#3680 CALPAIN INHIBITION PREVENTS FIBROSIS IN PROGRESSIVE CHRONIC KIDNEY DISEASE
Authors: Gutiérrez-Calabrés Elena , de Blas Sofía Campillo , Miranda Susana García , Velázquez Sara Ruiz , Bueno Natalia Canales , Valero Cristina González , Griera-Merino Mercedes , García Sergio De Frutos , Calleros Laura , Rodríguez-Puyol Diego 
Published: June 2023

Abstract

Background and Aims
Kidney fibrosis is one of the main pathological processes of chronic kidney disease (CKD), although the pathogenesis of renal scar formation is not fully understood. Calpains (CAPN) are intracellular cysteine ​​proteases that play a key role in multiple biological processes linked to tissue damage and repair mechanisms, such as fibrosis and epithelial-mesenchymal transition. However, CAPN contribution in CKD genesis and progression remains to be fully elucidated. The aim of this study was to investigate the possible role of CAPN in the development of CKD and renal fibrosis in an experimental model of CKD induced by adenine and in human kidney proximal tubular cells (HK-2).

Method
C57BL/6 wild-type mice were fed a 0.2% adenine-rich diet (WTA) for 5 days and 2 weeks to induce tubulointerstitial damage resembling what occurs in human CKD. Mice with a standard diet were used as controls (WT). WT and 5 days WTA mice were injected intraperitoneally for 5 consecutive days with a dose of calpain inhibitor III (20 mg/kg). In vitro experiments were performed in HK-2 cells in the presence or absence of TGF-β (1 ng/ml, different times) and calpain inhibitor III (50 µM). Mice renal function was assessed by measuring plasma BUN and creatinine. Interstitial fibrosis was evaluated in kidney samples embedded in paraffin by Sirius red staining of the collagen renal cortex content. Fibrosis markers were determined by RT-qPCR. CAPN localization in the kidney was assessed by immunofluorescence. CAPN 2 and 5 protein content were analyzed by western blot. CAPN activity was determined by fluorescence assays. All data were analyzed using non-parametric statistics for comparisons, applying the Kruskal-Wallis with Mann-Whitney post-test. A value of p&lt;0.05 was considered statistically significant.

Results
Our results show a progressive worsening of renal function and structure in adenine-fed mice, with increased BUN, creatinine and COL I mRNA expression being significantly higher at 2 weeks of treatment. CAPN 2 and 5 protein content was significantly higher in animals that received adenine for 2 weeks compared to control, with a statistically significant increased renal CAPN activity. Our results point out that CAPN 2 and 5 content in renal tissue increases as CKD and fibrosis progress. To verify this potential relationship, we treated kidney tubular cells, where we observed a greater calpain expression compared to other kidney cells, with TGF-β to induce fibrosis. This treatment increased COL I mRNA expression, as well as CAPN 2 and 5 levels in HK-2 cells. However, calpain inhibitor III administration prevents increased COL I expression, both in vitro and in vivo.

Conclusion
We suggest a direct relationship between the cellular content of CAPN and the renal fibrosis observed in CKD, being involved in the genesis or progression of kidney disease. Thus, effective CAPN blockade or downregulation could be helpful as a therapeutic strategy to prevent CKD.