurately matched for age and sex. Standard ANOVA compared outcome measures in the three groups. Multiple linear regression analysis was used to test the expression levels of Keap1, miR-28-5p, miR-93-5p, miR-30e-5p, miR-125b-5p and miR-150-5p as potential mediators in the observed reduction of Nrf2 mRNA levels in patients with diabetic nephropathy.

Results
In patients with diabetic nephropathy, Nrf2 gene expression levels (0.82 arbitrary units, AU, IQR: 0.60-1.22 AU) were significantly lower than in diabetic patients without nephropathy (1.19 AU, 0.90-1.38 AU, P = 0.01) and control subjects (0.82 AU, 0.60-1.22 AU vs 1.04 AU, 0.87-1.66, P = 0.02) while there was no difference between diabetic patients without nephropathy and control subjects (P = 0.69). Keap1 gene expression levels were almost identical in patients with and without diabetic nephropathy (1.15 AU, 0.63-2.14 AU vs 1.13 AU, 0.79-1.73 AU, P = 0.91) and higher than in control subjects (1.15 AU, 0.63-2.14 AU vs 0.79 AU, 0.49-1.08 AU, P = 0.046). MiRNA expression levels were comparable in diabetic patients with and without nephropathy, but miRNA 30e-5p was lower in patients with diabetic nephropathy than in diabetic patients without nephropathy (0.91 AU, 0.76-1.10 AU vs 1.06 AU, 0.89-1.23 AU, P = 0.016). The expression levels of Nrf2 and miRNA 30e-5p were unrelated in patients with (r = 0.15, P = 0.44) and without (r = -0.02, P = 0.90) diabetic nephropathy. In linear regression analyses, eGFR emerged as the first factor in rank for explaining the difference in Nrf2 mRNA levels (explained variance 76%) among patients with and without diabetic nephropathy.

Conclusion
This case-control study comparing the gene expression level of Nrf2 in diabetic patients with and without nephropathy shows that kidney dysfunction is the key factor that explains the variability in Nrf2 mRNA levels in diabetes. These data suggest a primary role of Nrf2 in redox homeostasis and kidney damage in diabetic nephropathy.