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2016 ; 27
(3
): 745-65
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Low-Dose IL-17 Therapy Prevents and Reverses Diabetic Nephropathy, Metabolic
Syndrome, and Associated Organ Fibrosis
#MMPMID26334030
Mohamed R
; Jayakumar C
; Chen F
; Fulton D
; Stepp D
; Gansevoort RT
; Ramesh G
J Am Soc Nephrol
2016[Mar]; 27
(3
): 745-65
PMID26334030
show ga
Diabetes is the leading cause of kidney failure, accounting for >45% of new cases
of dialysis. Diabetic nephropathy is characterized by inflammation, fibrosis, and
oxidant stress, pathologic features that are shared by many other chronic
inflammatory diseases. The cytokine IL-17A was initially implicated as a mediator
of chronic inflammatory diseases, but recent studies dispute these findings and
suggest that IL-17A can favorably modulate inflammation. Here, we examined the
role of IL-17A in diabetic nephropathy. We observed that IL-17A levels in plasma
and urine were reduced in patients with advanced diabetic nephropathy. Type 1
diabetic mice that are genetically deficient in IL-17A developed more severe
nephropathy, whereas administration of low-dose IL-17A prevented diabetic
nephropathy in models of type 1 and type 2 diabetes. Moreover, IL-17A
administration effectively treated, prevented, and reversed established
nephropathy in genetic models of diabetes. Protective effects were also observed
after administration of IL-17F but not IL-17C or IL-17E. Notably, tubular
epithelial cell-specific overexpression of IL-17A was sufficient to suppress
diabetic nephropathy. Mechanistically, IL-17A administration suppressed
phosphorylation of signal transducer and activator of transcription 3, a central
mediator of fibrosis, upregulated anti-inflammatory microglia/macrophage WAP
domain protein in an AMP-activated protein kinase-dependent manner and favorably
modulated renal oxidative stress and AMP-activated protein kinase activation.
Administration of recombinant microglia/macrophage WAP domain protein suppressed
diabetes-induced albuminuria and enhanced M2 marker expression. These
observations suggest that the beneficial effects of IL-17 are isoform-specific
and identify low-dose IL-17A administration as a promising therapeutic approach
in diabetic kidney disease.