Kidney Res Clin Pract.  2012 Mar;31(1):4-11.

Smads as therapeutic targets for chronic kidney disease

• Lan HY

Abstract

Renal fibrosis is a hallmark of chronic kidney disease (CKD). It is generally thought that transforming growth factor-beta1 (TGF-beta1) is a key mediator of fibrosis and mediates renal scarring positively by Smad2 and Smad3, but negatively by Smad7. Our recent studies found that in CKD, TGF-beta1 is not a sole molecule to activate Smads. Many mediators such as angiotensin II and advanced glycation end products can also activate Smads via both TGF-beta-dependent and independent mechanisms. In addition, Smads can interact with other signaling pathways, such as the mitogen-activated protein kinase and nuclear factor-kappaB (NF-kappaB) pathways, to regulate renal inflammation and fibrosis. In CKD, Smad2 and Smad3 are highly activated, while Smad7 is reduced or lost. In the context of fibrosis, Smad3 is pathogenic and mediates renal fibrosis by upregulating miR-21 and miR-192, but down-regulating miR-29 and miR-200 families. By contrast, Smad2 and Smad7 are protective. Overexpression of Smad7 inhibits both Smad3-mediated renal fibrosis and NF-kappaB-driven renal inflammation. Interestingly, Smad4 has diverse roles in renal fibrosis and inflammation. The complexity and distinct roles of individual Smads in CKD suggest that treatment of CKD should aim to correct the imbalance of Smad signaling or target the Smad3-dependent genes related to fibrosis, rather than to block the general effect of TGF-beta1. Thus, treatment of CKD by overexpression of Smad7 or targeting Smad3-dependent miRNAs such as downregulation of miR-21 or overexpression of miR-29 may represent novel therapeutic strategies for CKD.

Keyword

Chronic kidney disease; Fibrosis; Gene therapy; Inflammation; MicroRNA; TGF-beta/Smads

MeSH Terms

Angiotensin II
Cicatrix
Down-Regulation
Fibrosis
Genetic Therapy
Glycosylation End Products, Advanced
Humans
Inflammation
MicroRNAs
Protein Kinases
Renal Insufficiency, Chronic
Transforming Growth Factor beta1
Angiotensin II
Glycosylation End Products, Advanced
MicroRNAs
Protein Kinases
Transforming Growth Factor beta1