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5-aminolaevulinic acid (ALA), enhances heme oxygenase (HO)-1 expression and attenuates tubulointerstitial fibrosis and renal apoptosis in chronic cyclosporine nephropathy
Authors:Chi Liu  Ping Zhu  Masayuki Fujino  Yoshitaka Isaka  Hidenori Ito  Kiwamu Takahashi  Motowo Nakajima  Tohru Tanaka  Jian Zhuang  Xiao-Kang Li
Affiliation:1. Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan;2. Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China;3. AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan;4. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan;5. SBI Pharmaceuticals Co., Ltd., Tokyo, Japan
Abstract:

Background

Cyclosporine-A (CsA) is an immunosuppressant indicated for various immunological diseases; however, it can induce chronic kidney injury. Oxidative stress and apoptosis play a crucial role in CsA-induced nephrotoxicity. The present study evaluated the protective effect of combining 5-aminolaevulinic acid with iron (5-ALA/SFC), a precursor of heme synthesis, to enhance HO-1 activity against CsA-induced chronic nephrotoxicity.

Methods

Mice were divided into three groups: the control group (using olive oil as a vehicle), CsA-only group, and CsA+5-ALA/SFC group. After 28 days, the mice were sacrificed, and blood and kidney samples were collected. In addition to histological and biochemical examination, the mRNA expression of proinflammatory and profibrotic cytokines was assessed.

Results

Renal function in the 5-ALA/SFC treatment group as assessed by the serum creatinine and serum urea nitrogen levels was superior to that of the CsA-only treatment group, demonstrating that 5-ALA/SFC significantly attenuated CsA-induced kidney tissue inflammation, fibrosis, apoptosis, and tubular atrophy, as well as reducing the mRNA level of TNF-α, IL-6, TGF-β1, and iNOS while increasing HO-1.

Conclusion

The activity of 5-ALA/SFC has important implications for clarifying the mechanism of HO-1 activity in CsA-induced nephrotoxicity and may provide a favorable basis for clinical therapy.
Keywords:Cyclosporine-A  Oxidative stress  Apoptosis  5-Aminolaevulinic acid  Iron  Heme oxygenase (HO)-1
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