Aprocitentan mitigates ischemia reperfusion induced kidney injury in rats by attenuating inflammation and pyroptosis through suppressing NF-κB/NLRP3/caspase-1 signaling pathway

Authors

DOI:

https://doi.org/10.15584/ejcem.2025.4.13

Keywords:

acute kidney injury, caspase-1, endothelin receptor antagonist, ischemia-reperfusion, pyroptosis, NLRP3 inflammasome

Abstract

Introduction and aim. Renal ischemia-reperfusion (I/R) injury is a primary cause of acute kidney injury (AKI). The NF-κB/NLRP3/caspase-1 signaling system is crucial for I/R-induced kidney damage, which leads to inflammation, pyroptosis, and tissue damage. Aprocitentan has anti-inflammatory and vasoprotective properties, suggesting its potential nephroprotective advantages.

The aim of this investigation was to evaluate the protective advantages of aprocitentan against renal I/R injury in rat models. This was achieved by evaluating the impact of aprocitentan on inflammation, pyroptosis, and kidney function by altering the NF-κB/NLRP3/Caspase-1 pathway.

Material and methods. Using twenty-four adult male Sprague-Dawley rats, four separate groups were formed: sham group, I/R control group, dimethyl sulfoxide group (DMSO) and aprocitentan group (10 mg/kg). Renal ischemia/reperfusion was induced by a period of forty minutes of bilateral ischemia, which was followed by two hours of reperfusion. To evaluate the renoprotective effect of aprocitentan urea, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), phosphorylated nuclear factor kappa B p65 (NF-κB p65), NOD-like receptor protein 3 (NLRP3), and cysteine-aspartic protease-1 (caspase-1), were measured, along with histopathological examination.

Results. Compared to the sham group, the I/R control group had significantly increased concentrations of urea, creatinine, NGAL, NF-κB p65, NLRP3, as well as caspase-1. These signs decreased in the aprocitentan group, leading to enhanced renal function, reduction of inflammation, and inhibition of pyroptosis. Histology showed a decrease in tubular inflammation and necrosis in the aprocitentan group.

Conclusion. Aprocitentan decreases inflammation and inhibits pyroptosis by suppressing the NF-κB/NLRP3/Caspase-1 pathway. These results illustrate its promising potential to prevent ischemic renal diseases, including acute kidney injury.

Downloads

Download data is not yet available.

References

Zuk A, Bonventre JV. Acute Kidney Injury. Annu Rev Med. 2016;67(1):293-307. doi: 10.1146/annurev-med-050214-013407

Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. In: Comprehensive Physiology. Wiley; 2012:1303-1353. doi: 10.1002/cphy.c110041

Malek M, Nematbakhsh M. Renal ischemia/reperfusion injury; from pathophysiology to treatment. J Renal Inj Prev. 2015;4(2):20-27. doi: 10.12861/jrip.2015.06

Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant. 2011;11(11):2279-2296. doi: 10.1111/j.1600-6143.2011.03754.x

Xiao C, Zhao H, Zhu H, et al. Tisp40 induces tubular epithelial cell GSDMD-mediated pyroptosis in renal ischemia-reperfusion injury via NF-κB signaling. Front Physiol. 2020;11:906. doi: 10.3389/fphys.2020.00906

Liu Y, Lei H, Zhang W, et al. Pyroptosis in renal inflammation and fibrosis: current knowledge and clinical significance. Cell Death Dis. 2023;14(7):472. doi: 10.1038/s41419-023-06005-6

Wang X, Wu S, Jiang Y, et al. Anwulignan alleviates IRI by the activation of Nrf2/HO-1 signaling pathway and inhibiting NLRP3-caspase-1-GSDMD-mediated pyroptosis in rats. Tissue Cell. 2025;93(1):102775. doi: 10.1016/j.tice.2025.102775

Ma X, Liang Y, Chen W, Zheng L, Lin H, Zhou T. The role of endothelin receptor antagonists in kidney disease. Ren Fail. 2025;47(1):e2465810. doi: 10.1080/0886022X.2025.2465810

Blazek O, Bakris GL. Novel Therapies on the Horizon of Hypertension Management. Am J Hypertens. 2023;36(2):73-81. doi: 10.1093/ajh/hpac111

Haryono A, Ramadhiani R, Ryanto GRT, Emoto N. Endothelin and the cardiovascular system: the long journey and where we are going. Biology (Basel). 2022;11(5):759. doi: 10.3390/biology11050759

Wu Z, Tan W, Wang C, et al. TAX1BP1 regulates the apoptosis of renal tubular epithelial cells in ischemia/reperfusion injury via the NF-kB/PMAIP1 signaling pathway. Inflamm Res. 2025;74(1):9. doi: 10.1007/s00011-024-01976-4

Younis NS, Ghanim AMH. The protective role of celastrol in renal ischemia-reperfusion injury by activating Nrf2/HO-1, PI3K/AKT signaling pathways, modulating NF-κB signaling pathways, and inhibiting ERK phosphorylation. Cell Biochem Biophys. 2022;80(1):191-202. doi: 10.1007/s12013-022-01064-6

Zheng Z, Xu K, Li C, et al. NLRP3 associated with chronic kidney disease progression after ischemia/reperfusion-induced acute kidney injury. Cell Death Discov. 2021;7(1):324. doi: 10.1038/s41420-021-00719-2

Su X, Liu B, Wang S, et al. NLRP3 inflammasome: A potential therapeutic target to minimize renal ischemia/reperfusion injury during transplantation. Transpl Immunol. 2022;75:101718. doi: 10.1016/j.trim.2022.101718

Wang S, Chen Y, Han S, et al. Selenium nanoparticles alleviate ischemia reperfusion injury-induced acute kidney injury by modulating GPx-1/NLRP3/Caspase-1 pathway. Theranostics. 2022;12(8):3882-3895. doi: 10.7150/thno.70830

Yang B, Jain S, Ashra SY, Furness PN, Nicholson ML. Apoptosis and caspase-3 in long-term renal ischemia/reperfusion injury in rats and divergent effects of immunosuppressants. Transplantation. 2006;81(10):1442-1450. doi: 10.1097/01.tp.0000209412.77312.69

Vince JE, Silke J. The intersection of cell death and inflammasome activation. Cell Mol Life Sci. 2016;73(11-12):2349-2367. doi: 10.1007/s00018-016-2205-2

Suliman H, Ma Q, Zhang Z, et al. Annexin A1 Tripeptide Mimetic Increases Sirtuin-3 and Augments Mitochondrial Function to Limit Ischemic Kidney Injury. Front Physiol. 2021;12:683098. doi: 10.3389/fphys.2021.683098

Wang S, Zhu H, Li R, et al. DNA-PKcs interacts with and phosphorylates Fis1 to induce mitochondrial fragmentation in tubular cells during acute kidney injury. Sci Signal. 2022;15(725): eabh1121. doi: 10.1126/scisignal.abh1121

Trensz F, Bortolamiol C, Kramberg M, et al. Pharmacological characterization of aprocitentan, a dual endothelin receptor antagonist, alone and in combination with blockers of the renin angiotensin system, in two models of experimental hypertension. J Pharmacol Exp Ther. 2019;368(3):462-473. doi: 10.1124/jpet.118.253864

Torres-González L, Cienfuegos-Pecina E, Perales-Quintana MM, et al. Nephroprotective effect of Sonchus oleraceus extract against kidney injury induced by ischemia-reperfusion in Wistar rats. Oxid Med Cell Longev. 2018;2018:9572803. doi: 10.1155/2018/9572803

Herrera-Luna Y, Lozano M, Pasten C, Multhoff G, Irarrázabal CE. The ischemia and reperfusion injury involves the toll-like receptor-4 participation mainly in the kidney cortex. Cell Physiol Biochem. 2022;56(6):613-628. doi: 10.33594/000000586

Tiba AT, Qassam H, Hadi NR. Semaglutide in renal ischemia-reperfusion injury in mice. J Med Life. 2023;16(2):317-324. doi: 10.25122/jml-2022-0291

Khalid U, Pino-Chavez G, Nesargikar P, et al. Kidney ischaemia reperfusion injury in the rat: the EGTI scoring system as a valid and reliable tool for histological assessment. J Histol Histopathol. 2016;3(1):1. doi: 10.7243/2055-091X-3-1

Younes-Ibrahim MS, Younes-Ibrahim M. Biomarkers and kidney diseases: a brief narrative review. J Lab Precis Med. 2022;7:20. doi: 10.21037/jlpm-22-1

Jallawee HQ, Janabi AM. Trandolapril improves renal ischemia-reperfusion injury in adult male rats via activation of the autophagy pathway and inhibition of inflammation, oxidative stress, and apoptosis. J Biosci Appl Res. 2024;10(6):114-127. doi: 10.21608/jbaar.2024.315239.1077

Tweij TAR, Al-Issa MA, Hamed M, Khaleq MAA, Jasim A, Hadi NR. Pretreatment with erythropoietin alleviates the renal damage induced by ischemia reperfusion via repression of inflammatory response. Wiad Lek. 2022;75(12):2939-2947. doi: 10.36740/WLek202212108

Flack JM, Schlaich MP, Weber MA, et al. Aprocitentan for Blood Pressure Reduction in Black Patients. Hypertension. 2025;82(4):601-610. doi: 10.1161/HYPERTENSIONAHA.124.24142

Yang H, Chen Y, He J, Li Y, Feng Y. Advances in the diagnosis of early biomarkers for acute kidney injury: a literature review. BMC Nephrol. 2025;26(1):115. doi: 10.1186/s12882-025-04040-3

Han M, Li Y, Wen D, Liu M, Ma Y, Cong B. NGAL protects against endotoxin-induced renal tubular cell damage by suppressing apoptosis. BMC Nephrol. 2018;19(1):168. doi: 10.1186/s12882-018-0977-3

Calistro Neto JP, Torres RC, Gonçalves GM, et al. Parecoxib reduces renal injury in an ischemia/reperfusion model in rats. Acta Cir Bras. 2015;30(4):270-276. doi: 10.1590/S0102-865020150040000006

Martínez-Díaz I, Martos N, Llorens-Cebrià C, et al. Endothelin Receptor Antagonists in Kidney Disease. Int J Mol Sci. 2023;24(4):3427. doi: 10.3390/ijms24043427

Varzideh F, Jankauskas SS, Jain U, et al. The dual endothelin-1 antagonist aprocitentan alleviates mitochondrial oxidative stress in human cardiac fibroblasts. Eur Heart J Cardiovasc Pharmacother. 2024;10(6):566-568. doi: 10.1093/ehjcvp/pvae050

Chen Y, Lin L, Rao S, Tao X, Cui J, Wan J. Complement C3 mediates podocyte injury through TLR4/NFΚB-P65 signaling during ischemia–reperfusion acute kidney injury and post-injury fibrosis. Eur J Med Res. 2023;28(1):135. doi: 10.1186/s40001-023-01054-1

Alaasam ER, Janabi AM, Al-Buthabhak KM, et al. Nephroprotective role of resveratrol in renal ischemia-reperfusion injury: a preclinical study in Sprague-Dawley rats. BMC Pharmacol Toxicol. 2024;25(1):82. doi: 10.1186/s40360-024-00809-8

Alsaaty EH, Janabi AM. Moexipril improves renal ischemia/reperfusion injury in adult male rats. J Contemp Med Sci. 2024;10(1):e1477. doi: 10.22317/jcms.v10i1.1477

Dhaun N, Webb DJ, Kluth DC. Endothelin‐1 and the kidney – beyond BP. Br J Pharmacol. 2012;167(4):720-731. doi: 10.1111/j.1476-5381.2012.02070.x

Ye Z, Zhang J, Xu Z, et al. Pioglitazone ameliorates ischemia/reperfusion-induced acute kidney injury via oxidative stress attenuation and NLRP3 inflammasome. Hum Cell. 2024;37(4):959-971. doi: 10.1007/s13577-024-01059-w

Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;54(6):1012-1024. doi: 10.1053/j.ajkd.2009.07.020

Niu J, Wu J, Li X, Zhang F. Association between endothelin-1/endothelin receptor A and inflammation in mouse kidneys following acute ischemia/reperfusion. Mol Med Rep. 2015;11(5):3981-3987. doi: 10.3892/mmr.2014.3138

Varzideh F, Kansakar U, Jankauskas SS, Santulli G. Aprocitentan: New insights. Front Cardiovasc Med. 2022;9. doi: 10.3389/fcvm.2022.1093406

Chen YF, Qi RQ, Zhao L, et al. Aprocitentan mitigates doxorubicin-induced cardiotoxicity by inhibiting cuproptosis, oxidative stress, and mitochondrial impairments via the activation of sirtuin 7. Int Immunopharmacol. 2025;148:114141. doi: 10.1016/j.intimp.2025.114141

Alkhafaji GA, Janabi AM. GIP/GLP-1 dual agonist tirzepatide ameliorates renal ischemia/reperfusion damage in rats. Int J Appl Pharm. 2025;17(2):165-173. doi: 10.22159/ijap.2025v17i2.53156

Wilhelm SM, Stowe NT, Robinson A V., Schulak JA. The use of the endothelin receptor antagonist, tezosentan, before or after renal ischemia protects renal function. Transplantation. 2001;71(2):211-216. doi: 10.1097/00007890-200101270-00007

Zheng L, Liu M, Gu X, Zhang Y, Wang Y. Efficacy and safety of aprocitentan in the treatment of hypertension: a meta-analysis of evidence from randomized controlled trials. Rev Cardiovasc Med. 2025;26(1):e25909. doi: 10.31083/RCM25909

Downloads

Published

2025-06-29

How to Cite

Alfatli, L. A. R., & Tweij, T.-A. R. (2025). Aprocitentan mitigates ischemia reperfusion induced kidney injury in rats by attenuating inflammation and pyroptosis through suppressing NF-κB/NLRP3/caspase-1 signaling pathway. European Journal of Clinical and Experimental Medicine. https://doi.org/10.15584/ejcem.2025.4.13

Issue

Section

ORIGINAL PAPERS