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Gut-derived uremic toxin handling in vivo requires OAT-mediated tubular secretion in chronic kidney disease
Kevin T. Bush, Prabhleen Singh, Sanjay K. Nigam
Kevin T. Bush, Prabhleen Singh, Sanjay K. Nigam
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Research Article Metabolism Nephrology

Gut-derived uremic toxin handling in vivo requires OAT-mediated tubular secretion in chronic kidney disease

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Abstract

The role of the renal organic anion transporters OAT1 (also known as SLC22A6, originally identified as NKT) and OAT3 (also known as SLC22A8) in chronic kidney disease (CKD) remains poorly understood. This is particularly so from the viewpoint of residual proximal tubular secretion, a key adaptive mechanism to deal with protein-bound uremic toxins in CKD. Using the subtotal nephrectomy (STN) model, plasma metabolites accumulating in STN rats treated with and without the OAT inhibitor, probenecid, were identified. Comparisons with metabolomics data from Oat1-KO and Oat3-KO mice support the centrality of the OATs in residual tubular secretion of uremic solutes, such as indoxyl sulfate, kynurenate, and anthranilate. Overlapping our data with those of published metabolomics data regarding gut microbiome–derived uremic solutes — which can have dual roles in signaling and toxicity — indicates that OATs play a critical role in determining their plasma levels in CKD. Thus, the OATs, along with other SLC and ABC drug transporters, are critical to the movement of uremic solutes across tissues and into various body fluids, consistent with the remote sensing and signaling theory. The data support a role for OATs in modulating remote interorganismal and interorgan communication (gut microbiota–blood-liver-kidney-urine). The results also have implications for understanding drug-metabolite interactions involving uremic toxins.

Authors

Kevin T. Bush, Prabhleen Singh, Sanjay K. Nigam

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Figure 2

Analysis of uremic solutes found on the metabolomics platform.

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Analysis of uremic solutes found on the metabolomics platform.
(A) Parti...
(A) Partial least squares discrimination analysis of the metabolomic profiling data reveals clear separations between serum/plasma metabolites obtained from sham-operated animals (control; red) and subtotal nephrectomized animals (STN; green). (B and C) Volcano plots displaying metabolomics data derived from the analysis of the serum obtained from sham-operated control and STN animals. The negative logarithm of the P value for each metabolite is plotted against the logarithm to the base 2 of the fold change (sham treated vs. STN). Each point in the plot represents an individual metabolite. (B) The red triangles indicate those metabolites accumulating in the serum of the STN animal either significantly (P ≤ 0.05) or with a trend towards significance (0.1 ≥ P ≥ 0.05), the green dots represent those metabolites decreased in the serum of the STN animal (P ≤ 0.05 or 0.1 ≥ p ≥ 0.05), while the gray crosses indicate those metabolites not significantly altered in the STN animal. (C) The same image as B except that the 165 suspected uremic solutes/toxins found on the metabolomics platform are highlighted in purple. The majority of these metabolites are accumulating in the serum of the STN animal. (D) Box-and-whisker plots of the changes in concentrations in sham-treated controls (gray boxes) versus STN animals (red boxes) for some representative uremic toxins/solutes (5 measures of plasma concentration were used for each experimental group; a 2-tailed Student’s t test was used to determine statistical significance; a P value less than 0.05 was considered significant).

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