Acute kidney injury (AKI) is a destructive clinical condition induced by multiple insults including ischemic reperfusion, nephrotoxic drugs and sepsis. It is characterized by a sudden decline in renal function, in addition to excessive inflammation, oxidative stress and programmed cell death of renal tubular epithelial cells. RIPK1-mediated necroptosis plays an important role in AKI. In the present study, we evaluated the treatment effects of Compound-71 (Cpd-71), a novel RIPK1 inhibitor, by comparing with Necrostatin-1 (Nec-1), a classic RIPK1 inhibitor, which has several drawbacks like the narrow structure–activity relationship (SAR) profile, moderate potency and non-ideal pharmacokinetic properties, in vivo and in vitro. Our results showed that pretreatment of Cpd-71 attenuated cisplatin-induced renal injury, restored renal function and suppressed renal inflammation, oxidative stress and cell necroptosis. In addition, Cpd-71 inhibited renal damage while reducing the up-regulated serum creatinine (Cr) and blood urea nitrogen (BUN) levels in established AKI mice model. Consistently, we confirmed that Cpd-71 exhibited more effectively suppressive effect on cisplatin-induced renal tubular cell necroptosis than Nec-1, by physically binding to the allosteric type III ligand binding site of RIPK1, thereby reduced RIPK1 kinase activity, RIPK1/RIPK3 complex formation and phosphor-MLKL membrane translocation by molecular docking, Western blot, co-immunoprecipitation and cellular thermal shift assay (CETSA). Taken together, we currently showed that targeting RIPK1 with Cpd-71 may serve as a promising clinical candidate for AKI treatment.
Acute kidney injury (AKI), characterized by an abrupt loss of kidney function, is a devastating clinical condition induced by insults like ischemic reperfusion, nephrotoxic drugs and sepsis [1,2]. As one of the most common complications in hospitalized patients, AKI shows a rapidly increasing incidence specially in the elderly with high morbidity and mortality, which it accounts for approximately 2 million deaths per year worldwide [3–5]. Despite a certain percentage of renal repair and recovery, severe or repeated AKI may transit into chronic kidney disease (CKD) or even end-stage renal disease [6,7]. In this regard, potential biomarkers and effective therapy are urgently needed for the treatment of AKI.
Many types of resident and infiltrated cells are involved in pathophysiology of AKI . In response to ischemic or nephrotoxic insults, tubular cells often undergo a series of intracellular changes involving oxidative stress , mitochondrial dysfunction  and programmed cell death [10–12]. Necroptosis is a type of programmed cell death mediated by RIPK/MLKL signaling. As the key molecule for initiating necroptosis, RIPK1 forms the complex I with type 1 TNF receptor 1 (TNFR1), TNFR1-associated death domain protein (TRADD) and TNFR-associated factor 2 (TRAF-2) via death domain, thereby induces necroptosis by forming RIPK1/RIPK3/MLKL necrosome in absence of caspase 8 [13,14]. Necroptosis plays a significant role in different types of diseases like stroke , myocardial infarction , ischemia–reperfusion (I/R) injury [17,18], atherosclerosis , drug-induced liver injury , extran sulfate sodium-induced colitis  etc.
Previous studies showed that necroptosis played critical roles in inducing damage in multiple renal disease models, and knockout or pharmacologically blockade of necroptosis regulatory molecules like RIPK1, RIPK3 and MLKL alleviated renal injury [22–25]. Necrostatin-1 (Nec-1), a classic RIPK1 inhibitor, prevents RIPK1 activation with high kinase selectivity by directly binding to an allosteric pocket next to the kinase active site . However, Nec-1 failed to be applied in clinic due to several drawbacks like poor metabolic stability and a narrow structure–activity relationship (SAR) profile [27–29], although it showed merits in animal models of AKI [30–32]. In our recent work, we focused on exploring novel RIPK1 inhibitors with high efficiency and safety. A very recent study published in top journal of medicinal chemistry identified a compound, termed as compound 71 (Cpd-71), showed a stronger affinity for RIPK1 compared with Nec-1 and inhibited TNF-induced necroptosis both in vitro and in TNF-induced systemic inflammatory response syndrome model . However, whether Cpd-71 is a renoprotective agent and promising therapeutic molecule for AKI has been unexplored. We currently tested the anti-necroptotic effect of Cpd-71 in cisplatin-induced tubular epithelial cells while determining its protective effect on inflammation and oxidative stress compared with Nec-1. More importantly, we evaluated the effects of Cpd-71 using different dose and time administration protocols of this compound in cisplatin-treated mice.
Materials and methods
Reagents and materials
Compound-71(N-(4-((4-((5-methyl-1H-pyrazol-3-yl)amino)-6-morpholinopyrimidin-2-yl)amino)phenyl)cyclopropanecarboxamide, (Cpd-71)), a derivative of the Aurora kinase inhibitor tozasertib, was discovered by Augustyns et al. through optimization of tozasertib to increase the inhibitory activity of RIPK1 meanwhile to decrease the effect on Aurora kinase . Cpd-71, used for the present study, was synthesized according to the procedures in the literature. Briefly, starting from 2,4,6-trichloropyrimidines, 5-methyl-1H-pyrazol-3-yl)amino was introduced to the 4-position of pyrimidine, followed by reaction with morpholine at 6-position of pyrimidine in the presence of piperidine. Subsequently, the intermediate was reacted with N-(4-aminophenyl)cyclopropanecarboxamide to give the crude product. Finally, the crude product was further purified by flash-column chromatography to give the title compound Cpd-71. The chemical structure of synthesized Cpd-71 was confirmed by 1H-nuclear magnetic resonance (NMR) and high resolution mass spectrometry (HRMS), which was consistent with the original literature . The purity of Cpd-71 was more than 95% which was determined by HPLC.
The antibodies specific for RIPK1, RIPK3, TNF-α, KIM1 and β-actin were purchased from Santa Cruz Biotechnology (Santa Cruz, CA, U.S.A.). Anti-Nox4 was purchased from BiossBiotechnology (Bioss, Beijing, China). According to the manufacturer’s instructions and our preliminary experiment, anti-KIM1 (1:200), anti-TNF-α (1:200) and anti-RIPK1 (1:200) were diluted in 1% BSA/PBS solution and then used in IHC and immunofluorescence (IF) staining, respectively. Rabbit anti-p-MLKL was obtained from Cell Signaling Technology (CST, Danvers, MA, U.S.A.). Lipofectamine 2000 was purchased from SciencBio Technology (Invitrogen, Carlsbad, CA, U.S.A.). Cisplatin was purchased from Sigma–Aldrich (Sigma, CA, U.S.A.). Nec-1 was obtained from Santa Cruz Biotechnology (Santa Cruz, CA, U.S.A.). Recombinant human TNF-α and zVAD-fmk (herein referred to as zVAD) were purchased from R&D System (Minneapolis, MN, U.S.A.). Protein Assay Kit was bought from Beyotime Institute of Biotechnology (Jiangsu, China). Periodic acid–Schiff (PAS), Cell Malondialdehyde (MDA) assay kit (Colorimetric method), reduced glutathione (GSH) assay kit, Creatinine (Cr) Assay kit and blood urea nitrogen (BUN) assay kit were obtained from Jiancheng Bioengineering Institute (Nanjing, China). Reactive Oxygen Species Assay (DCF Assay) Kit and Dihydroethidium (DHE) were purchased from Beyotime Institute of Biotechnology (Jiangsu, China).
Model of cisplatin-induced AKI
Male C57BL/6J mice (approximately 20–22 g) were provided by the Experimental Animal Center, Anhui Medical University. All animal procedures were approved by the Animal Experimentation Ethics Committee from Anhui Medical University, Anhui, China. All animal experiments were conducted at Anhui Medical University. Mice were intraperitoneally injected with a single dose of cisplatin at 20 mg/kg. In protocol I, Cpd-71, concentrations of 0.825, 1.65 and 3.3 mg/kg, were given via intraperitoneal injection 12 h before cisplatin administration and then injected once daily. In protocol II, Cpd-71 was intraperitoneally injected 24 h after cisplatin injection and then injected once daily. Mice were killed under anesthesia 3 days after cisplatin injection. The kidney tissues and blood were collected for further analysis. Blood was collected for BUN and Cr measurements according to the manufacturer’s instructions. Kidneys were harvested for paraffin embedding, molecular analysis and electron microscopy studies. Paraffin sections (4 μm) were stained with PAS Staining kit (Fuzhou Maixin Biotech. Co., Ltd.). At least six independent experiments were performed throughout the study.
Human kidney tubular epithelial cells (HK2) were cultured in DMEM-F12 (5% FBS). Cells were pretreated respectively with Cpd-71 (0.1, 0.2 and 0.4 μM) for 12 h before being exposed to cisplatin (20 μM) for 24 h. At least three independent experiments were performed throughout the study.
Cell viability assay
Cell viability was determined by MTT assay. According to a purple formazan product produced by mitochondrial dehydrogenase of viable cells, HK2 cells were seeded in 96-well plates and cultured with a set of concentrations of Cpd-71 (arranged from 0.1 to 12.8 μM) for 24 h with or without administration of cisplatin (20 μM), respectively. Then 5 mg/ml MTT solution was added to each well and incubated at 37°C for 4 h. After supernatant was removed, 150 μl of DMSO was used to dissolve formazan crystals. Optical density (OD) detection was performed at 492-nm wavelength (Multiskan MK3, Thermo, U.S.A.).
Determination of MDA and GSH
The levels of MDA and GSH in cell or in mouse serum were measured with a commercial kit (Jiancheng Co., Nanjing, China) according to the manufacturer’s instructions. Thiobarbituric acid reacts with MDA, degradation product of lipid peroxidation in, to generate red compound which has maximum absorbance at 532 nm wavelength. 5,5-dithiobis-2-nitrobenzoic acid (DTNB) reacts with sulfhydryl compounds to generate a yellow compound, whose absorption peaks at 405 nm wavelength. GSH concentration was determined based on the absorbance of yellow compound.
Reactive oxygen species determination
The level of intracellular reactive oxygen species (ROS) was measured using a fluorescent dye 2′,7′-dichlorofluorescein diacetate (DCFH-DA). Briefly, cells were incubated with DCFH-DA (10 μl/l) for 20 min at 37°C. After washing with serum-free medium, cells were imaged on a fluorescence microscope at 488 nm (Leica, Bensheim, Germany). The oxidation of DHE, ethidium bound to DNA and fluorescent red, was also used to estimate intracellular ROS levels. Cells were incubated with 5 mM freshly prepared DHE solution (Beyotime, Jiangsu, China) for 30 min at 37°C. After washing with serum-free medium then measured under fluorescence microscopy.
Cellular thermal shift assay
Cellular thermal shift assay (CETSA) was conducted according to the protocol as previously described . Mice were intraperitoneally injected with Cpd-71 or vehicle control. One hour after drug administration, mice were killed under anesthesia and kidney tissues were collected. The samples were added to RIPA lysis buffer, and were homogenized with tissue breaker (Tissue-prp, Shanghai, China) using 3.0 mm zirconium under chilled conditions. Total protein adjusted with the same concentration was quantified by Protein Assay Kit (Beyotime, Jiangsu, China). Then, it was distributed equally into different PCR tubes and denatured the samples at various temperatures for 8 min on PCR instrument (Eppendorf, Germany), and freeze-thawed the samples three times using liquid nitrogen. Samples were centrifuged and the supernatants were analyzed by Western blot.
Molecular docking study was performed using Discovery Studio 2017 R2 (DS, BIOVIA Software, Inc., San Diego, CA, United States) to gain an insight into the possible binding interaction between Cpd-71 and RIPK1. Crystal structure of RIPK1 kinase (PDB 6HHOco-crystallized with G4W) was obtained from the Protein Data Bank. The structure of RIPK1 kinase derived from the complex 6HHO was prepared through the Protein Preparation protocol. And the hydrogen atoms and CHARMm force fields were then added. The entire RIPK1 kinase was defined as a receptor. The binding site was specified by the center of co-crystallized ligand G4W. Molecular Cpd-71 energy minimization was used the Minimize Ligands protocol and docking program was performed by CDOCKER module. Other parameters were set as default.
Western blot analysis
Proteins were separated from pulverized tissue or cells from six-well plates in ice-cold RIPA Buffer (Beyotime, Jiangsu, China) containing PMSF. The protein concentration was determined by using a BCA protein quantitative kit (Beyotime, Jiangsu, China). Samples were subjected to 10% SDS/PAGE and transferred to nitrocellulose membranes. After blocking, membranes were incubated with rabbit anti-KIM1 (1:500), anti-RIPK1 (1:800), anti-RIPK3 (1:800), anti-Nox4 (1:500) and mouse anti-β-actin (1:500) overnight at 4°C, and then incubated with IRDye800–conjugated secondary antibody for 1.5 h at room temperature. Signals were detected with Licor/Odyssey infrared image system (Li-COR Biosciences, Lincoln, NE, U.S.A.) and the intensities of bands were quantified by using the ImageJ software (NIH, Bethesda, MD, U.S.A).
HK2 cells were cultured in eight-chamber glass slides and then fixed in acetone and incubated overnight with the antibodies detecting KIM1 or p-MLKL (1:200). Cells were washed with PBS and incubated with goat anti-rabbit IgG-rhodamine (BiossBiotechnology, Beijing, China) for 2 h at room temperature. Cells were counterstained with DAPI and visualized using fluorescence microscopy (Leica, Bensheim, Germany).
For immunoprecipitation analysis, cells were washed three times with ice-cold PBS solution and were lysed in NP-40 buffer. The samples were precipitated with the indicated antibodies (1 μg) and protein A/G-agarose beads (Santa Cruz, CA, U.S.A.) by incubating at 4°C overnight. Beads were washed three times with 1 ml NP-40 buffer, and the bound proteins were removed by boiling in SDS buffer and resolved in 4–20% SDS/polyacrylamide gels for Western blot analysis.
RNA extraction and real-time PCR
Total RNA obtained from fresh kidney homogenate or cultured HK2 cells by RNA-iso reagent (Qiagen, Valencia, CA, U.S.A.). NanoDrop 2000 Spectrophotometer (Thermo Scientific, U.S.A.) was applied for the quantitative RNA concentration . The levels of KIM1, IL-1β, IL-6, TNF-α, MCP-1, Nox4 and β-actin were determined by SYBR-Green I Real time quantitative PCR in a CFX96 Real-time RT-PCR detection system (Bio-Rad, U.S.A.). The ratio for the mRNA of interest was normalized to β-actin and presented as the mean ± S.E.M. Primers sequences used in the present study were listed in Table 1.
|Genes||Forward primer (5′–3′)||Reverse primer (5′–3′)|
|Genes||Forward primer (5′–3′)||Reverse primer (5′–3′)|
Transmission electron microscopy
Kidney tissue or cultured HK2 cells was immersed in 2.5% glutaraldehyde in 0.1 mol/l sodium cacodylate (pH 7.4) at 4°C overnight, and postfixed for 4 h in buffered 1% osmium tetroxide on ice. After rinsing with 0.1 mol/l sodium cacodylate (pH 7.4), specimens were dehydrated in a graded series of ethanol and embedded in LR White resin (London Resin Company, Reading, U.K.). Polymerization was achieved in gelatin capsules at 60°C for 48 h. Specimens were then detected by a transmission electron microscope (H-7700, Tokyo, Japan).
Histology, immunohistochemistry and morphological assessment
Kidneys were collected and fixed in 4% paraformaldehyde overnight. Fixed kidney samples were embedded in paraffin and sectioned at 4 μm. To evaluate the histological damage, PAS staining was performed with the ‘PAS Kit’ according to routine protocols. The degree of tubular damage including tubular dilation, tubular atrophy and cast formation was scored by three experienced renal pathologists without knowing the group. The rating criteria were as follows: 0 = normal; 1 = 10%; 2 = 10–25%; 3 = 26–50%; 4 = 51–75%; 5 = 75–95%; 6 = more than 96%. For immunohistochemistry, the kidney sections was treated with 0.01 M sodium citrate buffer (pH 6.0) by a microwave-based antigen retrieval technique for 20 min at 95°C was used followed by 10 min of 3% H2O2 to block endogenous peroxidase activity, incubated with rabbit anti- TNF-α, anti-RIPK1 and anti-KIM1 antibodies for 24 h at 4°C and secondary antibodies for 30 min at 37°C. After staining with DAB, the slides were visualized with microscope (Leica, Bensheim, Germany).
Plasma concentration of Cpd-71-time profiles
Rats were given with a single dose of Cpd-71 (5 mg/kg) in PEG400-ethanol-saline (40:20:40, v/v/v) intravenously. Then, the whole blood (approximately 120 μl) was collected from the vein of animals into heparinized tubes at 0 (pro-drug), 5, 15 and 30 min, and 1, 2, 4, 6, 8, 24 h, respectively after administration. These blood samples were immediately centrifuged at 2000 r/min for 10 min, and the plasma sample (50 μl) was precisely collected and stored at −80°C until analysis. All plasma samples were then processed with the procedures as described in the literature .
Data are expressed as the mean ± S.E.M. Statistical significance was analyzed using one-way analysis of variance (ANOVA), followed by Tukey’s post hoc tests using GraphPad Prism 5 software (GraphPad, La Jolla, CA, U.S.A.).
Cpd-71 attenuated cisplatin-induced cell damage in HK2 cells
The molecular structure of Cpd-71 was shown in Figure 1A. We first evaluated the effect of Cpd-71 on HK2 cells viability, MTT results showed Cpd-71 at concentrations lower than 0.8 μM had limited effect on the cell growth of HK2 cells (Figure 1B). Then we further determined the effects of Cpd-71 on cisplatin-induced cell damage. MTT results showed cisplatin prevented cell growth, but Cpd-71 at concentrations of 0.1, 0.2 and 0.4 μM restored cell viability in a concentration-dependent manner (Figure 1C). We also analyzed mRNA level and protein expression of KIM1, a marker evaluating tubular damage. Western blot and real-time PCR results showed cisplatin up-regulated KIM1 level, but Cpd-71 (0.1, 0.2 and 0.4 μM) suppressed KIM1 expression in HK2 cells (Figure 2A,B). Pretreatment with Cpd-71 (0.4 μM) had better suppressive effects on KIM1 expression than Nec-1 (50 μM), a necroptosis inhibitor. The suppressive effect of Cpd-71 on KIM1 was further confirmed by IF analyses (Figure 2C).
Effect of different concentrations of Cpd-71 on HK2 cell viability with or without cisplatin inducement
Effects of Cpd-71 on cisplatin-induced cell injury
Cpd-71 reduced inflammatory response and oxidative stress in cisplatin-induced HK2 cells
In cisplatin-induced HK2 cells, inflammatory factors including TNF-α, IL-1β and IL-6 were markedly inhibited by Cpd-71, and the anti-inflammatory effect of Cpd-71 (0.4 μM) was comparable with Nec-1 (50 μM) (Figure 3A). Next, we evaluated the antioxidant effect of Cpd-71. Result of DHE staining and DCF staining showed that ROS generation was increased in cisplatin-induced HK2 cells, however, ROS was significantly reduced when cisplatin-induced HK2 cells following Cpd-71 or Nec-1 treatment (Figure 3B,C). In addition, Western blot analyses revealed that Cpd-71 shows more suppressive effect on Nox4, a main member of Nox family in kidney, than Nec-1 treatment group, this result was further confirmed by real-time PCR (Figure 3D,E).
Effects of Cpd-71 on cisplatin-induced cell inflammation and oxidative stress
Effect of Cpd-71 on necroptosis of cisplatin-induced HK2 cells
Next, electron microscopy showed that cisplatin-induced HK2 cells exhibited plasma membrane rupture, organelle swelling and loss of cell organelle contents, these effects were alleviated in Cpd-71 treatment group (Figure 4A). Consistently, IF analyses showed the suppressive effect of Cpd-71 on phosphorylation and membrane translocation of MLKL was better than Nec-1 (Figure 4B). We then further detected the mechanisms by which Cpd-71 suppressed necroptosis in two cell necrosis models. RIPK1 and RIPK3 are activated when HK2 cells are exposed to TNF-α and zVAD [25,36] and we found that Cpd-71 had a suppressive effect on RIPK1/RIPK3 signaling (Figure 5A), which was further confirmed in cisplatin-induced cell model (Figure 5B). Importantly, the suppressive effect of Cpd-71 was more significant than Nec-1. Moreover, co-immunoprecipitation revealed RIPK1 interacted with RIPK3 to mediate necroptosis in cisplatin-treated group, but Cpd-71 decreased the formation of RIPK1/RIPK3 complex (Figure 5C). In addition, a docking experiment was performed to propose a possible binding mode for Cpd-71 in RIPK1. Cpd-71 was docked into a cocrystal structure 6HHO of RIPK1 complexed with a pyrimidine analog G4W. The proposed binding mode was illustrated in Figure 5D. Similar to Nec-1, Cpd-71 locates in an allosteric pocket next to the ATP binding site, termed astype III ligand binding site . The amide carbonyl of Cpd-71 formed two H-bond with backbone of residues Val91 and Met92. Another H-bone occurred between the nitrogen atom of pyrimidine ring of Cpd-71 and residue Asp156. Moreover, the cyclopropyl group of Cpd-71 located in a hydrophobic region surrounded by hydrophobic residues of Val31, Lys45 and Leu157.
Cpd-71 protected against cisplatin-induced HK-2 cells necroptosis
Effect of Cpd-71 on RIPK signaling in HK2 cells
Cpd-71 attenuated cisplatin-induced AKI, inflammation and oxidative stress in mice
We then assessed the treatment effect of Cpd-71 in cisplatin nephropathy. In protocol I, mice were respectively pretreated with Cpd-71 (0.825, 1.65 and 3.3 mg/kg) and 1.65 mg/kg Nec-1 as positive control 12 h before cisplatin injection. PAS staining showed mice displayed severe pathological damage after exposure to cisplatin, which is characterized by the dilation of renal tubules, loss of brush border, cytoplasmic vacuoles. Interestingly, kidney damage induced by cisplatin was alleviated after pretreatment of Cpd-71. Notably, Cpd-71 has better protective effects compared with Nec-1 in the same concentration (1.65 mg/kg) (Figure 6A). Pharmacokinetics studies revealed that the pharmacokinetic properties of Cpd-71 were similar to Nec-1 without obvious advantage (Supplementary Table S1). Considering the more effective potency of Cpd-71 than that of Nec-1 in AKI mice model, we think that Cpd-71 may exert stronger inhibition than Nec-1 against RIPK1. Renoprotective effect of Cpd-71 was further confirmed by detecting serum Cr and BUN which indicated renal function (Figure 6B,C). Additionally, Western blot and immunohistochemistry analyses results showed Cpd-71 significantly reduced KIM1 expression (Figure 7A,B). Besides, we evaluated the anti-inflammatory effect of Cpd-71 in cisplatin-induced mice. Immunohistochemistry showed Cpd-71 reduced macrophage infiltration and TNF-α positive signal in injured kidney (Figure 8A,B). Consistently, pro-inflammatory cytokines and chemokines TNF-α, IL-6 and MCP-1 were down-regulated following Cpd-71 treatment (Figure 8C). We further found that GSH, an important endogenous antioxidant, was significantly decreased in cisplatin-induced mice but restored after Cpd-71 pretreatment, this is in line with the finding that Cpd-71 suppressed MDA level in mice exposed to cisplatin (Figure 9A,B). As shown in Figure 9C,D, Cpd-71 treatment reduced cisplatin-induced Nox4 protein expression. This was further validated at mRNA levels by real-time PCR.
Cpd-71 attenuated renal injury in cisplatin-induced AKI
Cpd-71 down-regulated KIM1 level in cisplatin nephropathy
Cpd-71 attenuated renal inflammation and oxidative stress in cisplatin nephropathy
Cpd-71 reduced oxidative stress in cisplatin nephropathy
Cpd-71 attenuated renal injury by targeting RIPK1-mediated necroptosis
It has been well accepted that necroptosis relates to the activation of RIPK1. Immunohistochemistry staining showed that Cpd-71 reduced RIPK1 expression in renal tubules (Figure 10A). Western blot confirmed that Cpd-71 had more inhibitory effects on RIPK1 and RIPK3 activation compared with Nec-1 in cisplatin nephropathy (Figure 10B). Furthermore, IF analysis suggested that Cpd-71 suppressed phosphorylation of MLKL in cisplatin-induced mice (Figure 10C), in vivo. In order to further verify the interaction between Cpd-71 and RIPK1 protein, we performed a CETSA that enables us to evaluate target engagement in vivo [33,38]. Results showed that the detected soluble RIPK1 proteins clearly differ at denaturation temperatures ranging from 47 to 59°C with and without Cpd-71 treatment, Cpd-71-treated mice showed a significant increase in the thermal stability of RIPK1 (Figure 10D). Which indicated that Cpd-71 is directly bound to the RIPK1 protein.
Cpd-71 inhibited RIPK1-mediated necroptosis in cisplatin nephropathy
Effect of Cpd-71 on kidney injury in established AKI mouse model
Next, we further detected whether Cpd-71 had therapeutic effects in established AKI model. In protocol II, Cpd-71 was administrated 1 day after cisplatin injection. As shown in Figure 11A, PAS staining showed Cpd-71 distinctly suppressed tubule damage compared with group of cisplatin on day 3. This finding was further confirmed by detecting BUN and serum Cr (Figure 11B,C). Additionally, Cpd-71 decreased KIM1 positive signals in established AKI mice (Figure 11D).
Cpd-71 attenuated cisplatin-induced kidney injury in established AKI mouse model
In the present study, we demonstrated that Cpd-71 protected against cisplatin-induced kidney injury both in vivo and in vitro by limiting cell necroptosis, inflammation and oxidative stress. We further evaluated RIPK1-targeting therapy in nephrotoxic AKI model. Moreover, we identified that Cpd-71 showed high efficiency in inhibiting necroptosis and kidney injury compared with Nec-1, a classic inhibitor for RIPK1.
Necroptosis, a type of programmed necrosis, is mediated by RIPK1/RIPK3/MLKL activation and plays a significant role in various pathologic conditions . When death signals transduce to RIPK1, it recruits and binds with RIPK3 in the presence of RIP homotypic interaction motif (RHIM), and then phosphorylates MLKL and promotes translocation of phospho-MLKL on to the plasma membrane which finally leads to plasma membrane disruption [39,40]. In the kidney, involvement of necroptosis in various pathologic conditions has gained much attention in recent years [41,42]. With respect to AKI condition, pharmacological inhibition and deficiency of RIPK1 protected against AKI induced by cisplatin, I/R injury  and contrast . Additionally, disruption of downstream RIPK3 or MLKL prevented AKI by alleviating necroptosis [25,43,44]. Importantly, a previous study in our group had revealed that wogonin, a Traditional Chinese Medicine monomer, attenuated cisplatin nephropathy by inactivating RIPK1 via occupying its ATP-binding pocket . And miR-500a-3p suppressed toxic and ischemic insults and inflammatory response via targeting MLKL-mediated necroptosis in renal epithelial cells .
Available evidence suggested that targeting RIPK1 may have an important role in AKI models. Nec-1 is an extensively used RIPK1 inhibitor with high kinase selectivity, however, it failed to be applied in clinic due to the narrow SAR profile and poor metabolic stability [28,47]. In this regard, we evaluated the renoprotective effect of Cpd-71, a novel RIPK1 inhibitor, which showed high affinity for RIPK1. For the first time, we found that Cpd-71 significantly inhibited RIPK1 activation, RIPK1/RIPK3 interaction, MLKL phosphorylation and membrane translocation, thereby attenuated kidney injury in two cell necrosis models (HK2 induced by TNF-α + zVAD and cisplatin, respectively), the binding of Cpd-71 to RIPK1 was further confirmed in mice by CETSA. Notably, Cpd-71 showed more efficiency in being renoprotective than Nec-1.
Additionally, increasing evidence has shown necroptosis, rather than apoptosis, leads to inflammation in AKI. Cells suffered necroptosis release damage-associated molecular patterns (DAMPs) like high-mobility group box 1 (HMGB1) and heat-shock proteins, binding with its receptors and inducing necro-inflammation which lead to more severe programmed cell death, immune cell infiltration and further renal damage in a positive feedback loop [48,49]. A recent study confirmed RIPK1 mediates a second wave of cell death in AKI models . It is of note that RIPK1 regulate the inflammation in cell death-independent manner . In this setting, blocking RIPK1-mediated necroptosis with Cpd-71 seemed to be an effective therapy against renal inflammation. In the current study, our work suggested that Cpd-71 exhibited higher anti-inflammatory effects compared with Nec-1 both in cisplatin-induced tubular epithelial cells and nephrotoxic AKI model, in vivo and in vitro.
Furthermore, previous studies also demonstrated that ROS increased cellular oxidative stress, and then led to DNA damage and programmed cell death [51,52]. ROS scavenger dramatically reduces Hypoxia/reoxygenation- or H2O2-induced cell necroptosis . Consistently, we found that Nox-mediated oxidative stress was highly correlated to cell necroptosis [54,55]. Currently, we confirmed the role of Cpd-71 on distinctly attenuated oxidative stress by targeting RIPK1 in cisplatin-induced tubular epithelial cells and nephrotoxic AKI model, indicating that Cpd-71 may inhibit the feedback loop of oxidative stress and necroptosis simultaneously.
Collectively, our work demonstrated that Cpd-71, a novel RIPK1 kinase inhibitor, showed significant anti-necroptosis, anti-inflammation and antioxidant effects in cisplatin-induced tubular epithelial cells and nephrotoxic AKI models. We also found Cpd-71 had powerful renoprotective effects in treatment of AKI model. Our study raises a possibility that Cpd-71 may serve as a potential clinical candidate for AKI therapy.
RIPK1 may serve as a potential therapeutic target for AKI.
Cpd-71 is a novel RIPK1 inhibitor with high efficiency in treatment of AKI.
Cpd-71 protects kidney function and attenuates necroptosis, inflammation and oxidative stress in cisplatin nephropathy.
J.-n.W and F.W. performed the experiment, analyzed the data and wrote the manuscript. M.-m.L. conceived the molecular docking experiments. X.-M.M. designed, supervised and wrote the manuscript. X.C., Q.Y. and L.J. provided a series of experimental instructions and help. J.-n.W., F.W., Y.-t.C., C.L., X.-w.H., X.-q.L., J.-t.Y. and B.W. performed the animal experiments. T.-t.M, J.J., Y.-g.W. and J.L. contributed new reagents or analytic tools. All authors approved the final version of the manuscript.
This work was supported by the National Natural Science Foundation of China [grant number 81570623]; the Science and Technological Fund of Anhui Province for Outstanding Youth of China [grant number 1608085J07]; the Scientific Research Grants of Anhui Medical University [grant number XJ201627]; the Innovation and Entrepreneurship Support Program for Overseas Returnees in Anhui Province [grant number zd201708]; the Key Projects of Outstanding Youth Foundation in Colleges of Anhui Province of China [grant number gxyqZD2017021]; and the Research Foundation Project of the Anhui Institute of Translational Medicine [grant number 2017zhyx01].
The authors declare that there are no competing interests associated with the manuscript.
acute kidney injury
blood urea nitrogen
cellular thermal shift assay
chronic kidney disease
compound 71 (N-(4-((4-((5-methyl-1H-pyrazol-3-yl)amino)-6-morpholinopyrimidin-2-yl)amino)phenyl)cyclopropanecarboxamide)
damage-associated molecular patterns
human kidney tubular epithelial cell
high resolution mass spectrometry
high-mobility group box 1
nuclear magnetic resonance
reactive oxygen species
RIP homotypic interaction motif
TNF receptor 1
TNFR-associated factor 2
These authors contributed equally to this work.