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Pyruvate kinase M2 activation may protect against the progression of diabetic glomerular pathology and mitochondrial dysfunction

Nature Medicine volume 23, pages 753–762 (2017)Cite this article

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Abstract

Diabetic nephropathy (DN) is a major cause of end-stage renal disease, and therapeutic options for preventing its progression are limited. To identify novel therapeutic strategies, we studied protective factors for DN using proteomics on glomeruli from individuals with extreme duration of diabetes (ł50 years) without DN and those with histologic signs of DN. Enzymes in the glycolytic, sorbitol, methylglyoxal and mitochondrial pathways were elevated in individuals without DN. In particular, pyruvate kinase M2 (PKM2) expression and activity were upregulated. Mechanistically, we showed that hyperglycemia and diabetes decreased PKM2 tetramer formation and activity by sulfenylation in mouse glomeruli and cultured podocytes. Pkm-knockdown immortalized mouse podocytes had higher levels of toxic glucose metabolites, mitochondrial dysfunction and apoptosis. Podocyte-specific Pkm2-knockout (KO) mice with diabetes developed worse albuminuria and glomerular pathology. Conversely, we found that pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, reversed hyperglycemia-induced elevation in toxic glucose metabolites and mitochondrial dysfunction, partially by increasing glycolytic flux and PGC-1α mRNA in cultured podocytes. In intervention studies using DBA2/J and Nos3 (eNos) KO mouse models of diabetes, TEPP-46 treatment reversed metabolic abnormalities, mitochondrial dysfunction and kidney pathology. Thus, PKM2 activation may protect against DN by increasing glucose metabolic flux, inhibiting the production of toxic glucose metabolites and inducing mitochondrial biogenesis to restore mitochondrial function.

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Figure 1: Elevation of glucose metabolic enzymes in glomeruli from individual with diabetes, but without DN.
Figure 2: Regulation of PKM2 activity by high glucose and diabetes.
Figure 3: Pkm2 deletion in podocytes accelerates DN progression.
Figure 4: PKM2 activation normalizes abnormalities in glucose metabolism and mitochondrial function and prevents podocyte apoptosis induced by high glucose.
Figure 5: PKM2 activation reverses diabetes-induced defects in glucose metabolism and mitochondrial function in a mouse model of DN.
Figure 6: Pharmacologically activating PKM2 by TEPP-46 prevents the development of glomerular pathology.

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Acknowledgements

We are grateful to all the fellows who participated in Medalist Kidneys collection, D. Anastasiou, J. Lee, C. Thomas and M. Lauterbach for their technical advice. We also thank the technical support from E. Yu, daily-oral-gavaging team members, Z. Zsengeller and E. Pernicone. We are grateful to M. Maurer, who gave us technical advice on human kidney pathology assessment. We thank C. Clish for plasma metabolomics analysis. We are grateful to J. Hourihan for technical advice and review of the manuscript. W. Qi was a recipient of awards from the Juvenile Diabetes Research Foundation and Mary Iacocca Research Foundation. Mouse podocytes and human podocytes cell lines were kind gifts from P.M. and J.K. This project was funded by NIH 1DP3DK112192-01 (G.L.K.); DK094333-01 (G.L.K. and H.A.K.), 1R24DK090961-01 (G.L.K.); DRC grant-P30DK036836-30 (G.L.K.); JDRF 8-2005-358 (G.L.K.); JDRF 18-2008-363 (G.L.K.); JDRF17-2011-47 (G.L.K.); and JDRF17-2013-310 (H.A.K.). Additional research support was provided by the Thomas Beatson, Jr Foundation, the Brehm Foundation and a research grant from Sanofi-Aventis (G.L.K.). Other co-authors were supported by the following funding: DK107339-02 (M.A.Y.); Harold Whitworth Pierce Charitable Trust Postdoctoral Fellowship (A.M.B.); R01 DK109015 and R00 DK090210 (C.W.L.) and JDRF CDA-2015-89-A-B (M.A.N.).

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Authors and Affiliations

  1. Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA

    Weier Qi, Hillary A Keenan, Qian Li, Atsushi Ishikado, I-Hsien Wu, Alison M Burkart, Stephanie Hastings, David Pober, Christopher Cahill, Monika A Niewczas, Liane Tinsley, Peter S Amenta, Edward P Feener, Robert C Stanton & George L King

  2. Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany

    Aimo Kannt, Thorsten Sadowski & Anja Pfenninger

  3. Veterans Affairs Medical Center, Iowa City, Iowa, USA

    Mark A Yorek & Lawrence J Coppey

  4. Queen's University Belfast, Belfast, UK

    Samuel Lockhart

  5. Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, Illinois, USA

    Chong Wee Liew & Guifen Qiang

  6. State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College and Beijing Key Laboratory of Drug Target and Screening Research, Beijing, China

    Guifen Qiang

  7. Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    William J Israelsen

  8. Division of Anatomic Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Isaac E Stillman

  9. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Matthew G Vander Heiden

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  1. Weier Qi
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Contributions

W.Q. designed and performed the experiments, analyzed the data and wrote the manuscript. H.A.K. assisted in the design of the Medalist study. Q.L., A.I., A.K., T.S., M.A.Y., S.L., L.J.C., A.P., C.W.L., G.Q., A.M.B. and W.J.I. provided technical support and/or critical discussions of the manuscript. I.-H.W. analyzed proteomics data. S.H. managed clinical data and samples. D.P. and L.T. performed all the clinical and some nonclinical statistical analysis and checked all the statistical analysis. C.C. performed electron-microscopy-related imaging work. M.A.N. analyzed metabolomics data. E.P.F. participated in proteomics analysis and critical review and discussion of the manuscript. M.G.V.H. provided technical advice on both TEPP-46 and Pkm2fl/fl mouse studies and constructs of pLHCX-Flag-mPKM2 and pLHCXFlag-mPKM1. I.E.S. and P.S.A. assessed all the human kidney pathology. R.C.S. provided critical review of the clinical data. G.L.K. supervised the project and wrote the manuscript. All the authors have reviewed the manuscript.

Corresponding author

Correspondence to George L King.

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Competing interests

A.K., T.S. and A.P. are employees of Sanofi-Aventis.

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Qi, W., Keenan, H., Li, Q. et al. Pyruvate kinase M2 activation may protect against the progression of diabetic glomerular pathology and mitochondrial dysfunction. Nat Med 23, 753–762 (2017). https://doi.org/10.1038/nm.4328

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