WO2022073416A1 - 微囊藻毒素-rr在用于制备预防或治疗肾纤维化疾病的药物中的应用 - Google Patents
微囊藻毒素-rr在用于制备预防或治疗肾纤维化疾病的药物中的应用 Download PDFInfo
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- microcystin
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- renal fibrosis
- renal
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
- A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P13/00—Drugs for disorders of the urinary system
- A61P13/12—Drugs for disorders of the urinary system of the kidneys
Definitions
- the invention belongs to the technical field of medicine, and specifically relates to the use of microcystin-RR in the preparation of medicines for preventing or treating human renal fibrosis.
- Chronic kidney disease is a common disease that seriously threatens human health and life, with a high incidence of about 7-12% in different parts of the world.
- the damage of renal structure and function in patients with chronic kidney disease gradually aggravates with the passage of time, and the clinical treatment methods are very limited.
- fibrosis, RF is the main pathological feature of end-stage renal failure, which clinically requires lifelong dialysis or kidney transplantation to maintain life.
- the etiology of chronic kidney disease-renal fibrosis is complex, involving genetic susceptibility, environment (infection, poison) and internal factors of the body, among which diabetes and hypertension are the most common risk factors.
- the occurrence of renal fibrosis shows a similar pathological process: inflammation, macrophage infiltration and abnormal expression of inflammatory factors, proliferation and differentiation of myofibroblasts, increased synthesis and secretion of collagen fibers, extracellular matrix (extracellular matrix) matrix, ECM) is widely deposited.
- TGF- ⁇ /Smad is an important signaling molecule to promote renal fibrogenesis, and myofibroblasts are the main effector cells of fibrosis.
- Microcystins are a class of common toxins produced by cyanobacteria in environmental freshwater ecosystems, which have toxic effects on body tissues and cells. After environmental exposure, the accumulation and distribution of MCs in different tissues and organs of the body varied greatly, and kidney and liver belonged to the accumulation organs with higher concentrations of MCs. Therefore, exposure to MCs in the body often manifests as liver and kidney toxicity.
- MCs are cyclic 7-peptide molecules that are metabolized by cyanobacteria. The head and tail amino acids of MCs molecules are connected to form a ring structure. There are many variants of MCs in nature, and the toxicity of different variants varies greatly.
- Microcystin-LR M-LR
- the 2nd and 4th amino acids are leucine (Leucine, L) and arginine (Arginine, L), respectively.
- R Microcystin-LR
- the applicant of the present invention accidentally discovered in his previous genetic toxicology research on MCs that the changes in the expression of certain cell signaling molecules caused by exposure to Microcystin-LR may be applied to the prevention and treatment of fibrotic diseases that plague humans.
- the present invention implements its anti-renal fibrosis animal model experiment based on the less toxic variant Microcystin-RR (MC-RR).
- MC-RR Microcystin-RR
- the results show good intervention and treatment effects, and the intervention dose of Microcystin -RR exerted a therapeutic effect without producing observable microcystin-associated toxic effects.
- the present invention discloses that Microcystin-RR can be used for transformation and preparation of preventive and therapeutic drugs for renal fibrotic diseases.
- Microcystin-RR (MC-RR) studied in the present invention
- the second and fourth amino acids of its cyclic heptapeptide are both arginine (R).
- the second amino acid of Microcystin-LR is leucine (L), which is a neutral amino acid;
- the second position of Microcystin-RR is arginine (R), which is a polar (basic) amino acid. Due to the difference in the amino acid composition of Microcystin-LR and Microcystin-RR, the charges carried by them are different, which will affect the interaction and efficiency of Microcystin-LR and Microcystin-RR with their target molecules. The results of toxicological analysis also showed that the toxicity of Microcystin-RR was low, only about 1/10 of that of Microcystin-LR.
- the present invention proposes that Microcystin-RR has significant effects in preventing and treating renal fibrosis.
- the experimental results underlying the present invention clearly show that Microcystin-RR has an effective medical effect on the pathological changes of renal fibrosis induced by ureteral ligation (occlusion).
- the medicinal Microcystin-RR of the present invention changes the microenvironment of the renal tissue in the renal tissue of the model mice with renal fibrosis induced by ureteral ligation (resulting in ureteral obstruction), inhibits the proliferation and differentiation of myofibroblasts, and inhibits the synthesis and secretion of collagen. , to achieve the effect of blocking and reducing extracellular matrix (ECM) deposition in renal tissue.
- ECM extracellular matrix
- the present invention provides the application of microcystin-RR in the preparation of medicines for preventing or treating renal fibrosis.
- the drugs for preventing or treating renal fibrosis include but are not limited to single-component or compound preparations.
- the dosage forms of the drugs for preventing or treating renal fibrosis include but are not limited to tablets, capsules, oral liquids, syrups, drop pills, injection dosage forms or freeze-dried powder dosage forms.
- the daily oral administration dose of the microcystin-RR is 5-20 ⁇ g/kg mice.
- microcystin-RR in a drug for inhibiting the expression of myofibroblast marker molecules Fibronectin and ⁇ -SMA protein.
- the medicinal microcystin-RR proposed in the present invention inhibits the expression of myofibroblast marker molecules Fibronectin and ⁇ -SMA proteins in the kidney tissue of a ureteral ligation-induced renal fibrosis model mouse.
- microcystin-RR in a drug for inhibiting the expression of collagen I, TGF- ⁇ /p-Smad signal molecule, p-AKT protein or STAT6 protein.
- microcystin-RR in a drug for changing the expression of the macrophage differentiation marker molecule CD-206.
- microcystin-RR in a drug for restoring the expression of matrix metalloproteinase 13 in renal tissue cells.
- the medicinal microcystin-RR proposed in the present invention reduces the main structural protein Collagen of fibrosis in the kidney tissue of ureteral ligation-induced renal fibrosis model mice 1 content.
- the medicinal microcystin-RR proposed in the present invention inhibits the expression of TGF- ⁇ 1 and p-Smad3 in the renal tissue of ureteral ligation-induced renal fibrosis model mice, and inhibits the activation of key signaling pathways that promote fibrosis. .
- the medicinal microcystin-RR proposed in the present invention inhibits the expression of fibrosis-promoting signaling molecules p-AKT and STAT6 in the kidney tissue of ureteral ligation-induced renal fibrosis model mice.
- the medicinal microcystin-RR proposed in the present invention reduces the expression level of M2 macrophage marker molecule CD206 in the kidney tissue of ureteral ligation-induced renal fibrosis model mice, and reduces the M2 type differentiation of macrophages .
- M2 macrophages secrete cytokines that promote fibrosis.
- the medicinal microcystin-RR proposed in the present invention restores the protein expression of matrix metalloproteinase 13 (MMP13) in the kidney tissue of ureteral ligation-induced renal fibrosis model mice.
- MMP13 matrix metalloproteinase 13
- MMP13 has an anti-fibrotic effect, and the expression of MMP13 is inhibited in the occurrence of renal fibrosis.
- the present invention constructs unilateral ureteral ligation/occlusion (Unilateral ureteral ligation/occlusion) ureteral obstruction, UUO) induced renal fibrosis in mice, a classic animal disease model, using Microcystin-RR for medical intervention. Based on the analysis results of histopathology, renal fibrosis marker proteins, key signaling molecules and changes in the renal tissue microenvironment, it is proposed for the first time that Microcystin-RR can transform and prepare drugs for the prevention and treatment of renal tissue fibrosis.
- UUO Unilateral ureteral ligation/occlusion
- UUO ureteral obstruction
- the invention constructs an animal model of renal fibrosis in mice caused by unilateral ureteral ligation (UUO), and is treated with Microcystin-RR by daily gavage. Combined with histopathology, organ tissue fibrosis marker proteins, and molecular analysis of key signaling pathways, the effect of MC-RR on the prevention and treatment of renal fibrosis was determined. The results showed that the intragastric administration of Microcystin-RR could significantly reduce and improve the occurrence and pathological state of renal tissue fibrosis induced by UUO.
- Microcystin-RR treatment significantly reduces the expression of TGF- ⁇ 1 in renal tissue cells of UUO mice and inhibits the activation of TGF- ⁇ 1.
- Smad3 phosphorylation p-Smad3 phosphorylation (p-Smad3), which is the activated form of Smad3; at the same time, Microcystin-RR treatment can significantly inhibit the expression of AKT protein activation (p-AKT) and STAT6 in renal tissue cells, both of which have the ability to promote The role of tissue fibrosis.
- Microcystin-RR treatment can alter the differentiation status of macrophages in kidney tissue of UUO mice, reduce CD206 expression (attenuated M2-type differentiation of macrophages), and restore UUO-inhibited renal tissue cell matrix metalloproteinases 13 (MMP13) expression and the associated changes in the renal tissue microenvironment are both beneficial to alleviate the pathological state of renal tissue fibrosis.
- MMP13 renal tissue cell matrix metalloproteinases 13
- the present invention implements its anti-renal fibrosis animal model experiment based on the less toxic variant Microcystin-RR (MC-RR) of MCs, the results show good intervention and treatment effects, and the intervention dose of Microcystin-RR is effective in the treatment of The effect was accompanied by no observable microcystin-associated toxic effects. Based on the above experimental results, the present invention discloses that Microcystin-RR can be used for transformation and preparation of preventive and therapeutic drugs for renal fibrotic diseases.
- FIG 1A shows the chemical structure of Microcystin-RR (Microcystin-RR), which is a cyclic heptapeptide molecule.
- the abnormal amino acid mutation of microcystin occurs in its second and fourth amino acids.
- the second and fourth amino acids of Microcystin-RR are both arginine (Arginine, R), which is a variant with lower toxicity of microcystin-RR. body.
- the most common one in environmental water is Microcystin-LR (Microcystin-LR), which is highly toxic.
- Figure 1B shows the toxicity test of Microcystin-RR and Microcystin-LR on the proliferation activity of in vitro cultured cells (liver cell line LO2). The results show that the cytotoxicity of Microcystin-RR is significantly lower than that of Microcystin-LR.
- FIG. 1 Comparison of the intervention effects of Microcystin-LR and Microcystin-RR on renal tissue fibrosis caused by ureteral obstruction (UUO); A is the comparison of the effects of Microcystin-LR and Microcystin-RR on the alleviation of renal tissue structure and inflammatory state in UUO mice.
- Microcystin-LR and Microcystin-RR interventions can alleviate the inflammatory state and inflammatory cell infiltration in the kidney tissue of UUO mice (HE staining ⁇ 400);
- B is the effect of Microcystin-LR and Microcystin-RR on the pathological state of renal tissue fibrosis in UUO mice The comparison of the alleviation effect showed that the effect of Microcystin-RR intervention on UUO-induced renal fibrosis in mice was more obvious than that of Microcystin-LR (Masson staining ⁇ 400);
- FIG. 3 Shows the alleviation effect of Microcystin-RR (MC-RR) intervention on UUO-induced renal tissue fibrosis at different implementation times.
- A shows the implementation of UUO modeling and MC-RR intervention in mice;
- B shows that compared with pure UUO mice, Microcystin-RR pre-intervention (4 weeks, 2 weeks, and 0 weeks, respectively) has an effect on the renal tissue structure and renal tissue of UUO mice.
- Relief effect of inflammatory state (HE staining ⁇ 400);
- Panel C shows the preventive and therapeutic effects of Microcystin-RR intervention on the pathological state of renal fibrosis in UUO mice (Masson staining ⁇ 400); Sham operation is the sham operation group (normal control);
- FIG. 4 Shows the effect of Microcystin-RR (MC-RR) intervention (20 ⁇ g/kg/day, 4 weeks in advance) on UUO mice renal tissue myofibroblast marker molecule Fibronectin, ⁇ -SMA expression, and renal tissue fibrosis structural molecules Effects of Collagen-1 protein content. It indicated that Microcystin-RR had inhibitory effect on UUO-induced renal fibrosis.
- MC-RR Microcystin-RR
- FIG. 5 Shows that different doses of Microcystin-RR (MC-RR are 5 ⁇ g/kg/day, 10 ⁇ g/kg/day, 20 ⁇ g/kg/day) 4 weeks in advance of intervention on UUO mice kidney tissue myofibroblast marker molecule Fibronectin , ⁇ -SMA expression and renal fibrosis structural molecule Collagen-1 protein content. It indicated that Microcystin-RR had inhibitory effect on UUO-induced renal fibrosis.
- FIG. 6 It shows that Microcystin-RR (MC-RR) intervention can significantly inhibit the expression of TGF- ⁇ 1 and p-Smad3 protein molecules in the kidney tissue of UUO mice (experimental conditions are the same as in Figure 5). Activation of TGF- ⁇ 1 and p-Smad3 signaling plays an important role in promoting renal fibrosis.
- FIG. 7 It shows that Microcystin-RR (MC-RR) intervention has a significant inhibitory effect on the expression of p-AKT and STAT6 in the kidney tissue of UUO mice (the experimental conditions are the same as in Figure 5).
- p-AKT and STAT6 are important protein molecules that promote renal fibrosis.
- FIG 8. It shows that the expression of CD206 (M2 macrophage marker molecule) in the renal tissue of the fibrotic lesions of the pure UUO mice is significantly higher than that of the sham-operated control mouse kidney tissue (experimental conditions are the same as in Figure 5).
- Microcystin-RR (MC-RR) intervention significantly reduced the level of CD206 in kidney tissue of UUO mice, especially at doses of 10 ⁇ g/kg/day and 20 ⁇ g/kg/day;
- the molecular level of iNOS (M1 macrophage marker molecule) had no significant effect, and the expression level of iNOS was not significantly correlated with the occurrence of tissue fibrosis (the experimental conditions were the same as in Figure 5).
- FIG. 9 Shows the effect of Microcystin-RR (MC-RR) intervention on MMP13 in renal tissue cells.
- A, B show that the expression of MMP13 in renal fibrotic tissue of UUO mice is inhibited, and the intervention of Microcystin-RR can restore the expression of MMP13 in renal fibrotic tissue of UUO mice (experimental conditions are the same as in Figure 4);
- C, D show , Microcystin-RR (50nM, 100nM) treatment can significantly increase the MMP13 protein expression of cultured renal tubular epithelial cells HK2 in vitro.
- MMP13 has the effect of degrading collagen and anti-fibrosis.
- mice C57 BL/6 male mice (SPF grade), about 8 weeks old (weight 20-24 g), were provided by the Institute of Model Animals, Nanjing University. Breeding conditions: Well ventilated 20 °C constant temperature control, 12 hours of light/dark alternation, and sufficient rat food and drinking water (free access for mice). The experimental protocol was approved by the Laboratory Animal Welfare Ethics Committee of Nanjing University.
- Microcystin-RR was purchased from Alexis Biochemicals (Lausen, Switzerland).
- UUO ureteral obstruction
- UUO Unilateral ureteral ligation/occlusion
- mice Sham operation group
- the skin was incised and the left ureter was exposed for a while, but no ligation was applied, that is, the wound was sutured.
- mice were randomly divided into 4 groups, namely control group (sham operation group), simple UUO group, Microcystin-LR or Microcystin-RR intervention group (10 per group), used to observe and compare the intervention effect of Microcystin-LR and Microcystin-RR on UUO-induced renal fibrosis.
- control group sham operation group
- simple UUO group simple UUO group
- Microcystin-LR or Microcystin-RR intervention group (10 per group), used to observe and compare the intervention effect of Microcystin-LR and Microcystin-RR on UUO-induced renal fibrosis.
- Microcystin-LR or Microcystin-RR began to intervene 4 weeks before UUO surgery, and were given by gavage at a dose of 20 ⁇ g/kg/day; the second batch of experimental mice, a total of 50 mice, were randomly divided into 5 groups, namely control group, The UUO group alone and the Microcystin-RR intervention group at three times (10 mice in each group) were used to observe the effect of Microcystin-RR on UUO-induced mice at different times (4 weeks, 2 weeks) before UUO surgery and on the day of surgery. Prevention and treatment of renal fibrosis.
- Microcystin-RR was administered by gavage at a dose of 20 ⁇ g/kg/day; a total of 25 experimental mice in the third batch were randomly divided into 5 groups, namely the control group, the simple UUO group and the three-dose Microcystin-RR intervention group (5 animals in each group), 4 weeks before UUO surgery, groups were given different doses of Microcystin-RR by intragastric administration, the doses were 5 ⁇ g/kg/day, 10 ⁇ g/kg/day and 20 ⁇ g/kg/day, respectively.
- Control mice and pure UUO mice in the above three batches of experiments were given an equal volume of normal saline by gavage at the same time during the experiment.
- kidney and liver tissue and serum samples were collected. Some kidney tissue samples were fixed with 10% neutral formaldehyde and used for histopathological examination. Some kidney tissue samples and liver tissue samples were cryopreserved in liquid nitrogen for tissue protein expression analysis, and serum samples were used for laboratory liver function analysis.
- Microcystin-RR affects the expression of matrix metalloproteinase 13 (MMP13) in epithelial-mesenchymal transition (EMT) cells cultured in vitro: Renal tubular epithelial cells HK2 (purchased from Shanghai Cell Bank, Chinese Academy of Sciences) were cultured in DMEM-F2 Epithelial-mesenchymal transition (EMT) was induced by TGF- ⁇ 1 (5 ng/ml) treatment for 48 hours. Different doses of Microcystin-RR (0, 10, 25, 50, 100 nM, respectively) were added to treat HK2 cells induced by TGF- ⁇ 1, and the regulation effect of Microcystin-RR on the expression of MMP13 in cultured cells was analyzed.
- MMP13 matrix metalloproteinase 13
- EMT epithelial-mesenchymal transition
- the most common cystin variant in environmental water is Microcystin-LR, which is highly toxic, mainly manifesting as liver and kidney toxicity.
- the present invention relates to Microcystin-RR (Fig. 1A), which is less toxic.
- Microcystin-sensitive liver cell line LO2, purchased from Shanghai Cell Bank, Chinese Academy of Sciences
- the toxicity test results of Microcystin-RR and Microcystin-LR on the proliferation activity of LO2 cells in vitro showed that the cells of Microcystin-RR Toxicity was significantly lower than Microcystin-LR (Fig. 1B), * P ⁇ 0.05.
- FIG. 2A shows the comparison of the alleviation effect on the renal tissue structure and inflammatory state of UUO mice (HE staining ⁇ 400);
- Figure 2B shows the comparison of the alleviation effect on the renal tissue fibrosis pathological state of UUO mice (Masson staining ⁇ 400).
- the results showed that both Microcystin-LR and Microcystin-RR could significantly alleviate renal fibrosis induced by ureteral obstruction (UUO). Histopathologically, Masson staining in the kidney tissue of Microcystin-RR-treated mice showed a more obvious fibrosis remission effect than that of Microcystin-LR-treated mice ( Figure 2).
- M2 macrophages secrete cytokines that promote renal fibrosis.
- the intervention of Microcystin-RR had no significant effect on the level of iNOS, a marker molecule of M1 macrophages in renal tissue, and the level of iNOS in the UUO group was lower than that in the sham operation (control group), P ⁇ 0.05.
- the comparison showed no significant difference (Figure 8).
- MMP13 has the effect of degrading collagen and anti-fibrosis.
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Abstract
天然环状七肽分子微囊藻毒素-RR在肾纤维化疾病预防和治疗中的医药应用。验证的微囊藻毒素-RR是其环状七肽结构的第二和第四位氨基酸均为精氨酸的微囊藻毒素。微囊藻毒素-RR对于由输尿管阻塞引起肾纤维化的病理发生具有预防和治疗作用。还验证微囊藻毒素-RR干预可改变输尿管阻塞导致的肾组织微环境，抑制肾组织细胞的肌成纤维细胞分化（FMD），产生抗肾纤维化的医疗效果。
Description
本发明属于医药技术领域，具体地说，本发明涉及微囊藻毒素-RR在预防或治疗人类肾纤维化疾病的药物制备中的用途。
慢性肾病（Chronic kidney disease, CKD）是一种严重威胁人类健康和生命的常见疾病，发病率高，在全球不同地区发病率约为7-12%。慢性肾病患者的肾脏结构和功能损害随着时间的推移而逐渐加重，临床治疗手段十分有限，绝大多数病例不可避免地出现以肾纤维化（Renal
fibrosis, RF）为主要病理特征的终末期肾功能衰竭，临床需要终生透析或肾移植以维持生命。
慢性肾病-肾纤维化病因复杂，涉及遗传易感、环境（感染、毒物）及机体内在因素等，其中糖尿病、高血压是其最常见的发病风险因素。无论病因如何，肾纤维化的发生表现出相似的病理过程：炎症，巨噬细胞浸润与炎症因子异常表达，肌成纤维细胞增殖分化，胶原纤维合成、分泌增多，细胞外基质（Extracellular
matrix, ECM）广泛沉积。目前普遍认为，TGF-β/Smad是促进肾纤维发生的重要信号分子，肌成纤维细胞是纤维化形成的主要效应细胞。阻滞TGF-β/Smad信号分子激活、抑制肌成纤维细胞分化是治疗肾纤维化的一个重要策略，但迄今临床尚缺乏令人满意的临床药物。在已报导肾纤维化的模型动物中，单侧输尿管结扎（引起输尿管阻塞）诱导小鼠肾纤维化是研究肾纤维化常规采用的动物模型。
微囊藻毒素（Microcystins，MCs）是由环境淡水生态系统中蓝藻菌产生的一类常见毒素，对机体组织细胞具有毒性作用。环境暴露后，MCs在机体不同组织器官中累积分布差异很大，肾脏和肝脏均属于MCs较高浓度的累积器官。因此，机体MCs暴露常表现为肝、肾毒性。MCs是一环状7肽分子，由蓝藻菌代谢产生。MCs分子的首尾氨基酸连接，形成环状结构。自然界MCs存在多种变异体，不同变异体之间毒性差异很大。环境中已发现的MCs 分子异构体有100余种，其中较大一部分异构体是由于MCs第2和第4位的L-氨基酸不同。最常见且毒性较强之一是Microcystin-LR
(MC-LR)，其第2、第4位氨基酸分别为亮氨酸（Leucine, L）和精氨酸（Arginine,
R）。文献报道的有关MCs的相关研究多以Microcystin-LR为研究对象。
本发明申请者在其前期有关MCs的遗传毒理学研究中偶然发现，Microcystin-LR暴露引起的某些细胞信号分子表达的改变可能被应用于困扰人类的纤维化性疾病的预防和治疗。基于肾组织器官对MCs暴露高度敏感，且Microcystin-LR较高的毒性特征，特别是Microcystin-LR用于肾脏纤维化疾病可能存在的肾组织蓄积高毒性风险，因此亟需研究毒性低，而且能够有效治疗肾脏纤维化疾病的药用分子。
为了解决上述技术问题，本发明基于毒性较小的变异体Microcystin-RR （MC-RR）实施其抗肾纤维化的动物模型实验，其结果表现出良好的干预和治疗效果，且干预剂量的Microcystin-RR在发挥治疗效果的同时未产生可观察的微囊藻毒素关联的毒性效应。基于上述实验结果，本发明公开了Microcystin-RR可用于转化、制备肾组织纤维化性疾病的预防和治疗药物。
本发明研究的Microcystin-RR（MC-RR)，其环状七肽的第二和第四位氨基酸均为精氨酸（R）。Microcystin-LR的第二位氨基酸是亮氨酸（L），属中性氨基酸；Microcystin-RR的第二位是精氨酸（R），属极性（碱性）氨基酸。由于Microcystin-LR与Microcystin-RR组成氨基酸的差异使其所承载的电荷存在差异，将影响Microcystin-LR、Microcystin-RR与其目标分子的相互作用及其效率。毒理学分析结果也显示，Microcystin-RR的毒性较低，仅约为Microcystin-LR的1/10。
本发明提出了Microcystin-RR在预防和治疗肾纤维化疾病中有显著效果。本发明基础的实验结果明确显示，对于输尿管结扎（阻塞）诱导的肾纤维化病理学改变，Microcystin-RR具有有效的医疗作用。本发明的药用Microcystin-RR在输尿管结扎（致使输尿管阻塞）诱导肾纤维化模型小鼠肾组织中，改变肾组织的微环境，阻抑肌成纤维细胞增殖、分化，抑制胶原蛋白合成、分泌，达到阻滞、减轻肾组织细胞外基质（ECM）沉积的效果。
技术方案：本发明提供了微囊藻毒素-RR在制备预防或治疗肾纤维化疾病的药物中的应用。
其中，所述预防或治疗肾纤维化疾病的药物包括但不仅限于单组份或复方制剂。
其中，所述预防或治疗肾纤维化疾病的药物的剂型包括但不仅限于片剂、胶囊、口服液、糖浆、滴丸、注射液剂型或冻干粉针剂型。
其中，所述微囊藻毒素-RR的每日口服给药剂量为5~20μg/kg小鼠。
其中，所述微囊藻毒素-RR用于抑制肌成纤维细胞标记分子Fibronectin和α-SMA蛋白质表达的药物中的用途。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中，抑制肌成纤维细胞标记分子Fibronectin和α-SMA蛋白质表达。
其中，所述微囊藻毒素-RR用于抑制胶原蛋白Ⅰ、TGF-β/p-Smad信号分子、p-AKT蛋白或STAT6蛋白表达的药物中的用途。
其中，所述微囊藻毒素-RR用于改变巨噬细胞分化标记分子CD-206表达的药物中的用途。
其中，所述微囊藻毒素-RR用于恢复肾组织细胞基质金属蛋白酶13表达的药物中的用途。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中降低纤维化主要结构蛋白Collagen
1的含量。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中抑制TGF-β1和p-Smad3的表达，阻抑促进纤维化发生的关键信号通路激活。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中抑制促进纤维化的信号分子p-AKT和STAT6的表达。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中减低M2型巨噬细胞标记分子CD206的表达水平，减少了巨噬细胞的M2型分化。M2型巨噬细胞分泌促进纤维化发生的细胞因子。
具体的，本发明提出的药用微囊藻毒素-RR在输尿管结扎诱导肾纤维化模型小鼠肾组织中恢复基质金属蛋白酶13（MMP13）的蛋白表达。MMP13具有抗纤维化的作用，在肾纤维化的发生中MMP13的表达受到抑制。
本发明构建单侧输尿管结扎/阻塞（Unilateral
ureteral obstruction，UUO）诱导小鼠肾纤维化这一经典动物疾病模型，采用Microcystin-RR进行医疗干预。依据组织病理学，肾纤维化标记蛋白、关键信号分子及肾组织微环境改变的分析结果，首次提出Microcystin-RR可以转化、制备肾组织纤维化性疾病的预防和治疗药物。
本发明构建单侧输尿管结扎（UUO）引起的小鼠肾纤维化动物模型，通过每日灌胃定量给与Microcystin-RR处理。结合组织病理学及器官组织纤维化标记蛋白、关键信号通路分子分析，确定MC-RR对肾纤维化病理发生的预防和治疗的效果。结果显示：Microcystin-RR的灌胃给药可明显减轻和改善由UUO诱导的肾组织纤维化的发生和病理状态。除病理学观察外，这一结果还得到肾组织中纤维化相关标记蛋白分子检测的支持：在Microcystin-RR处理的UUO小鼠肾组织中，病理性纤维化形成的主要效应细胞—肌成纤维细胞的标记分子α-SMA和Fibronectin明显减少，表明肌成纤维细胞分化增殖受到抑制，且纤维化组织主要结构蛋白Collagen
1的含量明显降低。机制研究方面发现，Microcystin-RR处理可明显阻抑肾纤维化发生的关键信号通路TGF-β/smad的激活，表现为Microcystin-RR处理明显减低UUO小鼠肾组织细胞TGF-β1的表达，抑制了Smad3磷酸化（p-Smad3），后者是Smad3的激活形式；同时Microcystin-RR处理可显著抑制肾组织细胞中AKT蛋白激活（p-AKT）和STAT6表达，这两个信号分子均具有促进组织纤维化发生的作用。在组织微环境方面，Microcystin-RR处理可以改变UUO小鼠肾组织中巨噬细胞的分化状态，CD206表达降低（巨噬细胞M2型分化减弱），且恢复了UUO抑制的肾组织细胞基质金属蛋白酶13（MMP13）的表达，这两者关联的肾组织微环境改变均有利于缓解肾组织纤维化的病理状态。
本发明基于MCs毒性较小的变异体Microcystin-RR （MC-RR）实施其抗肾纤维化的动物模型实验，其结果表现出良好的干预和治疗效果，且干预剂量的Microcystin-RR在发挥治疗效果的同时未产生可观察的微囊藻毒素关联的毒性效应。基于上述实验结果，本发明公开了Microcystin-RR可用于转化、制备肾组织纤维化性疾病的预防和治疗药物。
图1、A显示微囊藻毒素-RR（Microcystin-RR）的化学结构，为环状七肽分子。微囊藻毒素的氨基酸变异常发生在其第二和第四氨基酸，Microcystin-RR 的第二、四为氨基酸均为精氨酸（Arginine, R），是微囊藻毒素中毒性较低的变异体。环境水体中最为常见的是微囊藻毒素-LR（Microcystin-LR），其毒性较高。图1B显示Microcystin-RR与Microcystin-LR对体外培养细胞（肝细胞株LO2）增殖活力的毒性检测，结果表明Microcystin-RR的细胞毒性显著低于Microcystin-LR的作用。
图2、Microcystin-LR和Microcystin-RR对输尿管阻塞（UUO）产生肾组织纤维化干预效果的比较；A为Microcystin-LR和Microcystin-RR对UUO小鼠肾组织结构和炎症状态缓解作用比较，显示Microcystin-LR和Microcystin-RR干预均可缓解UUO小鼠肾组织炎症状态和炎性细胞浸润（HE染色×400）；B为Microcystin-LR和Microcystin-RR对UUO小鼠肾组织纤维化病理学状态缓解作用的比较，显示Microcystin-RR干预对UUO诱导小鼠肾组织纤维化的缓解效果较Microcystin-LR的干预效果更为明显（Masson染色×400）；
图3、显示Microcystin-RR（MC-RR）干预的不同实施时间对UUO诱导的肾组织纤维化的缓解效果。A为小鼠UUO建模与MC-RR干预实施方案；B显示，与单纯UUO小鼠比较，Microcystin-RR提前干预（分别为4周、2周，0周）对UUO小鼠肾组织结构和炎症状态的缓解作用（HE染色×400）；C图显示不同时间Microcystin-RR的干预对UUO小鼠肾纤维化病理学状态的预防和治疗作用（Masson染色×400）；Sham operation为假手术组（正常对照）；
图4、显示Microcystin-RR（MC-RR）干预（20μg/kg/day，提前4周）对UUO小鼠肾组织肌成纤维细胞标记分子Fibronectin，α-SMA表达，及肾组织纤维化结构分子Collagen-1 蛋白含量的影响。表明Microcystin-RR对UUO诱导的肾纤维化发生具有抑制作用。
图5、显示不同剂量Microcystin-RR（MC-RR分别为5μg/kg/day，10μg/kg/day，20μg/kg/day）提前4周干预对UUO小鼠肾组织肌成纤维细胞标记分子Fibronectin，α-SMA表达及肾组织纤维化结构分子Collagen-1 蛋白含量的影响。表明Microcystin-RR对UUO诱导的肾纤维化发生具有抑制作用。
图6、显示Microcystin-RR（MC-RR）干预可明显抑制UUO小鼠肾组织TGF-β1，p-Smad3蛋白分子的表达（实验条件同图5）。TGF-β1、p-Smad3信号激活对肾纤维化发生具有重要的促进作用。
图7、显示Microcystin-RR（MC-RR）干预对UUO小鼠肾组织p-AKT，STAT6的表达具有明显抑制作用（实验条件同图5）。p-AKT，STAT6是促进肾纤维化的重要蛋白分子。
图8、显示单纯UUO小鼠发生了纤维化病变的肾组织中CD206（M2型巨噬细胞标记分子）的表达明显高于假手术对照小鼠肾组织（实验条件同图5）。Microcystin-RR（MC-RR）干预明显降低UUO小鼠肾组织CD206的水平，特别是在10μg/kg/day、20μg/kg/day剂量干预小鼠；Microcystin-RR干预对UUO小鼠肾组织的iNOS（M1型巨噬细胞标记分子）分子水平无明显影响，iNOS的表达水平与组织纤维化的发生无明显关联（实验条件同图5）。
图9、显示Microcystin-RR（MC-RR）干预对肾组织细胞MMP13的影响。A，B显示，UUO小鼠肾纤维化组织中MMP13的表达被抑制，Microcystin-RR的干预使UUO小鼠肾纤维化组织中MMP13的表达得以恢复（实验条件同图4）；C，D显示，Microcystin-RR（50nM，100nM）处理可以明显提高体外培养肾小管上皮细胞HK2的MMP13蛋白表达。MMP13具有降解胶原蛋白、抗纤维化的作用。
具体实施方式：
实验动物：采用C57 BL/6雄性小鼠（SPF级），约8周龄（体重20-24g），南京大学模式动物研究所提供。饲养条件：通气良好的20℃恒温控制，进行12小时光照/黑暗交替，饲养提供充足的鼠粮和饮水（小鼠自由摄取）。实验方案得到南京大学实验动物福利伦理委员会批准。
微囊藻毒素-RR购自Alexis
Biochemicals (Lausen, Switzerland)。
单侧输尿管结扎/阻塞（Unilateral
ureteral obstruction, UUO）诱导的小鼠肾纤维化动物模型是国内外学术界针对肾纤维化发生机制、干预分子及治疗药物研究时常用的动物模型。UUO模型构建稳定，组织病理学特征明确，发生机制的认识深入，与人类肾纤维化的分子基础相似。实验采用假手术组小鼠作为正常组织对照。
单侧输尿管结扎/阻塞（UUO）手术：小鼠实施戊巴比妥钠腹腔注射麻醉。处于麻醉状态的小鼠固定于操作板，腹部朝上。对手术部位碘伏消毒，切开并暴露小鼠左侧输尿管，施以结扎左侧输尿管，之后缝合手术创口。
对照小鼠（假手术组）切开皮肤、左侧输尿管暴露片刻，但不施以结扎，即缝合创口。
小鼠实验共实施了3个批次：第一批次实验小鼠共40只，随机分为4组，即对照组（假手术组）、单纯UUO组、Microcystin-LR或Microcystin-RR干预组（每组10只），用于观察Microcystin-LR和Microcystin-RR 对UUO诱导的肾组织纤维化的干预效果并进行比较。Microcystin-LR或Microcystin-RR均于UUO手术之前4周开始干预，灌胃给予，剂量为20μg/kg/day；第二批次实验小鼠共50只，随机分为5组，即对照组、单纯UUO组及三个时间开始的Microcystin-RR干预组（每组10只），用于观察UUO手术之前不同时间（4周、2周）及手术当日开始给予Microcystin-RR对UUO诱导的小鼠肾纤维化的预防和治疗效果。采用灌胃给予Microcystin-RR，剂量为20μg/kg/day；第三批次实验小鼠共25只，随机分为5组，即对照组、单纯UUO组及三个剂量的Microcystin-RR干预组（每组5只），UUO手术之前4周分组开始灌胃给予不同剂量Microcystin-RR，剂量分别为5μg/kg/day，10μg/kg/day和20μg/kg/day。观察Microcystin-RR抗小鼠肾纤维化病理发生的效果。上述三个批次实验的对照小鼠、单纯UUO小鼠在实验过程中同时灌胃给予等体积的生理盐水。
全部实验小鼠于UUO手术7天后处死，留取肾脏及肝脏组织和血清样本。肾组织部分样本采用10%中性甲醛固定，组织病理学检查备用。部分肾组织样本及肝组织样本液氮冷冻保存，用于组织蛋白表达分析，血清样本用于实验室肝功能分析。
Microcystin-RR影响体外培养的上皮间质转化(epithelial-mesenchymal transition, EMT)细胞基质金属蛋白酶13 (MMP13)表达实验：肾小管上皮细胞HK2（购于中国科学院上海细胞库）培养于DMEM-F2培养液，TGF-β1 (5 ng/ml)处理48小时诱导其上皮间质转化（EMT）。加入不同剂量Microcystin-RR(分别为0、10、25、50、100nM)处理已经过TGF-β1诱导的HK2细胞，分析Microcystin-RR对培养细胞MMP13表达的调控作用。
检测数据的统计学分析应用SPSS11.5统计软件处理，采用单因素方差分析(one-way
ANOVA)，
P＜0 .05表示差异具有统计学意义。
具体实施步骤包括：
（1）首先采用体外培养细胞增殖/毒性分析（Cell Counting K-8, CCK-8）技术，对比分析Microcystin-LR和Microcystin-RR的细胞毒性。
（2）针对单侧输尿管结扎（UUO）诱导肾纤维化模型小鼠，（提前4周）分别采用已知高毒性Microcystin-LR和低毒性Microcystin-RR干预处理，对比观察Microcystin-LR和Microcystin-RR缓解肾纤维化的作用（每组10只小鼠）。
（3）采用低毒性Microcystin-RR（MC-RR），对单侧输尿管结扎（Unilateral
ureteral obstruction, UUO）诱导产生的肾纤维化模型小鼠进行进一步的干预和治疗分析。实验工作设计两种方案：
同一种剂量的Microcystin-RR于不同时间针对UUO诱导的肾纤维化小鼠实施干预和治疗（每组10只小鼠）；
选定同一个时间，用不同剂量的Microcystin-RR对UUO诱导的肾纤维化小鼠实施干预，观察、分析Microcystin-RR的抗肾纤维化的作用（每组5只小鼠）。
（4）蛋白质印迹（Western blot）技术分析鉴定Microcystin-RR干预对UUO诱导的小鼠肾纤维化预防和治疗效果的分子基础及其调控机制。Western blot技术：将模型小鼠肾组织加入细胞裂解液后进行研磨，离心后提取上清，抽提蛋白质。在对蛋白浓度定量后加入上样缓冲液（Loading
buffer），然后将检测样品100℃处理5 min后准备电泳分析。提取的蛋白质样品经SDS-聚丙烯酰胺凝胶电泳后，使用PVDF膜湿转移。转移后的PVDF膜经一抗，二抗孵育，使用ECL发光液进行显色分析。
结果显示，低毒性Microcystin-RR对UUO诱导的小鼠肾纤维化具有明显的预防和治疗效果：
1、环境水体中最常见的囊藻毒素变异体为Microcystin-LR，毒性较强，主要表现为肝、肾毒性。本发明涉及的是Microcystin-RR（图1A），毒性较低。选用对微囊藻毒素敏感的肝细胞株（LO2，购于中国科学院上海细胞库）体外培养，Microcystin-RR与Microcystin-LR对体外培养LO2细胞增殖活力的毒性检测结果表明，Microcystin-RR的细胞毒性显著低于Microcystin-LR（图1B），*
P<0.05。
2、关于Microcystin-LR和Microcystin-RR对输尿管阻塞（UUO）产生肾组织纤维化干预效果的比较。图2A显示对UUO小鼠肾组织结构和炎症状态缓解作用比较（HE染色×400）；图2B显示对UUO小鼠肾组织纤维化病理学状态缓解作用的比较（Masson染色×400）。结果表明：Microcystin-LR和Microcystin-RR均可显著缓解输尿管阻塞（UUO）诱导的肾组织纤维化。在组织病理学上，Microcystin-RR干预小鼠肾组织Masson染色显示的纤维化缓解效果较Microcystin-LR干预小鼠更为明显（图2）。
3、针对UUO肾纤维化模型小鼠，于UUO手术的不同时期（手术前4周、前2周及手术当日）开始给予Microcystin-RR（20μg/kg/day）干预。肾组织病理学结果显示，不同时期始动的Microcystin-RR干预均产生了缓解UUO诱导的小鼠肾纤维化效果，其中提前干预2周和提前4周实施干预的小鼠肾纤维化的缓解效果更为显著（图3）。
4、蛋白质印迹技术（Western blot）检测实验小鼠肾组织的结果显示，手术前的Microcystin-RR干预可明显降低UUO诱导肾纤维化小鼠肾组织中Fibronectin、α-SMA和Collagen-1的表达。Fibronectin和α-SMA是肾纤维化效应细胞—肌成纤维细胞的标记分子；Collagen-1是肾纤维化的结构蛋白（图4）。结果表明，UUO术前Microcystin-RR干预均能够抑制肾组织纤维化效应细胞-肌成纤维细胞的增殖与分化，且抑制肌成纤维细胞Collagen-1的表达与分泌。
# UUO组与假手术（对照）组比较，
P<0.01；*Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05。
5、Western blot技术检测UUO小鼠肾组织显示，手术前不同剂量的Microcystin-RR干预可明显降低UUO诱导肾纤维化小鼠肾组织中Fibronectin、α-SMA和Collagen-1的表达。Fibronectin和α-SMA是肾纤维化效应细胞-肌成纤维细胞的标记分子；Collagen-1是肾纤维化的结构蛋白（图5）。结果表明，UUO术前三个不同剂量的Microcystin-RR干预均能够抑制肾组织纤维化效应细胞-肌成纤维细胞的增殖与分化，且抑制肌成纤维细胞Collagen-1的表达与分泌。
#UUO组与假手术（对照）比较，
P<0.01；*Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05。
6、Western blot技术检测UUO小鼠肾组织显示，手术前不同剂量的Microcystin-RR干预可明显抑制UUO诱导肾纤维化小鼠肾组织中TGF-β1和p-Smad3表达，其中20 μg/kg/day 的Microcystin-RR干预抑制效果最为显著。TGF-β1、p-Smad3是肾纤维化发生信号通路激活的关键分子（图6）。
#UUO组与假手术（对照）比较，
P<0.01；*Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.01。
7、Western blot技术检测UUO小鼠肾组织显示，手术前不同剂量的Microcystin-RR干预可明显抑制UUO诱导肾纤维化小鼠肾组织中p-AKT和STAT6的表达，其中20 μg/kg/day 的Microcystin-RR干预抑制效果最为明显。p-AKT和STAT6是促进肾纤维化的重要蛋白分子（图7）。
#UUO组与假手术（对照）比较，
P<0.01；*p-AKT蛋白水平在不同剂量Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05。*STAT6蛋白的表达水平在5μg/kg/day的Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05；在10μg/kg/day，20μg/kg/day的Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.01。
8、Western blot技术检测UUO小鼠肾组织显示，手术前不同剂量的Microcystin-RR干预可明显降低UUO诱导肾纤维化小鼠肾组织中M2型巨噬细胞标记分子CD206的水平，其中以10μg/kg/day和20μg/kg/day的剂量干预效果显著，
#UUO组与假手术（对照）比较，
P<0.01；*5μg/kg/day的Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05；10μg/kg/day及20μg/kg/day的Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.01。M2型巨噬细胞可分泌促肾纤维化的细胞因子。Microcystin-RR的干预对肾组织中M1型巨噬细胞标记分子iNOS水平无明显影响，UUO组的 iNOS水平低于假手术（对照组），
P<0.05，Microcystin-RR干预小鼠与单纯UUO组比较无显著差异（图8）。
9、Western blot技术检测UUO小鼠肾组织显示，手术前Microcystin-RR干预可明显恢复UUO小鼠肾纤维化组织中被抑制的MMP13的表达（图9A，B）。
#UUO组与假手术（对照）比较，
P<0.01，*Microcystin-RR干预小鼠与单纯UUO组比较，
P<0.05；Microcystin-RR（50nM，100nM）处理体外培养肾小管上皮细胞HK2，明显提高了HK2细胞的MMP13蛋白表达（图9C，D），*50nM、100nM的Microcystin-RR处理细胞与无Microcystin-RR（0nM）处理细胞之间的比较，
P<0.05。MMP13具有降解胶原蛋白、抗纤维化的作用。
10、实验小鼠的血清生化检测显示，Microcystin-RR不同时间开始干预（MC-RR-4w、MC-RR-2w、MC-RR-0w分别表示手术前4周、前2周及手术当日开始干预）的UUO小鼠血清谷丙转氨酶（ALT）、谷草转氨酶（AST）及血清总蛋白（TP）含量与对照小鼠、单纯UUO诱导肾纤维化小鼠之间无明显差异（肝功能指标正常）。表明本发明中Microcystin-RR的使用对模型小鼠未产生可观察的肝脏毒性作用（表1）。
Claims (8)
- 微囊藻毒素-RR在制备预防或治疗肾纤维化疾病的药物中的用途。
- 根据权利要求1所述的用途，其特征在于，所述预防或治疗肾纤维化疾病的药物为单组份或复方制剂。
- 根据权利要求1所述的用途，其特征在于，所述预防或治疗肾纤维化疾病的药物的剂型为片剂、胶囊、口服液、糖浆、滴丸、注射液剂型或冻干粉针剂型。
- 根据权利要求1～3任一项所述的用途，其特征在于，所述微囊藻毒素-RR的每日口服给药剂量为5~20μg/kg小鼠。
- 根据权利要求1～3任一项所述的用途，其特征在于，所述微囊藻毒素-RR用于抑制肌成纤维细胞标记分子Fibronectin和α-SMA蛋白质表达的药物中的用途。
- 根据权利要求1～3任一项所述的用途，其特征在于，所述微囊藻毒素-RR用于抑制胶原蛋白Ⅰ、TGF-β/p-Smad信号分子、p-AKT蛋白或STAT6蛋白表达的药物中的用途。
- 根据权利要求1～3任一项所述的用途，其特征在于，所述微囊藻毒素-RR用于改变巨噬细胞分化标记分子CD-206表达的药物中的用途。
- 根据权利要求1～3任一项所述的用途，其特征在于，所述微囊藻毒素-RR用于恢复肾组织细胞基质金属蛋白酶13表达的药物中的用途。
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