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Am J Physiol Renal Physiol (February 27, 2008). doi:10.1152/ajprenal.00461.2007
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Submitted on October 5, 2007
Accepted on February 25, 2008

Chloroquine and inhibition of Toll-like receptor 9 protect from sepsis-induced acute kidney injury

Hideo Yasuda1, Asada Leelahavanichkul1, Shinichiro Tsunoda2, James W. Dear1, Yoshiyuki Takahashi3, Shuichi Ito2, Xuzhen Hu1, Hua Zhou1, Kent Doi1, Richard W. Childs3, Dennis M. Klinman2, Peter S.T. Yuen1*, and Robert A. Star1

1 NIDDK, NIH, Bethesda, Maryland, United States
2 NCI, NIH, Frederick, Maryland, United States
3 NHLBI, NIH, Bethesda, Maryland, United States

* To whom correspondence should be addressed. E-mail: py{at}nih.gov.

Mortality from sepsis has remained high despite recent advances in supportive and targeted therapies. Toll-like receptors (TLRs) sense bacterial products and stimulate pathogenic innate immune responses. Mice deficient in the common adapter protein MyD88, downstream from most TLRs, have reduced mortality and acute kidney injury (AKI) from polymicrobial sepsis. However, the identity of the TLR(s) responsible for the host response to polymicrobial sepsis is unknown. Here, we show that chloroquine, an inhibitor of endocytic TLRs (TLR3, 7, 8, 9), improves sepsis-induced mortality and acute kidney injury in a clinically relevant polymicrobial sepsis mouse model, even when administered 6h after the septic insult. Chloroquine administration attenuated the decline in renal function, splenic apoptosis, serum markers of damage to other organs, and prototypical serum pro- and anti-inflammatory cytokines TNF-{alpha} and IL-10. An oligodeoxynucleotide inhibitor (H154) of TLR9 and TLR9-deficient mice mirror the actions of chloroquine in all functional parameters that we tested. In addition, chloroquine decreased TLR9 protein abundance in spleen, further suggesting that TLR9 signaling may be a major target for the protective actions of chloroquine. Our findings indicate that chloroquine improves survival by inhibiting multiple pathways leading to polymicrobial sepsis, and that chloroquine and TLR9 inhibitors represent viable broad-spectrum and targeted therapeutic strategies, respectively, that are promising candidates for further clinical development.




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