Glycolytic lactate in diabetic kidney disease
Manjula Darshi, Luxcia Kugathasan, Soumya Maity, Vikas S. Sridhar, Roman Fernandez, Christine P. Limonte, Brian I. Grajeda, Afaf Saliba, Guanshi Zhang, Viktor R. Drel, Jiwan J. Kim, Richard Montellano, Jana Tumova, Daniel Montemayor, Zhu Wang, Jian-Jun Liu, Jiexun Wang, Bruce A. Perkins, Yuliya Lytvyn, Loki Natarajan, Su Chi Lim, Harold Feldman, Robert Toto, John R. Sedor, Jiten Patel, Sushrut S. Waikar, Julia Brown, Yahya Osman, Jiang He, Jing Chen, W. Brian Reeves, Ian H. de Boer, Sourav Roy, Volker Vallon, Stein Hallan, Jonathan A.L. Gelfond, David Z.I. Cherney, Kumar Sharma, for the Kidney Precision Medicine Project, and the CRIC Study Investigators
Manjula Darshi, Luxcia Kugathasan, Soumya Maity, Vikas S. Sridhar, Roman Fernandez, Christine P. Limonte, Brian I. Grajeda, Afaf Saliba, Guanshi Zhang, Viktor R. Drel, Jiwan J. Kim, Richard Montellano, Jana Tumova, Daniel Montemayor, Zhu Wang, Jian-Jun Liu, Jiexun Wang, Bruce A. Perkins, Yuliya Lytvyn, Loki Natarajan, Su Chi Lim, Harold Feldman, Robert Toto, John R. Sedor, Jiten Patel, Sushrut S. Waikar, Julia Brown, Yahya Osman, Jiang He, Jing Chen, W. Brian Reeves, Ian H. de Boer, Sourav Roy, Volker Vallon, Stein Hallan, Jonathan A.L. Gelfond, David Z.I. Cherney, Kumar Sharma, for the Kidney Precision Medicine Project, and the CRIC Study Investigators
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Research Article Nephrology

Glycolytic lactate in diabetic kidney disease

Abstract

Lactate elevation is a well-characterized biomarker of mitochondrial dysfunction, but its role in diabetic kidney disease (DKD) is not well defined. Urine lactate was measured in patients with type 2 diabetes (T2D) in 3 cohorts (HUNT3, SMART2D, CRIC). Urine and plasma lactate were measured during euglycemic and hyperglycemic clamps in participants with type 1 diabetes (T1D). Patients in the HUNT3 cohort with DKD had elevated urine lactate levels compared with age- and sex-matched controls. In patients in the SMART2D and CRIC cohorts, the third tertile of urine lactate/creatinine was associated with more rapid estimated glomerular filtration rate decline, relative to first tertile. Patients with T1D demonstrated a strong association between glucose and lactate in both plasma and urine. Glucose-stimulated lactate likely derives in part from proximal tubular cells, since lactate production was attenuated with sodium-glucose cotransporter-2 (SGLT2) inhibition in kidney sections and in SGLT2-deficient mice. Several glycolytic genes were elevated in human diabetic proximal tubules. Lactate levels above 2.5 mM potently inhibited mitochondrial oxidative phosphorylation in human proximal tubule (HK2) cells. We conclude that increased lactate production under diabetic conditions can contribute to mitochondrial dysfunction and become a feed-forward component to DKD pathogenesis.

Authors

Manjula Darshi, Luxcia Kugathasan, Soumya Maity, Vikas S. Sridhar, Roman Fernandez, Christine P. Limonte, Brian I. Grajeda, Afaf Saliba, Guanshi Zhang, Viktor R. Drel, Jiwan J. Kim, Richard Montellano, Jana Tumova, Daniel Montemayor, Zhu Wang, Jian-Jun Liu, Jiexun Wang, Bruce A. Perkins, Yuliya Lytvyn, Loki Natarajan, Su Chi Lim, Harold Feldman, Robert Toto, John R. Sedor, Jiten Patel, Sushrut S. Waikar, Julia Brown, Yahya Osman, Jiang He, Jing Chen, W. Brian Reeves, Ian H. de Boer, Sourav Roy, Volker Vallon, Stein Hallan, Jonathan A.L. Gelfond, David Z.I. Cherney, Kumar Sharma, for the Kidney Precision Medicine Project, and the CRIC Study Investigators

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Figure 6

ATP production and intracellular lactate accumulation in isolated kidney sections.

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ATP production and intracellular lactate accumulation in isolated kidney...
(A–C) Kidney sections (n = 5–6 each group) from 10- to 12-week-old male C57BL/6J mice were incubated with normal glucose (NG) and high glucose (HG) for 24 hours to measure the ATP level (A), extracellular lactate (B), and intracellular lactate (C). (D) The ATP level negatively correlates with intracellular lactate (n = 10). Two-tailed t test in A–C and simple linear regression analysis in D using the Pearson’s correlation coefficient were performed for the statistical analyses. Data represent mean ± SD.