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And Ischemic Preconditioning–Mediated Renal Protection J Am Soc Nephrol 12: 233–240, 2001 Protein Kinase C and Gi/o Proteins Are Involved in Adenosine- and Ischemic Preconditioning–Mediated Renal Protection H. THOMAS LEE and CHARLES W. EMALA Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York. ϩ Abstract. Renal ischemic reperfusion (IR) injury is a signifi- dil (K ATP channel opener), bradykinin, methacholine, or mor- cant clinical problem in anesthesia and surgery. Recently, it phine before renal ischemia. Twenty-four h later, plasma cre- was demonstrated that both renal ischemic preconditioning atinine was measured. Separate groups of rats received (IPC) and systemic adenosine pretreatment protect against pertussis toxin intraperitoneally 48 h before being subjected to renal IR injury. In cardiac IPC, pertussis toxin-sensitive G- the above protective protocols. IPC and adenosine pretreatment proteins (i.e.,Gi/o), protein kinase C (PKC), and ATP-sensitive protected against renal IR injury. Pretreatment with pertussis ϩ potassium (K ATP) channels are implicated in this protective toxin and chelerythrine abolished the protective effects of both signaling pathway. The aim of this study was to elucidate the renal IPC and adenosine. However, glibenclamide pretreatment signaling pathways that are responsible for renal protection had no effect on either renal IPC or adenosine-induced renal ϩ mediated by both IPC and adenosine pretreatment. In addition, protection, indicating no apparent role for K ATP channels. because A1 adenosine receptor antagonist failed to block renal Moreover, pinacidil, bradykinin, methacholine, and morphine IPC, whether activation of bradykinin, muscarinic, or opioid failed to protect renal function. Therefore, the conclusion is receptors can mimic renal IPC was tested because these recep- that cellular signal transduction pathways of renal IPC and tors have been implicated in cardiac IPC. Rats were acutely adenosine pretreatment in vivo involve Gi/o proteins and PKC ϩ pretreated with chelerythrine or glibenclamide, selective block- but not K ATP channels. Unlike cardiac IPC, bradykinin, mus- ϩ ers of PKC and K ATP channels, respectively, before IPC or carinic, and opioid receptors do not mediate renal IPC. adenosine pretreatment. Some rats were pretreated with pinaci- Renal dysfunction secondary to ischemic reperfusion (IR) in- demonstrated that IPC protects renal function and morphology jury contributes to frequent and grave clinical morbidity in in rats after 45 min of ischemia and 24 h of reperfusion (5). aortovascular surgery and anesthesia (1,2). Postoperative acute Extensive studies of cardiac IPC have implicated pre-isch- renal failure implies a poor clinical prognosis and is frequently emic activation of adenosine receptors (AR), specifically, A1 associated with many other life-threatening complications, in- AR, as a predominate mechanism that mediates protection cluding sepsis and multiorgan failure (1–3). In high-risk pa- (6,7). In addition, it is hypothesized in cardiac models of IPC tients undergoing major vascular surgery and anesthesia, the that stimulation of A1 AR results in activation and transloca- mortality and morbidity rate from perioperative acute renal tion of protein kinase C (PKC) from the cytosolic to the failure has changed little during the past 30 yr; the incidence of membrane compartment, resulting in phosphorylations of un- renal dysfunction after aortovascular surgery is reported to be known cytoprotective proteins (8,9). In addition to PKC, many as high as 50% (3). studies of cardiac protection with IPC and A1 AR activation Murry (4), in 1986, first reported the protective effects of suggest that activation and opening of ATP-sensitive potas- “ischemic preconditioning (IPC)” against IR injury in cardiac ϩ sium (K ATP) channels are involved (6,10). In models of muscle by showing that multiple brief ischemic periods before ϩ cardiac protection, PKC and K ATP channel activation are a prolonged ischemic period lessened myocardial dysfunction thought to be coupled to cell surface A1 AR via pertussis and infarction size after the reperfusion period. We recently toxin-sensitive G-proteins (i.e.,Gi/o, (11,12)). Therefore, we ϩ hypothesized that Gi/o, PKC, and K ATP channels are interme- diate signaling proteins involved in adenosine- and IPC-medi- Received March 30, 2000. Accepted June 21, 2000. ated renal protection from IR injury as has been demonstrated Correspondence to Dr. H. Thomas Lee, Department of Anesthesiology, Co- in the heart. lumbia Presbyterian Medical Center, P&S Box 46, 630 West 168th Street, New We recently demonstrated that systemic adenosine pretreat- York, NY 10032. Phone: 212-305-0586; Fax: 212-305-8980; E-mail: [email protected] ment protects renal function via A1 AR activation and mimics renal IPC (5). However, unlike most models of cardiac pre- 1046-6673/1202-0233 Journal of the American Society of Nephrology conditioning, renal IPC was not blocked by an A1 AR antag- Copyright © 2001 by the American Society of Nephrology onist. This suggests either that IPC- and adenosine-mediated 234 Journal of the American Society of Nephrology J Am Soc Nephrol 12: 233–240, 2001 protection follow completely different cellular signaling path- 45 min of left renal ischemia followed by reperfusion. Twenty-four h ways with a common physiologic end point or that multiple later, animals were killed and serum Cr levels were measured. endogenous agonists with common intermediate signaling ϩ pathways are involved in renal IPC. Evidence from cardiac Role of K ATP Channels in IPC- and Adenosine- preconditioning suggests that endogenously released agonists Mediated Renal Protection ϩ other than adenosine, e.g., bradykinin, acetylcholine, and opi- To determine the potential role of K ATP channels in renal IPC- or adenosine-induced renal protection, we subjected the rats to the fol- oid agonists, can also mimic IPC (13–17). ϩ The distal portion (S segment) of the proximal tubule lowing protocols after right nephrectomy: (1) high dose K ATP chan- 3 ϩ located in the outer medulla of the kidney is the primary site of nel antagonist (glibenclamide) controls (H-Glib Sham), gliben- clamide (6 mg/kg intravenously) 30 min before sham operations; (2) injury in renal ischemia and reperfusion (18,19) because of its high dose glibenclamide and ischemia-reperfusion (H-GlibϩIR), glib- marginal oxygenation under normal physiologic conditions enclamide (6 mg/kg intravenously) 30 min before 45 min of left renal coupled with high basal metabolic demand (19–21). These ischemia followed by reperfusion; (3) low dose glibenclamide before renal tubular cells express the A1 AR (22) as well as the adenosine (L-GlibϩADO), glibenclamide (1 mg/kg intravenously) 30 bradykinin (23,24), muscarinic (25,26), and opioid (27,28) min before 10 min of adenosine pretreatment followed by 45 min of receptors. Therefore, the second hypothesis of the current study left renal ischemia followed by reperfusion; (4) high dose gliben- was that bradykinin, muscarinic, or opioid receptors may clamide before adenosine (H-GlibϩADO), glibenclamide (6 mg/kg intravenously) 30 min before 10 min of adenosine pretreatment fol- mimic the protection induced by A1 AR activation. lowed by 45 min of left renal ischemia followed by reperfusion; (5) high dose glibenclamide before IPC (H-GlibϩIPC), glibenclamide (6 Materials and Methods mg/kg intravenously) 30 min before IPC treatment followed by 45 General Surgical Preparation min of left renal ischemia followed by reperfusion; and (6) pinacidil All protocols were approved by the Institutional Animal Care and ϩ ␮ pretreatment group, pinacidil, a K ATP channel opener, (100 g/kg Use Committee of Columbia University. Surgical procedures have per min ϫ 10 min intravenously) 2 min before 45 min of left renal been previously described (5). Briefly, adult male Wistar rats were ischemia followed by reperfusion. Twenty-four h later, animals were anesthetized with pentobarbital intraperitoneally (45 mg/kg body wt killed and serum Cr levels were measured. or to effect) and allowed to breathe room air spontaneously. After 500 U of heparin (intraperitoneally) and maintaining the body temperature Potential Roles of Muscarinic, Bradykinin, and Opioid at 37°C, the right femoral artery and vein were cannulated with heparinized (10 U/ml) polyethylene tubing (PE-50). After a 10-min Receptors in Renal Protection stabilization period, a midline laparotomy was performed. A right To determine whether other agonists with similar signaling path- nephrectomy was performed, and the left renal artery and vein were ways in renal cells mimic renal protection afforded by adenosine or isolated. IPC, methacholine (a muscarinic agonist), bradykinin, or morphine was given to rats before ischemia and reperfusion. Rats were divided to the following groups after right nephrectomy: (1) methacholine IPC and Adenosine Pretreatment pretreatment group (MCh), methacholine (2 mg/kg, intraperitoneally) For IPC and adenosine pretreatment protocols, rats were subjected 15 min before 45 min of left renal ischemia followed by reperfusion; to the following protocols after right nephrectomy as described pre- (2) bradykinin pretreatment group (BK), bradykinin (500 ␮g/kg per viously (5): (1) control group (SHAM), isolation of left renal artery min ϫ 10 min intravenously) terminating 2 min before 45 min of left and vein only; (2) ischemia-reperfusion group (IR), 45 min of left renal ischemia followed by reperfusion; and (3) morphine pretreat-
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