Visual Abstract

Background: Chronic kidney disease (CKD) is a global health burden, and the current treatment options only slow down the disease progression. GLP-1 receptor agonists (GLP-1 RA) have shown a renal protective effect in models of CKD; however, the mechanism behind the beneficial effect is not understood. In this study, we investigate the effect of the GLP-1 RA liraglutide in the nephrotoxic serum nephritis (NTN) CKD model. Moreover, we compare the gene expression pattern of liraglutide-treated mice to the gene expression pattern of mice treated with the angiotensin converting enzyme inhibitor, enalapril. Methods: The effect of liraglutide was tested in the NTN model by evaluating the glomerular filtration rate (GFR), albuminuria, mesangial expansion, renal fibrosis, and renal inflammation. Furthermore, the regulation of selected genes involved in CKD and in glomerular, cortical tubulointerstitial, and whole kidney structures was analyzed using a gene expression array on samples following laser capture microdissection. Results: Treatment with liraglutide improved CKD hallmarks including GFR, albuminuria, mesangial expansion, renal inflammation, and renal fibrosis. The gene expression revealed that both liraglutide and enalapril reversed the regulation of several fibrosis and inflammation associated genes, which are also regulated in human CKD patients. Furthermore, liraglutide and enalapril both regulated genes in the kidney involved in blood pressure control. Conclusions: Treatment with liraglutide improved the kidney function and diminished renal lesions in NTN-induced mice. Both liraglutide and enalapril reversed the regulation of genes involved in CKD and regulated genes involved in blood pressure control.

1.
Hill
NR
,
Fatoba
ST
,
Oke
JL
,
Hirst
JA
,
O’Callaghan
CA
,
Lasserson
DS
, et al.
Global prevalence of chronic kidney disease: a systematic review and meta-analysis
.
PLoS One
.
2016
;
11
(
7
):
e0158765
.
2.
Jha
V
,
Modi
GK
.
Getting to know the enemy better-the global burden of chronic kidney disease
.
Kidney Int
.
2018
;
94
(
3
):
462
4
.
3.
Anderson
J
,
Glynn
LG
.
Definition of chronic kidney disease and measurement of kidney function in original research papers: a review of the literature
.
Nephrol Dial Transplant
.
2011
;
26
(
9
):
2793
8
.
4.
Oh
YJ
,
Kim
SM
,
Shin
BC
,
Kim
HL
,
Chung
JH
,
Kim
AJ
, et al.
The impact of renin-angiotensin system blockade on renal outcomes and mortality in pre-dialysis patients with advanced chronic kidney disease
.
PLoS One
.
2017
;
12
(
1
):
e0170874
.
5.
Ruggenenti
P
,
Cravedi
P
,
Remuzzi
G
.
Mechanisms and treatment of CKD
.
J Am Soc Nephrol
.
2012
;
23
(
12
):
1917
28
.
6.
Hendarto
H
,
Inoguchi
T
,
Maeda
Y
,
Ikeda
N
,
Zheng
J
,
Takei
R
, et al.
GLP-1 analog liraglutide protects against oxidative stress and albuminuria in streptozotocin-induced diabetic rats via protein kinase A-mediated inhibition of renal NAD(P)H oxidases
.
Metab Clin Exp
.
2012
;
61
(
10
):
1422
34
.
7.
Kodera
R
,
Shikata
K
,
Kataoka
HU
,
Takatsuka
T
,
Miyamoto
S
,
Sasaki
M
, et al.
Glucagon-like peptide-1 receptor agonist ameliorates renal injury through its anti-inflammatory action without lowering blood glucose level in a rat model of type 1 diabetes
.
Diabetologia
.
2011
;
54
(
4
):
965
78
.
8.
Moellmann
J
,
Klinkhammer
BM
,
Onstein
J
,
Stöhr
R
,
Jankowski
V
,
Jankowski
J
, et al.
Glucagon-like peptide 1 and its cleavage products are renoprotective in murine diabetic nephropathy
.
Diabetes
.
2018
;
67
(
11
):
2410
9
.
9.
Knudsen
LB
,
Lau
J
.
The discovery and development of liraglutide and semaglutide
.
Front Endocrinol
.
2019
;
10
:
155
.
10.
Jensen
EP
,
Poulsen
SS
,
Kissow
H
,
Holstein-Rathlou
NH
,
Deacon
CF
,
Jensen
BL
, et al.
Activation of GLP-1 receptors on vascular smooth muscle cells reduces the autoregulatory response in afferent arterioles and increases renal blood flow
.
Am J Physiol Renal Physiol
.
2015
;
308
(
8
):
F867
77
.
11.
Sukumaran
V
,
Tsuchimochi
H
,
Sonobe
T
,
Shirai
M
,
Pearson
JT
.
Liraglutide improves renal endothelial function in obese Zucker rats on a high-salt diet
.
J Pharmacol Exp Ther
.
2019
;
369
(
3
):
375
88
.
12.
Rakipovski
G
,
Rolin
B
,
Nøhr
J
,
Klewe
I
,
Frederiksen
KS
,
Augustin
R
, et al.
The GLP-1 analogs liraglutide and semaglutide reduce atherosclerosis in ApoE
.
JACC Basic Transl Sci
.
2018
;
3
(
6
):
844
57
.
13.
Marso
SP
,
Daniels
GH
,
Brown-Frandsen
K
,
Kristensen
P
,
Mann
JFE
,
Nauck
MA
, et al.
Liraglutide and cardiovascular outcomes in type 2 diabetes
.
N Engl J Med
.
2016
;
375
(
4
):
311
22
.
14.
Mann
JFE
,
Orsted
DD
,
Brown-Frandsen
K
,
Marso
SP
,
Poulter
NR
,
Rasmussen
S
, et al.
Liraglutide and renal outcomes in type 2 diabetes
.
N Engl J Med
.
2017
;
377
(
9
):
839
48
.
15.
Hocher
B
,
Tsuprykov
O
.
Diabetic nephropathy: renoprotective effects of GLP1R agonists and SGLT2 inhibitors
.
Nat Rev Nephrol
.
2017
;
13
(
12
):
728
30
.
16.
Skov
J
,
Dejgaard
A
,
Frøkiær
J
,
Holst
JJ
,
Jonassen
T
,
Rittig
S
, et al.
Glucagon-like peptide-1 (GLP-1): effect on kidney hemodynamics and renin-angiotensin-aldosterone system in healthy men
.
J Clin Endocrinol Metab
.
2013
;
98
(
4
):
E664
71
.
17.
Pyke
C
,
Heller
RS
,
Kirk
RK
,
Orskov
C
,
Reedtz-Runge
S
,
Kaastrup
P
, et al.
GLP-1 receptor localization in monkey and human tissue: novel distribution revealed with extensively validated monoclonal antibody
.
Endocrinology
.
2014
;
155
(
4
):
1280
90
.
18.
Ougaard
MKE
,
Kvist
PH
,
Jensen
HE
,
Hess
C
,
Rune
I
,
Søndergaard
H
, et al.
Murine nephrotoxic nephritis as a model of chronic kidney disease
.
Int J Nephrol
.
2018
;
2018
:
8424502
.
19.
Ougaard
ME
,
Sembach
FE
,
Kvist
PH
,
Tonnesen
M
,
Frederiksen
KS
,
Egfjord
M
, et al.
Temporal regulation of glomerular and cortical tubulointerstitial genes involved in the development of nephrotoxic serum nephritis
.
Nephron
.
2018
;
140
(
3
):
218
30
.
20.
MacGregor
GA
.
Blood pressure, angiotensin-converting enzyme (ACE) inhibitors, and the kidney
.
Am J Med
.
1992
;
92
(
4b
):
20S
7S
.
21.
Ougaard
ME
,
Jensen
HE
,
Thuen
ID
,
Petersen
EG
,
Kvist
PH
.
Inhibitors of the renin-angiotensin system ameliorates clinical and pathological aspects of experimentally induced nephrotoxic serum nephritis
.
Ren Fail
.
2018
;
40
(
1
):
640
8
.
22.
Ellery
SJ
,
Cai
X
,
Walker
DD
,
Dickinson
H
,
Kett
MM
.
Transcutaneous measurement of glomerular filtration rate in small rodents: through the skin for the win?
Nephrology
.
2015
;
20
(
3
):
117
23
.
23.
Soendergaard
C
,
Nielsen
OH
,
Skak
K
,
Ropke
MA
,
Seidelin
JB
,
Kvist
PH
.
Objective quantification of immune cell infiltrates and epidermal proliferation in psoriatic skin: a comparison of digital image analysis and manual counting
.
Appl Immunohistochem Mol Morphol
.
2016
;
24
(
6
):
453
8
.
24.
Johnson
CA
,
Levey
AS
,
Coresh
J
,
Levin
A
,
Lau
J
,
Eknoyan
G
.
Clinical practice guidelines for chronic kidney disease in adults: part II. Glomerular filtration rate, proteinuria, and other markers
.
Am Fam Physician
.
2004
;
70
(
6
):
1091
7
.
25.
Crajoinas
RO
,
Oricchio
FT
,
Pessoa
TD
,
Pacheco
BP
,
Lessa
LM
,
Malnic
G
, et al.
Mechanisms mediating the diuretic and natriuretic actions of the incretin hormone glucagon-like peptide-1
.
Am J Physiol Renal Physiol
.
2011
;
301
(
2
):
F355
63
.
26.
Bisgaard
LS
,
Bosteen
MH
,
Fink
LN
,
Sorensen
CM
,
Rosendahl
A
,
Mogensen
CK
, et al.
Liraglutide reduces both atherosclerosis and kidney inflammation in moderately uremic LDLr−/− mice
.
PLoS One
.
2016
;
11
(
12
):
e0168396
.
27.
Kim
M
,
Platt
MJ
,
Shibasaki
T
,
Quaggin
SE
,
Backx
PH
,
Seino
S
, et al.
GLP-1 receptor activation and Epac2 link atrial natriuretic peptide secretion to control of blood pressure
.
Nat Med
.
2013
;
19
:
567
.
28.
Pinheiro
SV
,
Simões E Silva
AC
.
Angiotensin converting enzyme 2, angiotensin-(1-7), and receptor mas axis in the kidney
.
Int J Hypertens
.
2012
;
2012
:
414128
.
29.
Siragy
HM
,
Carey
RM
.
Role of the intrarenal renin-angiotensin-aldosterone system in chronic kidney disease
.
Am J Nephrol
.
2010
;
31
(
6
):
541
50
.
30.
Soler
MJ
,
Wysocki
J
,
Batlle
D
.
ACE2 alterations in kidney disease
.
Nephrol Dial Transplant
.
2013
;
28
(
11
):
2687
97
.
31.
Nematbakhsh
M
,
Mansouri
A
.
Renal vascular response to angiotensin 1-7 in rats: the role of Mas receptor
.
Res Pharm Sci
.
2018
;
13
(
2
):
177
80
.
32.
Reich
HN
,
Oudit
GY
,
Penninger
JM
,
Scholey
JW
,
Herzenberg
AM
.
Decreased glomerular and tubular expression of ACE2 in patients with type 2 diabetes and kidney disease
.
Kidney Int
.
2008
;
74
(
12
):
1610
6
.
33.
Romani-Perez
M
,
Outeirino-Iglesias
V
,
Moya
CM
,
Santisteban
P
,
Gonzalez-Matias
LC
,
Vigo
E
, et al.
Activation of the GLP-1 receptor by liraglutide increases ACE2 expression, reversing right ventricle hypertrophy, and improving the production of SP-A and SP-B in the lungs of type 1 diabetes rats
.
Endocrinology
.
2015
;
156
(
10
):
3559
69
.
34.
Muñoz
M
,
Martínez
MP
,
López-Oliva
ME
,
Rodríguez
C
,
Corbacho
C
,
Carballido
J
, et al.
Hydrogen peroxide derived from NADPH oxidase 4- and 2 contributes to the endothelium-dependent vasodilatation of intrarenal arteries
.
Redox Biol
.
2018
;
19
:
92
104
.
35.
Ray
R
,
Murdoch
CE
,
Wang
M
,
Santos
CX
,
Zhang
M
,
Alom-Ruiz
S
, et al.
Endothelial Nox4 NADPH oxidase enhances vasodilatation and reduces blood pressure in vivo
.
Arterioscler Thromb Vasc Biol
.
2011
;
31
(
6
):
1368
76
.
36.
Touyz
RM
,
Alves-Lopes
R
,
Rios
FJ
,
Camargo
LL
,
Anagnostopoulou
A
,
Arner
A
, et al.
Vascular smooth muscle contraction in hypertension
.
Cardiovasc Res
.
2018
;
114
(
4
):
529
39
.
37.
Younes
ST
,
Maeda
KJ
,
Sasser
J
,
Ryan
MJ
.
The glucagon-like peptide 1 receptor agonist liraglutide attenuates placental ischemia-induced hypertension
.
Am J Physiol Heart Circ Physiol
.
2020
;
318
(
1
):
H72
7
.
38.
Einbinder
Y
,
Ohana
M
,
Benchetrit
S
,
Zehavi
T
,
Nacasch
N
,
Bernheim
J
, et al.
Glucagon-like peptide-1 and vitamin D: anti-inflammatory response in diabetic kidney disease in db/db mice and in cultured endothelial cells
.
Diabetes Metab Res Rev
.
2016
;
32
(
8
):
805
15
.
39.
Kohan
DE
,
Barton
M
.
Endothelin and endothelin antagonists in chronic kidney disease
.
Kidney Int
.
2014
;
86
(
5
):
896
904
.
40.
Barton
M
,
Shaw
S
,
d’Uscio
LV
,
Moreau
P
,
Luscher
TF
.
Angiotensin II increases vascular and renal endothelin-1 and functional endothelin converting enzyme activity in vivo: role of ETA receptors for endothelin regulation
.
Biochem Biophys Res Commun
.
1997
;
238
(
3
):
861
5
.
41.
Culshaw
GJ
,
MacIntyre
IM
,
Dhaun
N
,
Webb
DJ
.
Endothelin in nondiabetic chronic kidney disease: preclinical and clinical studies
.
Semin Nephrol
.
2015
;
35
(
2
):
176
87
.
42.
Hasan
AA
,
von Websky
K
,
Reichetzeder
C
,
Tsuprykov
O
,
Gaballa
MMS
,
Guo
J
, et al.
Mechanisms of GLP-1 receptor–independent renoprotective effects of the dipeptidyl peptidase type 4 inhibitor linagliptin in GLP-1 receptor knockout mice with 5/6 nephrectomy
.
Kidney Int.
2019
;
95
(
6
):
1373
88
.
43.
Zhang
J
,
Chen
Q
,
Zhong
J
,
Liu
C
,
Zheng
B
,
Gong
Q
.
DPP-4 inhibitors as potential candidates for antihypertensive therapy: improving vascular inflammation and assisting the action of traditional antihypertensive drugs
.
Front Immunol
.
2019
;
10
:
1050
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.