Vitamins 696x496 1

vitamin d nrf2

Kentaro Nakai, Hideki Fujii, Keiji Kono, Shunsuke Goto, Riko Kitazawa, Sohei Kitazawa, Michinori Hirata, Masami Shinohara, Masafumi Fukagawa, Shinichi Nishi, Vitamin D Prompts the Nrf2-Keap1 Antioxidant Pathway and Ameliorates Nephropathy in Diabetic Rats, American Journal of Hypertension, Quantity 27, Challenge 4, April 2014, Pages 586–595,

The annual incidence of diabetic nephropathy is rising worldwide; even in Japan, diabetes is now the most important reason for end-stage kidney illness. It’s well-known that the development of diabetic nephropathy is said to many advanced elements, together with hyperglycemia, hypertension, hyperlipidemia, weight problems, irritation, and oxidative stress.1,2 Of those, we centered on the position of oxidative stress and noticed that diabetic nephropathy is related to oxidative stress in a nonobese kind 2 diabetic rat mannequin.3 Not too long ago, activator of the nuclear issue erythroid 2-related issue 2 (Nrf2)/Kelch-like erythroid cell-derived protein with CNC homology (ECH)-associated protein 1 (Keap1) antioxidant pathway was reported to ameliorate kidney operate in kind 2 diabetes.4 Nrf2 is negatively regulated by Keap1 and prompts expressions of assorted Reactive oxygen species (ROS) detoxifying and antioxidant genes. Thereby, Nrf2 performs an necessary position in regulating oxidative stress.

Vitamin D deficiency was related to glucose intolerance5–7 and incident kind 2 diabetes.8,9 Though the consequences of vitamin D supplementation on enhancing glycemic management and insulin resistance was unsure,10 a number of latest research have proven that vitamin D remedy suppresses oxidative stress.11–15 Subsequently, we decided whether or not vitamin D remedy might attenuate the development of diabetic nephropathy by amelioration of the Nrf2–Keap1 pathway and suppression of oxidative stress.



Not too long ago, many diabetic animal fashions have been used to elucidate the mechanisms of pathogenesis and problems in diabetes. Nonetheless, there are few stories of nonobese kind 2 diabetes. The spontaneously diabetic torii (SDT) rat mannequin used here’s a newly established nonobese kind 2 diabetic rat mannequin inbred from an outbred colony of Sprague-Dawley (SD) rats.3 In distinction to the streptozotocin (STZ)-induced diabetes mannequin, SDT rats steadily develop an insulin secretory defect that outcomes from gradual pathological injury to beta cells within the pancreatic islets and may survive for a very long time even with out insulin remedy. At age 20 weeks, male SDT rats (kindly offered by CLEA Japan Inc., Tokyo, Japan) had been divided into the next 3 teams (n = 6): insulin-treated rats (INS group), maxacalcitol (OCT)-treated rats (OCT group), and vehicle-treated rats (DM group). We used the SD rats for reference and the insulin-treated group because the management as a result of there have been some variations between SD and SDT rats and the hyperglycemic state performed an necessary position for oxidative stress.3 Rats had been housed with advert libitum entry to meals and water in light- and temperature-controlled environments. To regulate hyperglycemia, rats within the INS group had been injected subcutaneously with long-lasting insulin pellets (LinShin Canada Inc., Ontario, Canada) each 2 weeks beginning at age 20 weeks, as described beforehand.3 OCT (0.2 μg/kg physique weight) was intraperitoneally administered 3 occasions per week beginning at age 20 weeks and adjusted each week in response to adjustments in physique weight. The car was composed of 0.2% ethanol and 0.01% Tween 20 in phosphate-buffered saline (pH 8.0). At age 30 weeks, the rats had been sacrificed and each kidneys had been eliminated for evaluation by histology in addition to mRNA and protein expressions. The Institutional Animal Care and Use Committee accredited all animal procedures (Permission quantity: P081214), and all procedures had been carried out in response to Kobe College’s animal experimentation rules and the Nationwide Institutes of Well being animal use and care tips.

Serum and urine measurements

Blood samples had been obtained through the tail vein at age 20 weeks and through cardiac puncture on the time of sacrifice. To gather urine for twenty-four hours, rats had been positioned in metabolic cages with enough entry to water and meals. Serum chemistry ranges had been measured utilizing an automatic analyzer (Fuji Dri-Chem 3500; Fujifilm, Tokyo, Japan). Glycated hemoglobin A1c (HbA1c) was measured utilizing an immunoassay-based bench-top analyzer (DCA 2000; Bayer Inc., Tarrytown, NY). Urinary excretion of creatinine, albumin, and 8-hydroxy deoxyguanisine (8-OHdG) was measured utilizing enzyme-linked immunosorbent assay (ELISA) kits as described beforehand.3 Parathyroid hormone (PTH), high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and angiotensinogen (AGT) had been decided utilizing an ELISA equipment (PTH, Immutopics, CA; hs-CRP, Kamiya Biomedical Co., Seattle, WA; IL-6, Invitrogen Company, CA; AGT, Immuno-Organic Laboratories Co., Gunma, Japan). Creatinine clearance was normalized by physique floor space (BSA) calculated in accordance Meeh’s components: BSA = 9.83 × physique weight2/3.16

Blood strain measurements

Systolic blood strain was measured in aware, restrained rats by tail-cuff plethysmography (mannequin MK-2000; Muromachi Kikai Co. Ltd., Japan). To scale back the potential for stress artifacts, rats had been allowed to acclimatize sufficiently, and the typical of 10 measurements was calculated.

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Renal histology and immunohistochemistry

Glomerular quantity and the mesangial matrix index had been evaluated on periodic acid-Schiff slides as beforehand reported.3 Immunohistochemical staining was additionally carried out as described beforehand.3 In short, paraffin-embedded sections had been stained with the next major antibodies: anti-8-OHdG antibody (N45.1; Japan Institute for the Management of Growing old, Japan); anti–nuclear factor-κB (NF-κB) p65 antibody (Cell Signaling Know-how, Danvers, MA); anti-Nrf2 antibody (Abcam, Cambridge, United Kingdom); anti-Keap1 antibody (Abcam); and anti-vitamin D receptor (VDR) antibody (Santa Cruz Biotechnology, Santa Cruz, CA). The 8-OHdG- and NF-κB p65-positive cells within the glomeruli had been primarily endothelial and mesangial cells and had been counted in 20–30 random microscopic fields to provide 8-OHdG- and NF-κB p65-positive cell scores.

RNA extraction and real-time polymerase chain response analyses

Complete RNA was extracted from complete kidney as described beforehand.3 Actual-time polymerase chain response (RT-PCR) was carried out utilizing a LightCycler 350s RT-PCR system (Roche, Mannheim, Germany) with the LightCycler FastStart DNA Grasp SYBR Inexperienced I Package (Roche). The evaluation was carried out with the second spinoff most technique of the LightCycler software program (model. 4.0; Roche). The relative quantity of the pattern mRNA was normalized to β-actin mRNA. The PCR primers used on this examine are listed in Desk 1.

Western blot analyses

The nuclear and cytosolic fractions had been remoted from complete kidney utilizing a nuclear extraction equipment (Energetic Motif, Carlsbad, CA), following the producer’s directions. Protein focus was decided utilizing the Bradford technique (Bio-Rad Laboratories, Richmond, CA). Complete protein (20 µg per pattern) membranes had been blocked with 0.3% nonfat dry milk in Tris-buffered saline with Tween 20 (TBS-T) buffer for half-hour, washed in TBS-T, and hybridized with the specified major antibodies towards Nrf2 (Abcam), Keap1 (Abcam), VDR (Santa Cruz Biotechnology), and β-actin (Novus Biologics, Littleton, CO) for 1 hour at room temperature after which incubated with the suitable horseradish peroxidase–conjugated secondary antibodies for half-hour. Antibody binding was visualized with enhanced chemiluminescence (Chemi-Lumi One Tremendous; Nacalai Tesque, Inc., Kyoto, Japan) utilizing the LAS-3000 mini (Fujifilm). Immunoreactive band intensities had been analyzed by the Picture J software program (Nationwide Institutes of Well being, Bethesda, MD) and normalized to β-actin.

Transcription issue nuclear DNA-binding exercise

The nuclear DNA-binding actions of the p65 NF-κB subunit had been decided within the nuclear fractions of kidney tissues utilizing the ELISA-based TransAM NF-κB kits (Energetic Motif), in response to the producer’s directions.

Statistical analyses

Statistical analyses had been carried out utilizing the pc software program utility JMP model 9.0.2 (SAS Institute Inc., Cary, NC). Values are offered as means ± customary error of the imply. Variations between teams had been evaluated by the Tukey–Kramer truthfully important distinction technique for a number of comparisons. All statistical assessments had been 2-sided, and P < 0.05 was thought of statistically important.  


Animal traits and biochemical measurements

The three remedy teams had been comparable of their traits and biochemical parameters at age 20 weeks (Desk 2). At age 30 weeks, physique weight was considerably decreased within the DM and OCT teams in contrast with the INS group, whereas the ratio of kidney:physique weight (kidney/BW) within the DM and OCT teams was greater than that within the INS group. Kidney/BW was decreased by OCT remedy, although this distinction was not statistically important. HbA1c ranges had been considerably greater within the DM and OCT teams than within the INS group. Although the normalized creatinine clearance didn’t considerably differ among the many 3 teams, urinary excretion of albumin was considerably decrease within the INS and OCT teams than within the DM group. Serum calcium, phosphate, and blood strain had been comparable in all rats. Although the distinction was not statistically important, serum PTH ranges had been decreased within the OCT group. Urinary excretion of angiotensinogen considerably decreased within the INS group however not within the OCT group in contrast with the DM group.

Analysis of histomorphometric glomerular abnormalities

Histological examination of the kidneys revealed that the glomerular floor space and mesangial matrix fraction (% of glomerular floor space) had been each elevated within the DM group in contrast with that within the INS group. Moreover, growth of mesangial matrix was considerably decrease within the OCT group than within the DM group (Determine 1A–C).

Evaluation of oxidative stress in urine and kidney tissues

Determine 1D–F signifies the consequences of OCT on urinary and intrarenal ranges of the oxidative stress marker 8-hydroxydeoxyguanosine (8-OHdG). The variety of 8-OHdG–optimistic cells and urinary excretion of 8-OHdG was considerably greater within the DM group than within the INS group and was considerably diminished within the OCT group.

Evaluation of inflammatory markers

We measured serum hs-CRP, IL-6 ranges, and remodeling progress factor-beta (TGF-β) as systemic inflammatory markers. Serum hs-CRP ranges and the mRNA expression of TGF-β had been considerably decrease, and IL-6 ranges tended to be decrease within the OCT group in contrast with the DM group (Desk 2, Determine 2A).

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Expression of NF-κB, nicotinamide adenine dinucleotide phosphate oxidase p22 phox, and p47 phox

The variety of NF-κB p65-positive cells and activation of NF-κB p65 had been each greater within the DM group than within the INS group and had been considerably diminished with OCT remedy (Determine 3A–C). We additionally noticed that the mRNA expressions of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase p22 phox and p47 phox had been considerably decrease within the INS and OCT teams than within the DM group (Determine 2B, C).

Impact of OCT remedy on the Nrf2–Keap1 pathway

As proven in Determine 2D–H, expressions of Nrf2 and its downstream genes, heme oxygenase-1 (HO-1), glutamate-cysteine ligase catalytic subunit (GCLC), and a modifier subunit (GCLM), had been considerably elevated and Keap1 expression was decreased within the INS and OCT teams in contrast with the DM group. According to these outcomes, immunostaining for Nrf2 revealed that its expression within the glomeruli was attenuated within the DM group in contrast with the INS and OCT teams, whereas the extent of the Nrf2 repressor Keap1 was enhanced (Determine 4A). Furthermore, Nrf2 protein ranges had been elevated whereas Keap1 was decreased within the OCT and INS teams (Determine 4B, C). Thus, OCT ameliorated downregulation of Nrf2 expression induced by diabetic nephropathy.

Evaluation of VDR expression

We evaluated VDR expression utilizing immunostaining and western blotting. Outcomes confirmed diminished VDR expression within the DM group in contrast with the INS and OCT teams (Determine 4A, D).



On this examine we demonstrated the next: (i) urinary albumin excretion and mesangial matrix growth had been each considerably decrease within the OCT group than within the DM group; (ii) expressions of 8-OHdG, NF-κB p65, and NADPH oxidase had been extra attenuated within the OCT group than within the DM group; and (iii) the Nrf2–Keap1 pathway and VDR expression in diabetic nephropathy had been successfully modulated by OCT remedy.

It’s well-known that vitamin D deficiency is a outstanding characteristic of continual kidney illness (CKD), and there may be proof to recommend that vitamin D deficiency is related not simply with bone fractures but in addition the development of CKD and heart problems (CVD). Some scientific research have revealed that vitamin D remedy considerably decreases mortality and CVD occasions in hemodialysis sufferers and predialysis sufferers,17,18 and randomized managed trials have proven that paricalcitol, an lively vitamin D analogue, reduces proteinuria in CKD sufferers.19 Thus, the helpful results of vitamin D on renal safety are supported by latest experimental and scientific research.

Though hypertension is without doubt one of the most crucial and treatable elements within the development of CKD and CVD, the consequences of vitamin D on reducing blood strain are controversial. Some randomized managed trials revealed that paricalcitol and cholecalciferol barely however considerably lowered blood strain,19,20 whereas different research in CKD sufferers confirmed that blood strain was not modified by vitamin D remedy.21,22 Moreover, animal research couldn’t present conclusive details about the consequences of vitamin D remedy on hypertension in 5/6 nephrectomy and adriamycin-induced nephropathy.13,23–25 Since OCT remedy didn’t change blood strain within the current examine, we thought of that the renoprotective impact of OCT to be impartial of blood strain.

In a randomized managed trial, cotreatment with vitamin D and renin–angiotensin system (RAS) inhibitors considerably diminished albuminuria in sufferers with diabetic nephropathy.19 Moreover, experimental research utilizing kind 1 and a pair of diabetic fashions demonstrated that mixture remedy of vitamin D and an AT1 receptor blocker (ARB) successfully stop the development of diabetic nephropathy.26 Activation of the RAS is more and more being proven to be an important mediator of hyperglycemia-induced renal injury. Subsequently, it’s probably that vitamin D and ARB mixture remedy is simpler than monotherapy as a result of additive vitamin D remedy might suppress the compensatory improve of renin manufacturing brought on by the RAS inhibitors. Even in 5/6 nephrectomized rats, vitamin D suppresses renin transcription and downregulates the RAS.23 Within the current examine, though RT-PCR evaluation of angiotensinogen and immunostaining for angiotensin-II indicated that OCT remedy appeared to suppress the RAS exercise (information not proven), the outcomes weren’t statistically important and urinary excretion of angiotensinogen didn’t considerably differ between the DM and OCT teams. Subsequently, we speculate that the protecting results of OCT on the development of diabetic nephropathy are mediated primarily by way of a special pathway, though the protecting results of OCT on early diabetic nephropathy had been partly mediated by suppression of RAS exercise.

Current research reveal that oxidative stress performs a key position within the improvement and development of diabetic problems,2,11 and we’ve beforehand proven that oxidative stress is related to the event of diabetic nephropathy in kind 2 diabetic rat mannequin SDT rats and that the SDT rats develop early diabetic nephropathy with albuminuria, mesangial matrix growth, and glomerular hypertrophy.3 Primarily based on latest animal and scientific research,11–15 we hypothesized that vitamin D might attenuate oxidative stress in SDT rats. In assist of this, activated vitamin D analogs are identified to extend superoxide dismutase, catalase, and glutathione peroxidase in streptozotocin-induced diabetic rats,11 and calcitriol remedy reduces oxidized albumin and will increase serum thiol antioxidants in hemodialysis sufferers.12 The antioxidant results of vitamin D could also be related to inhibition of NADPH oxidase.13 According to this, we discovered that expression of the NADPH subunit mRNAs and the urinary excretion of 8-OHdG, which is a marker of oxidative DNA injury, had been each considerably decreased within the OCT group in contrast with the DM group. Moreover, oxidative stress in renal tissue was additionally decreased within the OCT group in contrast with the DM group. Taken collectively, these information recommend that OCT might stop the development of diabetic nephropathy by suppression of oxidative stress pathways. Corresponding with these findings, we beforehand reported that OCT additionally attenuated early diabetic vasculopathy by suppression of oxidative stress and irritation in the identical diabetic mannequin rats.27

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It has been reported that the variety of VDR decreases within the kidney of db/db mice.28 In VDR knockout and heterozygous mice, VDR loss is accompanied by extraordinarily excessive expression of 8-OHdG and NF-κB.29,30 Moreover, additionally it is identified that the diminished 8-OHdG labeling is related to expression of VDR in regular human colorectal mucosa.14 Thus, it’s believed that elevated oxidative stress in diabetes is said to a lower in VDR expression. In our examine, OCT ameliorated the numerous discount in VDR expression seen within the DM group. As well as, the earlier examine demonstrated that lively vitamin D remedy elevated VDR protein lifetime and upregulated its expression.31 Taken collectively, we speculated that the rise and activation of VDR by OCT may result in diminished oxidative stress. Thus, it’s instructed that vitamin D and its analogs cut back oxidative stress and inhibit NF-κB and NADPH oxidase exercise, presumably through VDR signaling.

NF-κB is a marker of oxidative stress and irritation and can also be activated in diabetes.32 Current research recommend that irritation performs an important position within the pathogenesis of diabetic nephropathy. Throughout hyperglycemia, elevated activation of NF-κB correlates carefully with elevated mesangial cell proliferation, which can be a key step within the pathogenesis of diabetic nephropathy.33 This will likely contribute to accumulation of renal extracellular matrix, leading to renal injury. It might due to this fact be important that some research have proven that vitamin D suppresses renal irritation by way of inhibition of NF-κB.34 In streptozotocin-induced diabetic mice, 1,25-dihydroxyvitamin D3 suppressed activation of NF-κB by hyperglycemia.35 In our examine, OCT remedy additionally suppressed NF-κB activation and led to corresponding decreases within the ranges of hs-CRP, IL-6, and TGF-β. These information recommend that inhibition of NF-κB exercise in kind 2 diabetes exerts a renoprotective impact by way of the suppression of oxidative stress and proinflammatory pathways.

Nrf2 regulates expression of detoxifying and antioxidant enzymes by way of the antioxidant response ingredient (ARE/EpRE). Underneath physiological circumstances, Nrf2 is sequestered within the cytoplasm by Keap1, an actin-binding repressor protein. By means of this mechanism, Keap1 contributes to elevated oxidative stress by way of unfavourable regulation of Nrf2 and ARE/EpRE exercise. Diminished expression of Nrf2 and elevated oxidative stress have been noticed in diabetes.36,37 Though the detailed mechanism of Nrf2 downregulation stays unclear, each augmentation of Keap1 and phosphorylation of extracellular-signal-regulated kinase (ERK) cut back Nrf2 ranges. As well as, lively vitamin D analogs activate Nrf2 transcription think about squamous carcinoma cells and myeloid leukemia cells.38,39 Subsequently, we speculated that vitamin D may have an effect on the Nrf2–Keap1 pathway even in diabetes. Within the current examine, OCT inhibited the hyperglycemia-induced downregulation of Nrf2 and expression of HO-1, GCLC, and GCLM, which is a downstream gene product of the Nrf2–Keap1 pathway. Thus, modulation of Nrf2 expression is prone to play a essential position in safety of the kidneys from the oxidative injury of hyperglycemia by vitamin D.

In conclusion, we’ve proven that OCT diminished oxidative stress and attenuated albuminuria and renal histological injury in nonobese kind 2 diabetic rats. OCT may enhance the downregulation of Nrf2–Keap1 pathway in addition to suppress NF-κB and NADPH oxidase exercise.



This work was supported partly by Chugai Pharmaceutical Co., Ltd. Michinori Hirata is an worker of Chugai Pharmaceutical Co., Ltd. The authors shouldn’t have another conflicts of curiosity to report.


ACKNOWLEDGMENTS – “vitamin d nrf2”

We thank Ken Kitamura and Yuriko Yonekura for his or her technical help.





“vitamin d nrf2”

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