Background
Renal ischemia–reperfusion injury (RIRI) is a major cause of perioperative acute kidney injury and a driver of chronic kidney disease, in which mitochondrial dysfunction and inflammatory activation create a vicious cycle of oxidative stress, inflammation, and tubular cell death. Puerarin, a natural isoflavone with established cardio- and neuroprotective effects, has not been fully evaluated as a modulator of the mitochondrial–immune axis in RIRI.
Methods
Network pharmacology and RNA sequencing of mouse kidneys with bilateral RIRI were integrated to identify shared puerarin–RIRI targets and enriched pathways. Molecular docking and 100-ns molecular dynamics simulations were performed to assess puerarin–PI3K binding. In vivo, C57BL/6 mice underwent 45-min bilateral renal ischemia and 24-h reperfusion with or without puerarin pretreatment and/or the PI3K inhibitor LY294002. In vitro, HK-2 cells were subjected to hypoxia/reoxygenation. Renal injury, apoptosis, oxidative stress, inflammatory cytokines, mitochondrial ultrastructure, membrane potential, and mitochondrial dynamics proteins (Drp1, Opa1, Mfn2) were evaluated.
Results
Network pharmacology and transcriptomics consistently pointed to the PI3K/AKT/NF-κB pathway, which was enriched in oxidative stress, apoptosis, inflammatory signaling, and mitochondrial processes. In both RIRI mice and HR-treated HK-2 cells, puerarin improved renal histology and function, reduced tubular apoptosis and IL-6/IL-1β/TNF-α levels, restored SOD and GSH-Px, lowered ROS and MDA, and preserved mitochondrial membrane potential and ultrastructure. These benefits were accompanied by activation of PI3K/AKT signaling and attenuation of NF-κB, together with normalization of mitochondrial fission–fusion (decreased Drp1, increased Opa1/Mfn2), whereas LY294002 markedly blunted puerarin-induced improvements in mitochondrial dynamics, membrane potential, and injury indices.
Conclusion
Puerarin ameliorates RIRI by activating PI3K/AKT signaling, restoring mitochondrial homeostasis, and attenuating NF-κB–linked inflammatory and apoptotic responses. These findings support puerarin as a mitochondria- and immune-targeted candidate for perioperative renal protection and justify further translational evaluation.
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