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From the Departments of Medicine-Nephrology,* Baylor College of Medicine, Houston, Texas; the Department of Medicine, Austin and Repatriation Medical Center, The University of Melbourne, Melbourne, Australia; and the Division of Surgical Science, College of Physicians & Surgeons, Department of Surgery, Columbia University, New York, New York
Advanced glycation end products (AGEs) have been shown to play a role in tubular epithelial-myofibroblast transdifferentiation (TEMT) in diabetic nephropathy, but the intracellular signaling pathway remains unknown. We report here that AGEs signal through the receptor for AGEs (RAGE) to induce TEMT, as determined by de novo expression of a mesenchymal marker (
-smooth muscle actin, -SMA) and loss of epithelial marker (E-cadherin), directly through the MEK1-ERK1/2 MAP kinase pathway, which is TGF-ß independent. This is supported by the following findings: AGEs induced de novo -SMA mRNA expression as early as 2 hours followed by a loss of E-cadherin before TGF-ß mRNA expression at 24 hours and occurred in the absence of TGF-ß and AGE-induced activation of ERK1/2 MAP kinase at 15 minutes and TEMT at 24 hours were completely blocked by a neutralizing RAGE antibody, a soluble RAGE receptor, an ERK1/2 MAP kinase inhibitor (PD98059), and DN-MEK1, but not by a neutralizing TGF-ß antibody. Thus, this study demonstrates that AGEs activate the RAGE-ERK1/2 MAP kinase pathway to mediate the early TEMT process. The findings from this study suggest that targeting the RAGE or the ERK MAP kinase pathway may provide new therapeutic strategies for diabetic nephropathy and shed new light on the pathogenesis of diabetic nephropathy.
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