1. Introduction
Diabetic nephropathy is one microangiopathic complication of diabetes mellitus and the greatest cause of end-stage renal failure, in which 16,000 patients newly begin dialysis therapy every year in Japan. The development of radical medicines for diabetic nephropathy is an urgent matter to prevent an increasing number of patients with end-stage renal failure.
The early stage of diabetes mellitus induces thickening of the basement membrane, podocyte injury by apoptosis and functional abnormality, and endothelial damage in the glomerulus, arising from the loss of glomerular barrier function. Diabetes mellitus also induces mesangial dysfunction, obstruction of the capillary arteries and nodular lesions that induce glomerular sclerosis [
1].
TGF-β comprises a large family of cytokines that help regulate growth, differentiation and morphogenesis in many cell types [
2]. TGF-β has been found to be a critical factor in renal diseases such as glomerulosclerosis and mesangioproliferative glomerulonephritis. It stimulates mesangial cell (MC) proliferation and the production of extracellular matrix (ECM) components and induces epithelial-mesenchymal transformation (EMT) in renal tissue, which is critical in the pathogenesis of renal injury [
3]. High glucose levels in diabetes mellitus induce TGF-β1 gene expression and the synthesis of renal ECMs that cause glomerular sclerosis [
4]. Increases in TGF-β1 induce endothelial-mesenchymal transition (EndMT) to suppress glomerular endothelial function resulting from a failure of crosstalk between glomerular endothelial cells and podocytes, and then podocyte injury associates proteinuria [
5]. Thus, TGF-β1 is a main molecule in the pathogenesis of diabetic nephropathy.
Pyrrole-imidazole (PI) polyamides are peptide compounds recognized by DNA that were first identified from antibiotics, such as duocarmycin A and distamycin A. As aromatic rings of the amino acids N-methylpyrrole and N-methylimidazole, PI polyamides recognize and bind to DNA according to specific sequences [
6,
7]. They can form hydrogen bonds with high affinity and specificity to double-stranded DNA (dsDNA), which is stronger than the bonds formed between protein and dsDNA. PI polyamides also inhibit protein interactions and some DNA transcription factors [
8]. dsDNA recognition is based on side-by-side pairing of pyrrole (Py) with imidazole (Im) in the minor groove. Im paired opposite to Py targets the G-C base pair, whereas the opposite pairing (Py-Im) targets the C-G base pair. The pairing of Py-Py targets A-T and T-A base pairs [
7]. PI polyamides are able to fully resist nuclease-induced biological degradation and do not require vector-assisted delivery systems because they can easily permeate cells and enter the nuclei. Thus, as novel DNA-recognized agents, PI polyamides may be more applicable than nucleic acid medicines [
9]. Synthetic PI polyamides, designed to target gene promoters, might be effective as practical medicines that can regulate gene transcription.
We showed significant inhibition in human cells of TGF-β1 promoter activity and the expression of TGF-β1 mRNA and protein by PI polyamides, targeting the human TGF-β1 promoter [
10]. We further showed that a PI polyamide targeting TGF-β1 could effectively retard the progression of renal diseases [
11,
12], post-angioplasty carotid artery stenosis [
13], cornea fibrosis by alkali burns [
14], skin hypertrophic scars [
15], liver fibrosis [
16], and encapsulating peritoneal sclerosis [
17] in rats.
In the present study, we evaluated the contribution of TGF-β1 and examined the effects of PI polyamide targeting TGF-β1 in the pathogenesis of diabetic nephropathy in rats.
3. Discussion
In regard to the mechanisms of the increase of TGF-β1 in diabetes mellitus, high glucose is known to activate protein kinase C and polyol pathway flux to increase radical oxygen species and advanced glycogen end-product [
18]. These conditions stimulate transcription factors USF1/2, AP-1 and CREB that activate several genes to accumulate ECM, and which induce inflammation and glomerulosclerosis in the kidney [
19]. Exposure to high glucose and fatty acid decreases AMP-kinase induces the activation of NFkB and the translocation of USF1 into the nucleus, which stimulates the transcription of TGF-β1 in the hyperglycemic condition [
20]. The increased TGF-β1 is involved in the pathogenesis of diabetic nephropathy.
Mesenchymal cells, including renal MCs, show a contractile or synthetic phenotype. MCs in a normal glomerulus show the contractile phenotype, which do not proliferate, whereas MCs in an abnormal glomerulus by diabetes mellitus or hypertension shows the synthetic phenotype, inducing hyperproliferation with increases in organelles to produce many cytokines [
21]. Increases in osteopontin, one of the synthetic phenotype markers and an inflammatory cytokine, strongly correlate with urinary albumin excretion and glomerulosclerosis in diabetic nephropathy [
22]. The increased TGF-β1 contributes to the formation of glomerular ECM and albuminemia, seen with podocyte injury. In addition, increased USF1 in diabetes mellitus also binds to the promoter of osteopontin, which induces mesangial proliferation that leads to glomerular hypertrophy.
In the present study, the expression of TGF-β1 was transiently increased, the expression of osteopontin was also increased, and the expression of αSMA as a contractile phenotype marker was decreased after culture in the high glucose medium. In addition, the high glucose condition significantly stimulated the growth of MCs, whereas TGF-β1 PI polyamide significantly decreased the growth of MCs under this condition. These results indicate that the high glucose condition increased TGF-β1 and osteopontin, which contribute to the synthetic phenotype and the increased growth of MCs in culture.
We first elucidated the delivery of PI polyamide into the kidney after the intraperitoneal injection. FITC-labeled TGF-β1 PI polyamide was distributed into the nucleus of the nephron tubule and glomerulus at day 3, and had mostly disappeared from the tissues by day 7, after intraperitoneal injection. On the basis of these results, we injected TGF-β1 PI polyamide twice a week, for 3 months into the STZ diabetic rats. Previously, we investigated the pharmacokinetics of PI polyamides injected into rats. We found that the FITC-labeled PI polyamide strongly localized in the nuclei of the nephron tubule and glomerulus, and in the nuclei of mid-layer smooth muscle cells in the aorta, lung, and liver, with no other drug delivery system needed [
11]. Thus, PI polyamides can distribute into the organs and strongly bind to their nuclei by themselves. This delivery property of PI polyamide administered into the body could be a potential advantage as medicines, compared to that of nucleic acid medicines. In addition, the PI polyamides were excreted mainly into the urine, and low molecular weight PI polyamide was excreted partially into the bile [
23]. The property of urinary excretion of PI polyamide could also be advantageous in progressive renal diseases.
The intraperitoneal administration of TGF-β1 PI polyamide inhibited the expression of TGF-β1, and ameliorated the degeneration of nephron tubules and glomeruli in kidney of STZ diabetic rats. These results indicate that TGF-β1 PI polyamide could be effective in diabetic nephropathy with glomerular mesangial proliferation and interstitial fibrosis. In addition, kidneys from STZ diabetic rats showed an interruption in the continuity of podocytes in the glomerulus. Electron microscopy showed fusion of the foot process and disappearance of the slit structure of glomerulus from the STZ diabetic rats, which improved with the administration of TGF-β1 PI polyamide. These results indicate that increased TGF-β1 is involved in podocyte injury. Recently, crosstalk between glomerular endothelial cells and podocytes was established [
24]. Podocytes generate many molecules including cytokines such as VEGF, CXCR4 and Tie-2. These molecules act to maintain the function of glomerular endothelial cells. However, these cells produce activated protein C to maintain podocyte function [
25]. TGF-β1 is known to induce EndMT by which endothelial function is suppressed by the mesenchymal transformation [
26]. The increased TGF-β1 is thought to contribute to impaired functions of glomerular endothelial cells and podocytes by disrupting their crosstalk in diabetes mellitus. Thus, treatment with TGF-β1 PI polyamide might be effective in improving the injury caused by diabetes mellitus by suppressing podocyte injury via improvement of EndMT, as well as the crosstalk between glomerular endothelial cells and podocytes that occur with this disease.
We examined the effects of treatments with TGF-β1 PI polyamide on STZ-induced diabetic nephropathy and found that TGF-β1 PI polyamide effectively improved diabetic nephropathy including degeneration of the nephron tubules and glomeruli, and podocyte injury. Thus, it is feasible that TGF-β1 PI polyamide may prevent the progression of human diabetic nephropathy. We recently developed a PI polyamide to target human TGF-β1 and examined this PI polyamide in a primate model of cyclosporine A-induced nephropathy and unilateral urethral obstruction in the common marmoset, which has high gene homology of 90% to the human TGF-β1 gene. The human TGF-β1 PI polyamide effectively improved these nephropathies in the common marmoset [
27]. We will, therefore, create diabetic mellitus in the common marmoset with STZ, and examine the effectiveness of human TGF-β1 PI polyamide as a preclinical study for the treatment of diabetic nephropathy.
In conclusion, we found mesangial proliferation with change in the synthetic phenotype and podocyte injury, which were improved with TGF-β1 PI polyamide in the present experiments. These findings suggest that TGF-β1 could be a pivotal factor in the progression of diabetic nephropathy, and as a practical medicine, TGF-β1 PI polyamide could feasibly improve diabetic nephropathy.
4. Materials and Methods
4.1. Ethics
This investigation conformed to the Guide for the Care and Use of Laboratory Animals published by the US National Institutes of Health (NIH Publication No. 85-23, 1996). The ethics committee of the Nihon University School of Medicine approved the research protocols involving the use of living animals in this study (approval no. 11-034).
4.2. Culture of MCs and Glucose Stimulation
Glomeruli were isolated from the kidneys of 8-week-old male Wistar Kyoto/Izm rats (Japan SLC, Hamamatsu, Japan) with a graded-sieve technique described previously [
28]. The renal cortex from three rats in each strain were excised and minced into small pieces under sterile conditions. After being pressed through a 200-mm sieve, the minced cortex was suspended in RPMI 1640 medium (GIBCO Laboratories, Grand Island, NY, USA). This suspension was then passed through a 120-mm sieve, and glomeruli collecting on the surface of the sieve were gathered and resuspended in RPMI1640. MCs were then isolated from explants of whole glomeruli according to the differential growth capacities of the glomerular epithelial cells and MCs. We confirmed that no cellular cytotoxicity and no cytolysis had occurred by measuring lactate dehydrogenase released into the culture medium of the MCs (Thermo Fisher Scientific, Waltham, MA, USA). MCs were then grown in DMEM containing 10% calf serum for 24 h, following which the culture medium was changed to DMEM with 0.2% FBS. Quiescence was established by incubating the cells in this medium for 48. The MCs were first cultured with normal glucose medium (glucose 5.6 mM [1000 mg/L] in DMEM) by 80% confluency and then with high glucose medium (glucose 25 mM [4500 mg/L] in DMEM).
4.3. RNA Extraction and Real-time PCR Analysis
A TRIzol reagent (Invitrogen, Carlsbad, CA, USA) was used to extract total RNA from the MCs. Total RNA (1 μg) was reverse transcribed into cDNA with random 9-mers with a Takara RNA PCR Kit (AMV) version 3.0 (Takara Bio, Ohtsu, Japan). Assay-on-Demand primers and probes (TGF-β1 [Rn00572010_m1], Acta2 [Rn01759928_g1], and Spp1 [Rn00681031_m1]) and osteopontin were obtained from Applied Biosystems Life Technologies (Tokyo, Japan). The mRNA was quantified with an ABI Prism 7300 (Applied Biosystems, Waltham, MA, USA). Each sample, with each reaction comprising 5 μL complementary DNA (total volume, 25 μL), was run in triplicate. We used glyceraldehyde-3-phosphate dehydrogenase (GAPDH) (4351317; Life Technologies, Carlsbad, CA, USA) with TaqMan Ribosomal RNA Control Reagents (Applied Biosystems) to control sample loading. Amplification conditions were 50 °C for 2 min, 95 °C for 10 min, 60 cycles of denaturation (95 °C for 15 s), and combined annealing-extension at 60 °C for 1 min. After we determined the threshold cycle (Ct), we used the comparative Ct method to calculate the relative quantification of the marker gene mRNA expression.
4.4. Synthesis of PI Polyamides Targeting Rat TGF-β1
The chemical structure of the PI polyamide targeting rat TGF-β1 promoter is shown in
Figure 9. To obtain specificity to the rat TGF-β1, we designed the polyamide targeting rat TGF-β1 to span the boundary of the AP-1 binding site (22303 to 22297) of the TGF-β1 promoter, as described previously [
11]. The mismatch polyamide was designed not to bind to the transcription sites of the promoter.
To create the PI polyamides by machine-assisted automatic synthesis of hairpin-type PI polyamides, we induced substitution of Im and Py with a PSSM-8 continuous-flow peptide synthesizer (Shimazu, Kyoto, Japan) at 0.1-µmol scale (200 mg of Fmoc-b-alanine-CLEAR Acid Resin, 0.50 mEq/g; Peptide Institute, Osaka, Japan). To perform the automatic solid-phase synthesis, we performed the first wash with dimethylformamide (DMF), then removed the Fmoc group with 20% piperidine/DMF, washed with methanol, coupling with a monomer for 60 min in an environment of 1-[bis(dimethylamino)methylene]-5-chloro-1H-benzotriazolium 3-oxide hexafluorophosphate and diisopropylethylamine (4 eq each), washed again with methanol, protected with acetic anhydride/pyridine, and performed a final wash with DMF. After the Fmoc group was removed from the Fmoc-β-alanine-Wang resin, it was successively washed with methanol. Fmoc-amino acid was used to perform the coupling step, followed by an additional methanol wash. These steps were repeated until all sequencing was complete. Thereafter, we protected and washed the N-terminal amino group with DMF and drained the reaction vessel. Next, following the cleavage step (5 mL of 91% trifluoroacetic acid-3% triisopropylsilane-3% 5 dimethylsulfide-3% water/0.1 mM resin), we performed cold ethyl ether precipitation to isolate the synthetic polyamides. After a further cleavage step (5 mL of N, N-dimethylaminopropylamine/0.1 mM resin, 50 °C overnight), we isolated the synthetic polyamides again by cold ethyl ether precipitation. Finally, we purified the polyamides by high-performance liquid chromatography (HPLC) with use of a PU-980 HPLC pump, UV-975 HPLC UV/VIS detector (Jasco, Easton, MD, USA), and a Chemcobound 5-ODS-H column (Chemco Scientific, Osaka, Japan).
4.5. Evaluation of MC Growth
Rat MCs were plated in 96 well dishes at 5 × 103 cells/well with 10% fetal bovine serum (FBS) in normal glucose DMEM at 37 °C in 5% CO₂ for 24 h, after which the culture medium was changed to DMEM with 0.2% FBS for 24 h to establish quiescence. The cells were then stimulated with 10% FBS in high-glucose DMEM with 0.01 μM PI polyamide to TGF-β1 or Mismatch polyamide for 24 h. Premix WST-1 (TAKARA Bio, Shiga, Japan) at 10 μL/well was added to the cells for 90 min. The absorbance of the samples was read with a microtiter plate reader against a background control as a blank. The wavelength used to measure the absorbance of the formazan product ranged between 420 to 480 nm.
4.6. Distribution of FITC-labeled PI Polyamide in Kidney
PI polyamide targeting TGF-β1 was labeled with FITC (Sigma-Aldrich, St. Louis, MO, USA). To evaluate the distribution of PI polyamide in kidney, we intraperitoneally injected 1 mg of FITC-PI polyamide into Wistar rats. After 1, 3 and 7 days, we removed the kidneys from the rats, prepared frozen specimens, and viewed them.
4.7. Creation of Diabetic Rats and Treatment with PI Polyamide
The experimental protocol used to create the diabetic rats and administrations of Mismatch or TGF-β1 PI polyamide are shown in
Figure 10. Male Wistar rats (Japan Charles River Laboratories, Yokohama, Japan) weighing 200 to 250 g were allowed free access to water and regular laboratory chow. Diabetes was induced in the rats by a single intraperitoneal injection of streptozotocin (STZ) (Sigma-Aldrich, 60 mg/kg body weight) according to a previous report [
29]. Blood glucose was measured from tail vein blood using the
o-toluidine method in the non-fasting conditions. Rats whose blood glucose level was at least 300 mg/dL 24 h after STZ treatment were subjected to further study.
STZ-induced diabetic rats were intraperitonially injected with 1 mL of 0.1% acetic acid to create Control rats. Five milligrams of PI polyamide to TGF-β1 or Mismatch polyamide dissolved in 1 mL of 0.1% acetic acid was intraperitonially injected twice a week for 3 months, following which the rats were sacrificed and their kidneys were removed.
4.8. Measurement of Blood Glucose, HbA1c, Urinary Protein and Renal Function in Rats
Blood glucose was measured in whole blood from rats with a Quick Auto Neo GLU-HK (SHINO-TEST CORPORATION, Tokyo, Japan). HbA1c was measured in whole blood from rats with a RAPIDIA Auto HbA1c-L system (FUJIREBIO Inc, Tokyo, Japan). Serum BUN and creatinine were measured by SRL Inc. (Wako, Saitama, Japan). Collection of 24-hour urine was done in metabolic cages. Urinary albumin and urinary creatinine were measured by SRL Inc. Urinary protein excretion was determined with a Bio-Rad protein assay kit (Bio-Rad Laboratories, Hercules, CA, USA). Urinary albumin excretion was expressed as the ratio of albumin to creatinine.
4.9. Immunofluorescence for Podocin
For the immunofluorescence assay, rat kidneys were fixed in 4% paraformaldehyde and cut into 5-μm sections. After the obtained cryosections were deparaffinized with xylene, they were rehydrated with a graded ethanol series. The sections were then blocked with 1% bovine serum albumin (BSA)/PBS for 1 h, incubated in a humidified chamber with anti-podocin (P 0372; Sigma-Aldrich, St Louis, MO, USA) diluted 1:1000 in 1% BSA/PBS for 1 h at room temperature, and then incubated with Alexa Fluor 488 anti-rabbit IgG (A21441; Invitrogen) at room temperature for 1 h. After washing with PBS, the samples were reacted with 4′,6-Diamidino-2-Phenylindole (D9542; Sigma-Aldrich) diluted 1:2000 in pure water, then enclosed in Fluoromount-G (0100-01; Southern Biotech, Birmingham, AL, USA) and observed by fluorescence microscope (IX73; OLYMPUS, Tokyo, Japan).
4.10. Western Blot Analysis for Protein Expression in Kidney
Renal medulla from rats was disrupted with lysis buffer (50 mM Tris·HCl, pH 8.0, 150 mM NaCl, 0.02% sodium azide, 100 µg/mL phenylmethylsulfonyl fluoride, 1 µg/mL aprotinin, and 1% Triton X-100). Total proteins were extracted and purified with 100 μL of chloroform and 400 μL of methanol. After the protein samples were boiled for 3 min, they were electrophoresed on 8% polyacrylamide gels and then transblotted to nitrocellulose membranes (Bio-Rad Laboratories). The blots were then incubated for 3 h at room temperature with rabbit polyclonal antibody for TGF-β1 (sc-146; Santa Cruz Biotechnology, Santa Cruz, CA, USA) diluted 1:200 and rabbit monoclonal antibody for GAPDH (Sigma-Aldrich) diluted 1:500 as a control in 5% nonfat milk in TBST solution (10 mM Tris·HCl, pH 8.0, 150 mM NaCl, and 0.05% Tween 20).
4.11. Evaluation of Renal Injury
Three-millimeter-thick paraffin sections of removed renal cortex were stained for semiquantitative evaluation with hematoxylin and eosin or Masson’s trichrome stain. Renal cortical thickness was measured under high magnification (×400). The GIS was obtained with the formula ((0 × n0) + (1 × n1) + (2 × n2) + (3 × n3) + (4 × n4))/50. The tubulointerstitial area was semi-quantified from 20 randomly selected areas of renal cortex. The percentage of involvement of each area showing sclerofibrotic change was estimated and assigned a score of 0, normal; 1, involvement of <10%; 2, involvement of 10% to 30%; 3, involvement of 30% to 50%; or 4, involvement of ≥50% of the area. The TIS was calculated as ((0 × n0) + (1 × n1) + (2 × n2) + (3 × n3) + (4 × n4))/20.
4.12. Electron Microscopy of Podocytes
The ultrastructure of the podocytes was assessed with a transmission electron microscope (JEM-1200EX, JEOL, Tokyo, Japan). Before observation, the specimens were fixed in a 2.5% glutaraldehyde solution overnight. After rinsing in PBS, they were fixed for 2 h in a 1% solution of osmium tetroxide (Gibco, Tokyo, Japan). After dehydration with graded acetone, the specimens were soaked in embedding medium. An ultramicrotome (ULTRACUT UCT, Leica, Wien, Austria) was used to create ultra-thin slides that were then subjected to transmission electron microscopy.
4.13. Statistical Analyses
Values are reported as means ±SE. The Student t-test was used to compare unpaired data, and two-way ANOVA with the Bonferroni/Dunn procedure as a post test was also used. A p-value <0.05 was considered to indicate statistical significance.