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@ARTICLE{Zhou:293859,
author = {L. Zhou and M. T. Pereiro and Y. Li and M. Derigs and C.
Kuenne and T. Hielscher$^*$ and W. Huang and B. Kränzlin
and G. Tian and K. Kobayashi and G. N. Lu and K. Roedl and
C. Schmidt$^*$ and S. Günther and M. Looso and J. Huber and
Y. Xu and T. Wiech and J.-P. Sperhake and D. Wichmann and
H.-J. Gröne and T. Worzfeld},
title = {{G}lucocorticoids induce a maladaptive epithelial stress
response to aggravate acute kidney injury.},
journal = {Science translational medicine},
volume = {16},
number = {767},
issn = {1946-6234},
address = {Washington, DC},
publisher = {AAAS},
reportid = {DKFZ-2024-01989},
pages = {eadk5005},
year = {2024},
abstract = {Acute kidney injury (AKI) is a frequent and challenging
clinical condition associated with high morbidity and
mortality and represents a common complication in critically
ill patients with COVID-19. In AKI, renal tubular epithelial
cells (TECs) are a primary site of damage, and recovery from
AKI depends on TEC plasticity. However, the molecular
mechanisms underlying adaptation and maladaptation of TECs
in AKI remain largely unclear. Here, our study of an autopsy
cohort of patients with COVID-19 provided evidence that
injury of TECs by myoglobin, released as a consequence of
rhabdomyolysis, is a major pathophysiological mechanism for
AKI in severe COVID-19. Analyses of human kidney biopsies,
mouse models of myoglobinuric and gentamicin-induced AKI,
and mouse kidney tubuloids showed that TEC injury resulted
in activation of the glucocorticoid receptor by endogenous
glucocorticoids, which aggravated tubular damage. The
detrimental effect of endogenous glucocorticoids on injured
TECs was exacerbated by the administration of a widely
clinically used synthetic glucocorticoid, dexamethasone, as
indicated by experiments in mouse models of myoglobinuric-
and folic acid-induced AKI, human and mouse kidney
tubuloids, and human kidney slice cultures. Mechanistically,
studies in mouse models of AKI, mouse tubuloids, and human
kidney slice cultures demonstrated that glucocorticoid
receptor signaling in injured TECs orchestrated a
maladaptive transcriptional program to hinder DNA repair,
amplify injury-induced DNA double-strand break formation,
and dampen mTOR activity and mitochondrial bioenergetics.
This study identifies glucocorticoid receptor activation as
a mechanism of epithelial maladaptation, which is
functionally important for AKI.},
keywords = {Animals / Acute Kidney Injury: metabolism / Acute Kidney
Injury: pathology / Humans / Glucocorticoids: adverse
effects / Glucocorticoids: pharmacology / COVID-19:
complications / COVID-19: metabolism / Mice / Epithelial
Cells: metabolism / Epithelial Cells: drug effects /
Epithelial Cells: pathology / Receptors, Glucocorticoid:
metabolism / Disease Models, Animal / Male / Kidney Tubules:
pathology / Kidney Tubules: metabolism / Kidney Tubules:
drug effects / Myoglobin: metabolism / Dexamethasone:
pharmacology / Dexamethasone: adverse effects / Stress,
Physiological: drug effects / SARS-CoV-2 / Mice, Inbred
C57BL / Female / Glucocorticoids (NLM Chemicals) /
Receptors, Glucocorticoid (NLM Chemicals) / Myoglobin (NLM
Chemicals) / Dexamethasone (NLM Chemicals)},
cin = {C060 / W210},
ddc = {500},
cid = {I:(DE-He78)C060-20160331 / I:(DE-He78)W210-20160331},
pnm = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
pid = {G:(DE-HGF)POF4-313},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:39356748},
doi = {10.1126/scitranslmed.adk5005},
url = {https://inrepo02.dkfz.de/record/293859},
}