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Том 17 №2 2015 год - Нефрология и диализ

Митохондриально-направленные подходы в терапии острого повреждения почек

Янкаускас С.С. Плотников Е.Ю. Зорова Л.Д. Попков В.А. Певзнер И.Б. Бабенко В.А. Адрианова Н.В. Зоров С.Д. Силачёв Д.Н. Зоров Д.Б.

Аннотация: Экспериментальные работы последних десяти лет накопили достаточное количество фактов, убедительно показывающих, что митохондрии играют ключевую роль в развитии острого повреждения почек (ОПП) при воздействии различных повреждающих агентов, включающих ишемию/реперфузию, миоглобинурию, эндотоксемический шок и нефротоксичные препараты. Во всех перечисленных случаях происходит нарушение нормального функционирования митохондрий почки, одним из основных последствий которого становится чрезмерная продукция активных форм кислорода (АФК), в основном производящихся в дыхательной цепи митохондрий. Развивающийся окислительный стресс нарушает или изменяет целый ряд внутриклеточных процессов, в результате чего падает эффективность работы канальцевого эпителия и изменяется реактивность почечных сосудов. При большей выраженности митохондриальной дисфункции развивается гибель клеток, ведущая к уменьшению количества действующих нефронов. В данном обзоре рассматриваются новые подходы к лечению ОПП, направленные на митохондриальные процессы. Первый из них заключается в использовании нового типа антиоксидантов, сконструированных таким образом, чтобы избирательно накапливаться в митохондриях клеток. Экспериментальные данные показывают, что достижение высоких концентраций антиоксидантных соединений в этих органеллах позволяет остановить цепочку деструктивных событий при моделировании ОПП и, как следствие, сохранить функцию почки. Вторая стратегия - умеренное разобщение дыхания митохондрий и окислительного фосфорилирования - изменяет работу дыхательной цепи таким образом, что уменьшает её способность к образованию кислородных радикалов. Третий подход связан не с уменьшением количества АФК, а с активацией эндогенных механизмов толерантности к окислительному стрессу путём «тренировки» органа короткими периодами ишемии. Пульсы АФК, образуемые дыхательной цепью митохондрии в эти периоды, активируют сигнальные пути, которые делают органеллу более устойчивой к условиям, в которых генерируется много АФК. Целый ряд фармакологических агентов способен активировать данные сигнальные пути и уменьшать тяжесть ОПП в экспериментах на животных.

Для цитирования: Янкаускас С.С., Плотников Е.Ю., Зорова Л.Д., Попков В.А., Певзнер И.Б., Бабенко В.А., Адрианова Н.В., Зоров С.Д., Силачёв Д.Н., Зоров Д.Б. Митохондриально-направленные подходы в терапии острого повреждения почек. Нефрология и диализ. 2015. 17(2):143-155. doi:

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Ключевые слова: острое повреждение почек, нефротоксичность, митохондрия, окислительный стресс, прекондиционирование, антиоксиданты, cute kidney injury, nephrotoxicity, mitochondria, oxidative stress, preconditioning, antioxidants

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