2.2. Discussion
AKI induced by renal ischemia is a common clinical complication characterized by an abrupt decrease in the glomerular filtration rate (GFR). Despite supportive care, including renal replacement therapy, the five-year mortality after AKI remains ~50% [
17]. Limited understanding of the cellular mechanisms of AKI induced by renal ischemia complicates the development of an effective treatment. Abundant evidence shows that necrosis, apoptosis, necroptosis, and autophagy are involved in AKI [
2–
5]. This indicates that targeting these cell deaths will probably improve the outcome of AKI.
Emerging evidences suggest that necroptosis is closely related to other cell death, at least in particular conditions [
14,
18,
19]. Recently, Linkermann
et al. also demonstrated the pathophysiological coexistence and corelevance of cyclophilin (Cyp)D-mediated mitochondrial permeability transition (MPT) and receptor interacting protein kinase (RIPK)1-mediated necroptosis [
20]. The parallel existence of the two separate pathways that induce regulated necrosis in the same organ, following the same ischemic stimulus, demonstrates the complexity in the pathophysiology of ischemia-reperfusion injury. Nec-1 is a key mediator of necroptosis, originally identified, selectively targets the kinase activity of RIP1. It has recently been discussed to directly influence other cell deaths, or to have other functions, in addition to its effects to block necroptosis [
14,
18,
19,
21]. Thus, further understanding of these additional roles of Nec-1 promise new therapeutic possibilities.
In the present study, we hypothesized that administration of Nec-1 could produce an effect on ischemia-induced renal tubular epithelial cell death. To test our hypothesis, we simulated ischemic AKI in rat tubular cell line NRK-52E with TNF-α stimulation and ATP depletion, and then we examined the potential effects of Nec-1 on ischemia-induced cell death. In addition, we also explored the potential mechanism of Nec-1 on cell death in, such a renal ischemia model.
In this study, we found that cell death, determined by Hoechst staining and flow cytometry with annexin V and PI double stains, was significantly increased in simulated ischemia injury of NRK-52E cells with TNF-α stimulation and ATP depletion. However, the effect of ischemia injury induced cell death in NRK-52E cells was blocked by concomitant treatment with Nec-1. Similarly, we also found cell viability was markedly improved in ischemia injury of NRK-52E cells after using Nec-1. These results suggest that Nec-1 has a protective effect on ischemia injury of renal tubular epithelial cells.
To further explore the mechanisms of Nec-1 inhibited ischemia injury-induced cell death, we next investigated the protein expression of Drp1, a member of the dynamin family of large GTPases [
22,
23]. Drp1 is a primarily cytoplasmic protein which, when activated, can form ring-like multimers and translocate to the mitochondria. There, in concert with accessory proteins, Drp1 facilitates mitochondrial division [
23]. A body of evidence has accumulated to suggest that Drp1 contributes to cell death [
24–
26]. Drp1 foci accumulate on mitochondria and mediate dramatic mitochondrial fission prior to caspase activation. Inhibiting Drp1 activity delays cytochrome C release, caspase activation, and subsequent steps in cell demolition [
27]. In this study, the protein expression level of Drp1 in cultured NRK-52E cells was significantly increased under simulated ischemia injury with TNF-α stimulation and ATP depletion, whereas Nec-1 or
Drp1-knock down treatment strongly abolished the elevation of Drp1 level induced by ischemia injury. Meanwhile, we also found that the cell injury induced by ischemia injury in NRK-52E cells was markedly improved after
Drp1 knock down. These results indicated that Nec-1 protects renal tubular epithelial cell from ischemia injury, probably through a mechanism dependent on Drp1.
This new finding will support a notion that Nec-1, which was originally identified to selectively target the kinase activity of RIP1, can also mediate cell death through Drp1, a member of the dynamin family of GTPases required for mitochondrial fission. However, one fact we must admit is that, in the present study, we cannot rule out the probability of the presence of other molecular mechanisms on Nec-1 playing such a protective effect in this ischemia injury model. Especially, one recent study from Mohib
et al. demonstrated that Indoleamine 2,3-dioxygenase (IDO), which is the rate-limiting enzyme in the kynurenine enzymatic pathway, is overexpressed in tubular epithelial cells subject to ischemia reperfusion injury, and IDO could promote ischemia-reperfusion injury by augmenting tubular cell death and worsening function [
28]. Therefore, whether the presence of the inhibitory activity of Nec-1 against IDO is still unknown, and this will need to be clarified in further studies.