TY - JOUR
T1 - The Complement Pathway
T2 - New Insights into Immunometabolic Signaling in Diabetic Kidney Disease
AU - Tan, Sih Min
AU - Snelson, Matthew
AU - Østergaard, Jakob A.
AU - Coughlan, Melinda T.
N1 - Publisher Copyright:
© 2022 Sih Min Tan et al. Published by Mary Ann Liebert, Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Significance: The metabolic disorder, diabetes mellitus, results in microvascular complications, including diabetic kidney disease (DKD), which is partly believe to involve disrupted energy generation in the kidney, leading to injury that is characterized by inflammation and fibrosis. An increasing body of evidence indicates that the innate immune complement system is involved in the pathogenesis of DKD; however, the precise mechanisms remain unclear. Recent Advances: Complement, traditionally thought of as the prime line of defense against microbial intrusion, has recently been recognized to regulate immunometabolism. Studies have shown that the complement activation products, Complement C5a and C3a, which are potent pro-inflammatory mediators, can mediate an array of metabolic responses in the kidney in the diabetic setting, including altered fuel utilization, disrupted mitochondrial respiratory function, and reactive oxygen species generation. In diabetes, the lectin pathway is activated via autoreactivity toward altered self-surfaces known as danger-associated molecular patterns, or via sensing altered carbohydrate and acetylation signatures. In addition, endogenous complement inhibitors can be glycated, whereas diet-derived glycated proteins can themselves promote complement activation, worsening DKD, and lending support for environmental influences as an additional avenue for propagating complement-induced inflammation and kidney injury. Critical Issues: Recent evidence indicates that conventional renoprotective agents used in DKD do not target the complement, leaving this web of inflammatory stimuli intact. Future Directions: Future studies should focus on the development of novel pharmacological agents that target the complement pathway to alleviate inflammation, oxidative stress, and kidney fibrosis, thereby reducing the burden of microvascular diseases in diabetes. Antioxid. Redox Signal. 37, 781-801.
AB - Significance: The metabolic disorder, diabetes mellitus, results in microvascular complications, including diabetic kidney disease (DKD), which is partly believe to involve disrupted energy generation in the kidney, leading to injury that is characterized by inflammation and fibrosis. An increasing body of evidence indicates that the innate immune complement system is involved in the pathogenesis of DKD; however, the precise mechanisms remain unclear. Recent Advances: Complement, traditionally thought of as the prime line of defense against microbial intrusion, has recently been recognized to regulate immunometabolism. Studies have shown that the complement activation products, Complement C5a and C3a, which are potent pro-inflammatory mediators, can mediate an array of metabolic responses in the kidney in the diabetic setting, including altered fuel utilization, disrupted mitochondrial respiratory function, and reactive oxygen species generation. In diabetes, the lectin pathway is activated via autoreactivity toward altered self-surfaces known as danger-associated molecular patterns, or via sensing altered carbohydrate and acetylation signatures. In addition, endogenous complement inhibitors can be glycated, whereas diet-derived glycated proteins can themselves promote complement activation, worsening DKD, and lending support for environmental influences as an additional avenue for propagating complement-induced inflammation and kidney injury. Critical Issues: Recent evidence indicates that conventional renoprotective agents used in DKD do not target the complement, leaving this web of inflammatory stimuli intact. Future Directions: Future studies should focus on the development of novel pharmacological agents that target the complement pathway to alleviate inflammation, oxidative stress, and kidney fibrosis, thereby reducing the burden of microvascular diseases in diabetes. Antioxid. Redox Signal. 37, 781-801.
KW - complement
KW - diabetes
KW - immunometabolism
KW - kidney
KW - Reactive Oxygen Species/metabolism
KW - Carbohydrates
KW - Inflammation Mediators/metabolism
KW - Humans
KW - Inflammation/metabolism
KW - Kidney/metabolism
KW - Complement Inactivating Agents/metabolism
KW - Fibrosis
KW - Complement C5a/metabolism
KW - Diabetic Nephropathies/etiology
KW - Diabetes Mellitus/metabolism
KW - Lectins/metabolism
UR - http://www.scopus.com/inward/record.url?scp=85139572415&partnerID=8YFLogxK
U2 - 10.1089/ars.2021.0125
DO - 10.1089/ars.2021.0125
M3 - Review
C2 - 34806406
AN - SCOPUS:85139572415
SN - 1523-0864
VL - 37
SP - 781
EP - 801
JO - Antioxidants & Redox Signaling
JF - Antioxidants & Redox Signaling
IS - 10-12
ER -