Current Opinion in Toxicology最新文献

Botanicals can cause nephrotoxicity via numerous mechanisms, including disrupting renal blood flow, damaging compartments along the nephron, and obstructing urinary flow. While uncommon, there are various reports of botanical-induced nephrotoxicity in the literature, such as from aristolochia (Aristolochia spp.) and rhubarb (Rheum spp.). However, at present, it is a challenge to assess the toxic potential of botanicals because their chemical composition is variable due to factors such as growing conditions and extraction techniques. Therefore, selecting a single representative sample for an in vivo study is difficult. Given the increasing use of botanicals as dietary supplements and herbal medicine, new approach methodologies (NAMs) are needed to evaluate the potential for renal toxicity to ensure public safety. Such approaches include in vitro models that use layers of physiological complexity to emulate the in vivo microenvironment, enhance the functional viability and differentiation of cell cultures, and improve sensitivity to nephrotoxic insults. Furthermore, computational tools such as physiologically based pharmacokinetic (PBPK) modeling can add confidence to these tools by simulating absorption, distribution, metabolism, and excretion. The development and implementation of NAMs for renal toxicity testing will allow specific mechanistic data to be generated, leading to a better understanding of the nephrotoxic potential of botanicals.

Flame retardants are high production volume chemicals that are environmentally persistent and detected in humans. These compounds are known hepatotoxicants and endocrine disruptors; however, studies linking flame retardant exposure to chronic kidney disease and impaired renal function indicate the kidneys may be at greater risk than previously assumed. Here, we outline the current state of knowledge regarding the toxic effects of two major classes of flame retardants: brominated flame retardants and organophosphate flame retardants on the kidney, and discuss several important considerations in flame retardant structure and toxicity evaluation. As flame retardant exposure continues to rise, further studies regarding the direct and indirect mechanisms of nephrotoxicity are urgently needed.

Cadmium (Cd) is a widespread toxic pollutant that affects millions of individuals worldwide. Cd exposure in humans occurs primarily through consumption of contaminated food and water, cigarette smoking, and industrial applications. The kidney proximal tubular (PT) epithelial cells are the primary target of Cd toxicity. Cd-induced injury to PT cells impedes tubular reabsorption. Despite the many long-term sequelae of Cd exposure, molecular mechanisms of Cd toxicity are poorly understood, and no specific therapies exist to mitigate the effects of Cd exposure. In this review, we summarize recent work linking Cd-mediated damage to epigenetic perturbations — DNA methylation, and levels of histone modifications, including methylation and acetylation. New insights into the links between Cd intoxication and epigenetic damage will contribute to an improved understanding of Cd's pleiotropic impacts on cells, and perhaps lead to new, mechanism-based treatments for this condition.

Nanotechnology-enabled drug delivery strategies have made significant advances in recent years. While there are many potential applications for nanotechnology-enabled drug delivery, their role in kidney-related conditions is especially significant. Innovations in chemistry have allowed for the creation of nano-sized delivery strategies. Nanoparticles, particles in the 1–100 nm range, can be used to effectively introduce drugs into the body where they last long enough to elicit therapeutic action before leaving the system in fragments through the kidney. We discuss recent advances in nano-encapsulation strategies to circumvent drug-induced kidney injury and targeted nanomedicines to treat kidney diseases.

Immunotherapy has transformed the landscape of cancer treatment. The goal of immunotherapy is to boost host-protective anti-tumor immunity. Immune checkpoint inhibitor and chimeric antigen receptor T cell (CAR-T cell) therapy have revolutionized cancer care. However, immunotherapies can cause multiorgan dysfunction including acute kidney injury (AKI). Acute tubulointerstitial nephritis (ATIN), the most common cause of AKI associated with immune checkpoint inhibitors, is caused by the overactivation of the immune system due to cytotoxic T lymphocyte-associated antigen 4 and programmed cell death receptor 1/programmed cell death ligand 1 inhibition. Early institution of corticosteroids improves kidney outcomes in immune checkpoint inhibitor-associated ATIN. CAR-T therapy can also cause AKI, and the underlying mechanism for AKI is predominantly hemodynamic, leading to poor renal perfusion. CAR-T therapy-associated AKI tends to be mild and generally reversible with hemodynamic support. Several electrolyte abnormalities have also been reported with immunotherapies. Immunotherapies are highly effective, but their use can be associated with renal toxicities. Prompt recognition and management of renal toxicities are essential in improving outcomes. Future studies are needed to shed light on the pathogenesis and management of immunotherapy-related renal injury.

The kidneys are responsible for maintaining physiologic homeostasis. The kidneys clear a variety of drugs and other substances through passive (filtration) and active processes that utilize transport proteins. Renal clearance is comprised of the processes of glomerular filtration, tubular secretion, and tubular reabsorption. Endogenous biomarkers, such as creatinine and cystatin C, are routinely used to estimate renal clearance. Understanding the contributing components of renal function and clearance, through the use of biomarkers, is necessary in elucidating the renal pharmacology of drugs and other substances. While exogenous markers of kidney function have been known for decades, several complexities have limited their usage. Several endogenous markers are being evaluated and hold promise to elucidate the individual components of kidney function that represent filtration, secretion, and reabsorption.

Since the advent of e-cigarettes (e-cigs) as alternatives to conventional cigarette smoking, there has been a dramatic increase in their use especially among adolescents and young adults. Vaping aerosols produced by e-cigs contain a variety of toxic and carcinogenic compounds, such as volatile organic compounds (VOCs), formaldehyde and acrolein, and metals including lead and nickel. General health effects of e-cig use range from respiratory health issues, hypertension and cardiovascular disease, as well as gastrointestinal problems and cognitive and nervous system decline. Unfortunately, there remains very limited information about e-cig use and its association with renal health, despite the fact that chronic kidney disease (CKD) affects about 37 million Americans. It has been reported that cigarette smoking causes the progression of CKD, and that nicotine, a constituent of both conventional cigarettes and e-cig devices, causes renal toxicity by promoting inflammation and injury through oxidative stress-mediated pathways. This contemporary review will discuss the results of current epidemiological and experimental toxicology literature (2016–2022), as well as possible mechanisms of e-cig-induced renal injury.

The global prevalence of chronic liver disease (CLD) is a major public health concern due to its ability to alter the predicted pharmacokinetics of xenobiotics, which may lead to nephrotoxicity. CLD etiologies include nonalcoholic steatohepatitis (NASH), alcohol-associated liver disease (ALD), and viral hepatitis, which cause a disruption in drug disposition and elimination through hepatic dysfunction, including expression changes in drug metabolizing enzymes and transporters. While altered drug metabolizing enzymes are of critical consideration for xenobiotic disposition in CLD patients, this review will focus on membrane transporters. This altered disposition may lead to an increase in plasma retention, a decrease in biliary excretion, and result in an increase in systemic exposure to nephrotoxic compounds. Additionally, CLD can elicit changes in renal physiology, such as decreased glomerular filtration rate, further influencing the elimination mechanism of xenobiotics. Investigating the variations in pharmacokinetic profiles of nephrotoxicants because of alterations in hepatic and renal elimination processes in CLD patients is critical for the prevention of adverse drug reactions and improvement of patient outcomes.