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2017 ; 13
(3
): 143-151
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Metabolic reprogramming and tolerance during sepsis-induced AKI
#MMPMID28090081
Gómez H
; Kellum JA
; Ronco C
Nat Rev Nephrol
2017[Mar]; 13
(3
): 143-151
PMID28090081
show ga
The host defence against infection is an adaptive response in which several
mechanisms are deployed to decrease the pathogen load, limit tissue injury and
restore homeostasis. In the past few years new evidence has suggested that the
ability of the immune system to limit the microbial burden - termed resistance -
might not be the only defence mechanism. In fact, the capacity of the host to
decrease its own susceptibility to inflammation- induced tissue damage - termed
tolerance - might be as important as resistance in determining the outcome of the
infection. Metabolic adaptations are central to the function of the cellular
immune response. Coordinated reprogramming of metabolic signalling enables cells
to execute resistance and tolerance pathways, withstand injury, steer tissue
repair and promote organ recovery. During sepsis-induced acute kidney injury,
early reprogramming of metabolism can determine the extent of organ dysfunction,
progression to fibrosis, and the development of chronic kidney disease. Here we
discuss the mechanisms of tolerance that act in the kidney during sepsis, with
particular attention to the role of metabolic responses in coordinating these
adaptive strategies. We suggest a novel conceptual model of the cellular and
organic response to sepsis that might lead to new avenues for targeted,
organ-protective therapies.