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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 3

Probenecid treatment affects tubular secretion but not glomerular filtration, leading to clear differences in metabolite profiles of uremic solutes.

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Probenecid treatment affects tubular secretion but not glomerular filtra...
(A and B) Box-and-whisker plots illustrating the effects of probenecid treatment on GFR (A) and tubular secretion (B). After treating the animals with probenecid, there was little to no effect on GFR in either the sham-operated animals or STN animals (A). Probenecid (PBD) treatment, however, had a significant (*P ≤ 0.05) effect on tubular secretion (B), such that, in both the sham-operated and the STN animals after probenecid treatment, there was a dramatic reduction in PAH clearance (PBD, probenecid; gray boxes, untreated sham-operated controls and untreated STN animals; white boxes, probenecid-treated sham-operated controls and STN animals). As in Figure 1, black cross in each box represents the mean; solid black center lines indicate the median; open circles represent the individual data points; box limits indicate the 25th and 75th percentiles, as determined by R software; whiskers extend 1.5 times the interquartile range from the 25th and 75th percentiles, outliers are represented by dots (92) (5 animals were used for each of the experimental groups; a 2-tailed Student t test was used to determine statistical significance; a P value less than 0.05 was considered significant.) (C) Partial least squares discrimination analysis of the metabolomic profiling data reveals clear separations between serum/plasma metabolites obtained from untreated sham-operated animals (control; red), untreated STN animals (STN; purple), and probenecid-treated STN animals (STN+PROB; green). (D) A Z score plot of metabolite intensities for the 58 uremic solutes affected by treatment of the STN animals with probenecid. The greater the distance of each dot (individual measurements for each metabolite) from the x axis, the greater the magnitude of change in plasma concentration for each metabolite (black circles, sham-treated control; green circles, STN rats; red circles, STN rats treated with probenecid). In this case, the distance of the green dot (STN alone) from the x axis is the average score of the STN animal above the sham-treated control (black dot), while the distance of the red dot (STN with probenecid) from the x axis is the average score of the probenecid-treated STN animal above the untreated STN animal. Plasma increases in metabolite concentration (positive Z scores) are seen above the x axis, while decreases in plasma concentration are represented by those dots below the x axis. As can be seen, many metabolites belonging to the amino acid metabolic superpathway show significant accumulation in the plasma of the STN animal following probenecid treatment.

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