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Calcineurin inhibitor cyclosporine a activates renal Na-K-Cl cotransporters via local and systemic mechanisms

Item Type:Article
Title:Calcineurin inhibitor cyclosporine a activates renal Na-K-Cl cotransporters via local and systemic mechanisms
Creators Name:Blankenstein, K.I. and Borschewski, A. and Labes, R. and Paliege, A. and Boldt, C. and McCormick, J.A. and Ellison, D.H. and Bader, M. and Bachmann, S. and Mutig, K.
Abstract:Calcineurin dephosphorylates NFAT transcription factors, thereby facilitating T-cell mediated immune responses. Calcineurin inhibitors are instrumental for immunosuppression after organ transplantation, but may cause side effects including hypertension and electrolyte disorders. Kidneys were recently shown to display activation of the furosemide-sensitive Na-K-2Cl cotransporter (NKCC2) of the thick ascending limb and the thiazide-sensitive Na-Cl cotransporter (NCC) of the distal convoluted tubule upon calcineurin inhibition using cyclosporin A (CsA). An involvement of major hormones like angiotensin II or arginine vasopressin (AVP) has been proposed. To resolve this issue, the effects of CsA treatment in normal Wistar and AVP-deficient Brattleboro rats, and cultured renal epithelial cells endogenously expressing either NKCC2 or NCC, were studied. Acute administration of CsA to Wistar rats rapidly augmented phosphorylation levels of NKCC2, NCC, and their activating kinases (WNK and SPAK/OSR1), suggesting intraepithelial activating effects. Chronic CsA administration caused salt retention and hypertension, along with stimulation of renin, and suppression of renal cyclooxygenase 2, pointing to a contribution of endocrine and paracrine mechanisms at long-term. In Brattleboro rats, CsA induced activation of NCC, but not NKCC2, and parallel effects were obtained in cultured cells in the absence of AVP. Stimulation of cultured TAL cells with AVP agonist restored their responsiveness to CsA. Our results suggest that the direct epithelial effect of calcineurin inhibition is sufficient for the activation of NCC, whereas its effect on NKCC2 is more complex and requires concomitant stimulation by AVP.
Keywords:Salt Transport, Hypertension, NKCC2, NCC, Vasopressin, Animals, Rats
Source:American Journal of Physiology Renal Physiology
Publisher:American Physiological Society
Page Range:F489-F501
Date:2 March 2017
Official Publication:https://doi.org/10.1152/ajprenal.00575.2016
External Fulltext:View full text on PubMed Central
PubMed:View item in PubMed

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