4.7 Article

Indoleamine 2,3-dioxygenase-1, a Novel Therapeutic Target for Post-Vascular Injury Thrombosis in CKD

Journal

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 32, Issue 11, Pages 2834-2850

Publisher

AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2020091310

Keywords

cardiovascular disease; cell signaling; thrombosis; uremic toxins; indoxyl sulfate; kynurenine; IDO1; uremic toxicity; arteriovenous fistula

Funding

  1. National Cancer Institute [R01CA175382]
  2. NIH [R01 HL132325, R01HL080442]
  3. Evans Faculty Merit award
  4. NHLBI [R01HL136363]
  5. American Heart Association CAT-HD Center [857078]
  6. T32 training grant in cardiovascular biology [T32 HL007224-40]
  7. T32 training grant in immunobiology of trauma [T32 GM08630806A1]
  8. Thrombosis to Hemostasis in Health and Disease Affinity Research Collaborative (Boston University, Evans Center For Interdisciplinary Biomedical Research)

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The study found that patients with chronic kidney disease are at increased risk of thrombosis after vascular injury, with indoleamine 2,3-dioxygenase-1 (IDO-1) playing a key role in this process. Inhibiting IDO-1 expression can reduce tissue factor expression in blood vessels, thereby reducing the risk of thrombosis.
Background CKD, characterized by retained uremic solutes, is a strong and independent risk factor for thrombosis after vascular procedures . Urem ic solutes such as indoxyl sulfate (IS) and kynurenine (Kyn) mediate prothrombotic effect through tissue factor (TF). IS and Kyn biogenesis depends on multiple enzymes, with therapeutic implications unexplored. We examined the role of indoleamine 2,3-dioxygenase-1 (IDO-1), a rate-limiting enzyme of kynurenine biogenesis, in CKD-associated thrombosis after vascular injury. Methods IDO-1 expression in mice and human vessels was examined. IDO-1(-/-) mice, IDO-1 inhibitors, an adenine-induced CKD, and carotid artery injury models were used. Results Both global IDO-1(-/-) CKD mice and IDO-1 inhibitor in wild-type CKD mice showed reduced blood Kyn levels, TF expression in their arteries, and thrombogenicity compared with respective controls. Several advanced IDO-1 inhibitors downregulated TF expression in primary human aortic vascular smooth muscle cells specifically in response to uremic serum. Further mechanistic probing of arteries from an IS-specific mouse model, and CKD mice, showed upregulation of IDO-1 protein, which was due to inhibition of its polyubiquitination and degradation by IS in vascular smooth muscle cells. In two cohorts of patients with advanced CKD, blood IDO-1 activity was significantly higher in sera of study participants who subsequently developed thrombosis after endovascular interventions or vascular surgery. Conclusion Leveraging genetic and pharmacologic manipulation in experimental models and data from human studies implicate IS as an inducer of IDO-1 and a perpetuator of the thrombotic milieu and supports IDO-1 as an antithrombotic target in CKD.

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