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Abstract

The sequelae of diabetes include microvascular complications such as diabetic kidney disease (DKD), which involves glucose-mediated renal injury associated with a disruption in mitochondrial metabolic agility, inflammation, and fibrosis. We explored the role of the innate immune complement component C5a, a potent mediator of inflammation, in the pathogenesis of DKD in clinical and experimental diabetes. Marked systemic elevation in C5a activity was demonstrated in patients with diabetes; conventional renoprotective agents did not therapeutically target this elevation. C5a and its receptor (C5aR1) were upregulated early in the disease process and prior to manifest kidney injury in several diverse rodent models of diabetes. Genetic deletion of C5aR1 in mice conferred protection against diabetes-induced renal injury. Transcriptomic profiling of kidney revealed diabetes-induced downregulation of pathways involved in mitochondrial fatty acid metabolism. Interrogation of the lipidomics signature revealed abnormal cardiolipin remodeling in diabetic kidneys, a cardinal sign of disrupted mitochondrial architecture and bioenergetics. In vivo delivery of an orally active inhibitor of C5aR1 (PMX53) reversed the phenotypic changes and normalized the renal mitochondrial fatty acid profile, cardiolipin remodeling, and citric acid cycle intermediates. In vitro exposure of human renal proximal tubular epithelial cells to C5a led to altered mitochondrial respiratory function and reactive oxygen species generation. These experiments provide evidence for a pivotal role of the C5a/C5aR1 axis in propagating renal injury in the development of DKD by disrupting mitochondrial agility, thereby establishing a new immunometabolic signaling pathway in DKD.

Item Type:	Article
Authors/Creators:	Tan, SM and Ziemann, M and Thallas-Bonke, V and Snelson, M and Kumar, V and Laskowski, A and Nguyen, T-V and Huynh, K and Clarke, MV and Libianto, R and Baker, ST and Skene, A and Power, DA and MacIsaac, RJ and Henstridge, DC and Wetsel, RA and El-Osta, A and Meikle, PJ and Wilson, SG and Forbes, JM and Cooper, ME and Ekinci, EI and Woodruff, TM and Coughlan, MT
Keywords:	diabetes, kidney, mitochondria
Journal or Publication Title:	Diabetes
Publisher:	Amer Diabetes Assoc
ISSN:	0012-1797
DOI / ID Number:	https://doi.org/10.2337/db19-0043
Copyright Information:	Copyright 2020 American Diabetes Association
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