Sex Difference in Renal Injury After Cardiac Arrest:Mechanisms of Estrogen Action

描述(申请人提供)：急性肾损伤(AKI)是一种无法治疗的，经常是致命的疾病，在危重病人中很常见。Aki在男性中更常见，也比女性更严重，这表明性行为代表着一种干预机会。对AKI的研究最近突出了内皮细胞。雌激素是一种内皮保护剂。这项建议验证了女性免受AKI影响的假设，部分原因是雌激素保护肾内皮细胞，保护整体肾功能。目的1确定心脏骤停心肺复苏(CA/CPR)后肾小球内皮细胞和肾功能损害是否具有性别二型性，并由雌激素介导。需要检验的假设是，在CA/CPR后，雌激素对两性的肾小球和肾小管功能都有保护作用。目标2将侧重于分子机制。需要检验的假设是，雌激素可以减轻肾小球内皮功能的变化，这些变化可能会损害近端肾小管上皮细胞。AIM 3将使用分子超声在活体模型中评估AIM 2的结果。需要检验的假设是，女性对CA/CPR的肾脏保护作用是因为雌激素增强了肾脏内皮的完整性。这些假说将使用CA/CPR的活体小鼠模型进行验证，在该模型中，小鼠接受10分钟的CA然后进行CPR。目标1在多个时间点评估肾脏结果。目标2将在体外模型中进行，使用小鼠肾小球内皮细胞和小鼠近端肾小管上皮细胞。肾小球内皮细胞暴露在缺氧/缺糖的环境中，与雌激素、雌激素受体拮抗剂及相关药物相结合。将评估肾小球内皮细胞通透性和缺氧-葡萄糖剥夺的肾小球内皮细胞对肾小管上皮细胞的影响。目的3利用分子超声结合抗体标记的微泡造影剂评价CA/CPR术后小鼠的肾内皮细胞。我们的初步数据表明，雌激素在CA/CPR后具有肾脏保护作用，这可能是通过G蛋白偶联的雌激素受体GPRR30实现的。我们还发现CA/CPR后肾小球内皮细胞的通透性发生改变，这些细胞在体外受到雌激素的保护。AKI在危重病人中极为常见，死亡率高达70%。这项研究的基础是观察到女性受到的影响较小。已经对AKI进行了重要的研究，但结果没有有意义的变化，但这项新的研究提供了一种新的方法。

DESCRIPTION (provided by applicant): Acute kidney injury (AKI) is an untreatable, frequently lethal malady which is common in the critically ill. AKI is more common and more severe in men than women, suggesting sex represents an opportunity for intervention. Investigation of AKI has recently highlighted endothelial cells. Estrogen is an endothelial protectant. This proposal tests the hypothesis that females are protected from AKI in part because estrogen protects renal endothelium, preserving overall renal function. Aim 1 will determine whether glomerular endothelial and renal functional injury after cardiac arrest and cardiopulmonary resuscitation (CA/CPR) is sexually dimorphic and mediated by estrogen. The hypothesis to be tested is that estrogen protects glomerular and tubular function in both sexes after CA/CPR. Aim 2 will focus on molecular mechanisms. The hypothesis to be tested is that estrogen attenuates glomerular endothelial functional changes which may damage proximal tubular epithelial cells. Aim 3 will use molecular ultrasound to evaluate the findings of aim 2 in an in vivo model. The hypothesis to be tested is that female renoprotection from CA/CPR occurs because estrogen augments renal endothelial integrity. These hypotheses will be tested using an in vivo mouse model of CA/CPR in which mice undergo 10 minutes of CA followed by CPR. Renal outcomes are assessed at multiple time points in aim 1. Aim 2 will be conducted in an in vitro model, using mouse glomerular endothelial cells and mouse proximal tubular epithelial cells. Gomerular endothelial cells are exposed to oxygen/glucose deprivation, in combination with estrogen, estrogen receptor antagonists, and related agents. Glomerular endothelial permeability and the effect of oxygen-glucose deprived glomerular endothelial cells on tubular epithelial cells will be assessed. Aim 3 will use molecular ultrasound with antibody-tagged microbubble contrast to assess renal endothelium in post-CA/CPR mice. Our preliminary data indicate that estrogen is renoprotective after CA/CPR, and that this may be through the G protein-coupled estrogen receptor GPRR30. We have also shown that glomerular endothelial permeability is altered after CA/CPR, and that these cells are protected by estrogen in vitro. AKI is extremely common in critically ill patients and has up to 70% mortality. This research is based on the observation that females are less affected. Significant research has been performed on AKI without meaningful change in outcome, but this novel research offers a new approach.