Indoxyl sulfate enhances p53-TGF-β1-Smad3 pathway in proximal tubular cells

Background/aim: Indoxyl sulfate-induced activation of nuclear factor (NF)-ĸB promotes transforming growth factor (TGF)-β1 in human proximal tubular cells (HK-2 cells). The present study aimed to elucidate the cross talk among indoxyl sulfate, p53 and TGF-β1-Smad3 signaling in proximal tubular cells.

Methods: The effects of indoxyl sulfate on the expression of TGF-β1, SMAD3, and α-smooth muscle actin (α-SMA) were determined using HK-2 cells. As for in vivo experiments the following Animals were used: Dahl salt-resistant normotensive rats (DN) and indoxyl sulfate-administered Dahl salt-resistant normotensive rats (DN+IS).

Results: Both indoxyl sulfate and nutlin-3, a specific p53 inducer, stimulated TGF-β1 expression, which was suppressed by pifithrin-α, p-nitro, a p53 inhibitor. Further, indoxyl sulfate stimulated TGF-β1-induced expression of α-SMA by enhancing SMAD3 expression and TGF-β1-induced SMAD3 phosphorylation. Indoxyl sulfate induced phosphorylation of extracellular signal-regulated kinase (ERK). U0126, an inhibitor of ERK pathway, prevented indoxyl sulfate-induced upregulation of SMAD3 expression. Immunohistochemistry demonstrated that TGF-β1 and SMAD3 were localized in renal tubular cells, and that indoxyl sulfate increased the TGF-β1 and Smad3-positive area in the kidney.

Conclusion: Indoxyl sulfate stimulates p53-induced TGF-β1 expression and TGF-β1-induced α-SMA expression in proximal tubular cells. Indoxyl sulfate-induced SMAD3 accelerates TGF-β1-induced α-SMA expression through ERK activation. Thus, indoxyl sulfate enhances p53-TGF-β1-Smad3 pathway in proximal tubular cells.