GIP/GLP-1 DUAL AGONIST TIRZEPATIDE AMELIORATES RENAL ISCHEMIA/REPERFUSION DAMAGE IN RATS

Authors

  • GHADA A. ALKHAFAJI Pharmacy Department, Babylon Directorate of Health, Babel, Iraq
  • ALI M. JANABI Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Kufa, Najaf, Iraq https://orcid.org/0000-0002-8569-7964

DOI:

https://doi.org/10.22159/ijap.2025v17i2.53156

Keywords:

Renal ischemia/reperfusion, Tirzepatide, Acute renal damage, Caspase-3, Akt, LC3-B, GSH

Abstract

Objective: Renal Ischemia/Reperfusion Injury (RIRI) initiates a cascade of deleterious events resulting in acute kidney injury with high mortality rates. Tirzepatide has anti-inflammatory, anti-apoptotic and antioxidant as well as activation of both autophagy and Protein Kinase B (PKB or Akt) signaling pathway. This study examines the potential nephroprotective effect of tirzepatide against RIRI in rats.

Methods: Twenty-eight male rats (Sprague Dawley) were split into four groups: sham, Ischemia/Reperfusion Injury (IRI), Distilled Water (D. W) and tirzepatide. The Sham group underwent identical procedures without bilateral renal pedicle clamping, whereas IRI group was exposed to 30 min of bilateral renal ischemia followed by 24 h of reperfusion. The vehicle group received distilled water intraperitoneally 2 h before ischemia, and the tirzepatide group received 3 mg/kg tirzepatide intraperitoneally 2 h before ischemia. Study parameters including urea, creatinine, Kidney Injury Molecule-1 (KIM-1), interleukin-6 (IL-6), caspase-3, Akt, autophagic protein microtubule-associated protein 1 light chain 3-B (LC3-B) and glutathione (GSH), and histopathological changes were examined.

Results: RIRI resulted in a significant elevation in serum urea, serum creatinine and renal levels of KIM-1, IL-6, caspase-3, Akt, and LC3-B while a concurrently reduction in renal GSH level. Tirzepatide treatment diminished the severity of kidney damage by alleviating inflammatory apoptotic and autophagy markers, augmenting antioxidant activity and improving histopathological consequences.

Conclusion: Tirzepatide elucidates significant nephroprotective effects in RIRI, via its anti-inflammatory, antioxidant, and antiapoptotic properties and activation of both autophagy and Akt signaling pathway.

References

Andrew R, Evans Laura E, Waleed A, Levy Mitchell M, Massimo A, Ricard F. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;18(2):197-204.

Zuo Y, Wang Y, HU H, Cui W. Atorvastatin protects myocardium against ischemia-reperfusion injury through inhibiting miR-199a-5p. Cell Physiol Biochem. 2016;39(3):1021-30. doi: 10.1159/000447809, PMID 27537066.

Granger DN, Kvietys PR. Reperfusion injury and reactive oxygen species: the evolution of a concept. Redox Biol. 2015 Dec;6:524-51. doi: 10.1016/j.redox.2015.08.020, PMID 26484802.

RJ, M SB, VY. Oxidative stress in acne vulgaris. Int J Pharm Pharm Sci. 2022;14(11):73-6. doi: 10.22159/ijpps.2022v14i11.45967.

Kellum JA, Unruh ML, Murugan R. Acute kidney injury. BMJ Clin Evid. 2011 Mar 28;2011:2001. PMID 21443811. doi: 10.1038/s41572-021-00284-z.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, DE Bacquer D. Rifle criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73. doi: 10.1186/cc4915, PMID 16696865.

Murugan R, Kellum JA. Acute kidney injury: whats the prognosis? Nat Rev Nephrol. 2011;7(4):209-17. doi: 10.1038/nrneph.2011.13, PMID 21343898.

Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013;84(3):457-67. doi: 10.1038/ki.2013.153, PMID 23636171.

Daniel Patschan GA. Acute kidney injury. J Inj Violence Res. 2015;7(1):19-26. doi: 10.5249/jivr.v7i1.604.

Weinberg JM, Venkatachalam MA, Roeser NF, Saikumar P, Dong Z, Senter RA. Anaerobic and aerobic pathways for salvage of proximal tubules from hypoxia-induced mitochondrial injury. Am J Physiol Renal Physiol. 2000;279(5):F927-43. doi: 10.1152/ajprenal.2000.279.5.F927, PMID 11053054.

Chen Y, Fry BC, Layton AT. Modeling glucose metabolism and lactate production in the kidney. Math Biosci. 2017;289:116-29. doi: 10.1016/j.mbs.2017.04.008, PMID 28495544.

Liu BC, Tang TT, LV LL, Lan HY. Renal tubule injury: a driving force toward chronic kidney disease. Kidney Int. 2018;93(3):568-79. doi: 10.1016/j.kint.2017.09.033, PMID 29361307.

Lee JW, Lee KH. Comparison of renoprotective effects of febuxostat and allopurinol in hyperuricemic patients with chronic kidney disease. Int Urol Nephrol. 2019;51(3):467-73. doi: 10.1007/s11255-018-2051-2, PMID 30604229.

Stroo I, Stokman G, Teske GJ, Raven A, Butter LM, Florquin S. Chemokine expression in renal ischemia/reperfusion injury is most profound during the reparative phase. Int Immunol. 2010;22(6):433-42. doi: 10.1093/intimm/dxq025, PMID 20410256.

Malek M, Nematbakhsh M. Renal ischemia/reperfusion injury; from pathophysiology to treatment. J Renal Inj Prev. 2015;4(2):20-7. doi: 10.12861/jrip.2015.06, PMID 26060833.

Hegner J, Patel J, Fong S, Jeffs S, PJ, Jeffs S. The role of specialist pharmacist in the management of adalinumab in patients with inflammatory bowel disease. Int J Pharm Pharm Sci. 2021;13(11):30-3. doi: 10.22159/ijpps.2021v13i11.42451.

Fuchs Y, Steller H. Programmed cell death in animal development and disease. Cell. 2011;147(4):742-58. doi: 10.1016/j.cell.2011.10.033, PMID 22078876.

Peters AE, Mihalas BP, Bromfield EG, Roman SD, Nixon B, Sutherland JM. Autophagy in female fertility: a role in oxidative stress and aging. Antioxid Redox Signal. 2020;32(8):550-68. doi: 10.1089/ars.2019.7986, PMID 31892284.

Kroemer G. Autophagy: a druggable process that is deregulated in aging and human disease. J Clin Invest. 2015;125(1):1-4. doi: 10.1172/JCI78652, PMID 25654544.

Turkmen K, Martin J, Akcay A, Nguyen Q, Ravichandran K, Faubel S. Apoptosis and autophagy in cold preservation ischemia. Transplantation. 2011;91(11):1192-7. doi: 10.1097/TP.0b013e31821ab9c8, PMID 21577181.

Suzuki C, Isaka Y, Takabatake Y, Tanaka H, Koike M, Shibata M. Participation of autophagy in renal ischemia/reperfusion injury. Biochem Biophys Res Commun. 2008;368(1):100-6. doi: 10.1016/j.bbrc.2008.01.059, PMID 18222169.

Gotoh K, LU Z, Morita M, Shibata M, Koike M, Waguri S. Participation of autophagy in the initiation of graft dysfunction after rat liver transplantation. Autophagy. 2009;5(3):351-60. doi: 10.4161/auto.5.3.7650, PMID 19158494.

Masella R, DI Benedetto R, Vari R, Filesi C, Giovannini C. Novel mechanisms of natural antioxidant compounds in biological systems: involvement of glutathione and glutathione related enzymes. J Nutr Biochem. 2005;16(10):577-86. doi: 10.1016/j.jnutbio.2005.05.013, PMID 16111877.

Hanschmann EM, Godoy JR, Berndt C, Hudemann C, Lillig CH. Thioredoxins glutaredoxins and peroxiredoxins molecular mechanisms and health significance: from cofactors to antioxidants to redox signaling. Antioxid Redox Signal. 2013;19(13):1539-605. doi: 10.1089/ars.2012.4599, PMID 23397885.

Caruso I, Giorgino F. Renal effects of GLP-1 receptor agonists and tirzepatide in individuals with type 2 diabetes: seeds of a promising future. Endocrine. 2024;84(3):822-35. doi: 10.1007/s12020-024-03757-9, PMID 38472620.

Alaasam ER, Janabi AM, Al Buthabhak KM, Almudhafar RH, Hadi NR, Alexiou A. Nephroprotective role of resveratrol in renal ischemia-reperfusion injury: a preclinical study in sprague dawley rats. BMC Pharmacol Toxicol. 2024;25(1):82. doi: 10.1186/s40360-024-00809-8, PMID 39468702.

Oxburgh L, DE Caestecker MP. Ischemia reperfusion injury of the mouse kidney. Kidney development. Methods Protoc. 2012:363-79.

Martin JA, Czeskis B, Urva S, Cassidy KC. Absorption distribution metabolism and excretion of tirzepatide in humans rats and monkeys. Eur J Pharm Sci. 2024;202:106895. doi: 10.1016/j.ejps.2024.106895, PMID 39243911.

Guo X, Lei M, Zhao J, WU M, Ren Z, Yang X. Tirzepatide ameliorates spatial learning and memory impairment through modulation of aberrant insulin resistance and inflammation response in diabetic rats. Front Pharmacol. 2023;14:1146960. doi: 10.3389/fphar.2023.1146960, PMID 37701028.

Al Amir H, Janabi A, Hadi NR. Ameliorative effect of nebivolol in doxorubicin-induced cardiotoxicity. J Med Life. 2023;16(9):1357-63. doi: 10.25122/jml-2023-0090, PMID 38107721.

Jallawee HQ, Janabi AM. Potential nephroprotective effect of dapagliflozin against renal ischemia-reperfusion injury in rats via activation of autophagy pathway and inhibition of inflammation oxidative stress and apoptosis. S East Eur J Public Health. 2024;24 Suppl 2:488-500. doi: 10.70135/seejph.vi.1009.

Cheng YT, TU YC, Chou YH, Lai CF. Protocol for renal ischemia-reperfusion injury by flank incisions in mice. Star Protoc. 2022;3(4):101678. doi: 10.1016/j.xpro.2022.101678, PMID 36208451.

Skrypnyk NI, Harris RC, DE Caestecker MP. Ischemia reperfusion model of acute kidney injury and post-injury fibrosis in mice. J Vis Exp. 2013;(78):50495. doi: 10.3791/50495, PMID 23963468.

Shishido T, Nozaki N, Yamaguchi S, Shibata Y, Nitobe J, Miyamoto T. Toll like receptor-2 modulates ventricular remodeling after myocardial infarction. Circulation. 2003;108(23):2905-10. doi: 10.1161/01.CIR.0000101921.93016.1C, PMID 14656915.

Goyal A DP, Hashim MF. Acute Kidney Inj (nursing). In: Stat Pearls Treasure Island (FL): In: Stat Pearls Treasure Island (FL); 2024.

Han SJ, Lee HT. Mechanisms and therapeutic targets of ischemic acute kidney injury. Kidney Res Clin Pract. 2019;38(4):427-40. doi: 10.23876/j.krcp.19.062, PMID 31537053.

Srisawat N, Kulvichit W, Mahamitra N, Hurst C, Praditpornsilpa K, Lumlertgul N. The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study. Nephrol Dial Transplant. 2020;35(10):1729-38. doi: 10.1093/ndt/gfz087, PMID 31075172.

El Sabbahy ME, Vaidya VS. Ischemic kidney injury and mechanisms of tissue repair. Wiley Interdiscip Rev Syst Biol Med. 2011;3(5):606-18. doi: 10.1002/wsbm.133, PMID 21197658.

Pallet N, Livingston M, Dong Z. Emerging functions of autophagy in kidney transplantation. Am J Transplant. 2014;14(1):13-20. doi: 10.1111/ajt.12533, PMID 24369023.

Ghazi HS. Ibudilast and octreotide can ameliorate acute pancreatitis via downregulation of the inflammatory cytokines and nuclear factor kappa B expression. Ann Trop Med Public Health. 2019;22(8):1-9. doi: 10.36295/ASRO.2019.22081.

Liu LJ, YU JJ, XU XL. Kappa opioid receptor agonist U50448H protects against renal ischemia-reperfusion injury in rats via activating the PI3K/Akt signaling pathway. Acta Pharmacol Sin. 2018;39(1):97-106. doi: 10.1038/aps.2017.51, PMID 28770825.

Mima A, Nomura A, Fujii T. Current findings on the efficacy of incretin-based drugs for diabetic kidney disease: a narrative review. Biomed Pharmacother. 2023 Sep;165:115032. doi: 10.1016/j.biopha.2023.115032, PMID 37331253.

Dalboge LS, Christensen M, Madsen MR, Secher T, Endlich N, Drenic V. Nephroprotective effects of semaglutide as mono and combination treatment with lisinopril in a mouse model of hypertension accelerated diabetic kidney disease. Biomedicines. 2022;10(7):1661. doi: 10.3390/biomedicines10071661, PMID 35884965.

Ahmad A, Sattar MA, Rathore HA, Khan SA, Lazhari MI, Afzal S. A critical review of pharmacological significance of hydrogen sulfide in hypertension. Indian J Pharmacol. 2015;47(3):243-7. doi: 10.4103/0253-7613.157106, PMID 26069359.

Al Chlaihawi M, Janabi A. Azilsartan improves doxorubicin-induced cardiotoxicity via inhibiting oxidative stress proinflammatory pathway and apoptosis. J Med Life. 2023;16(12):1783-8. doi: 10.25122/jml-2023-0106, PMID 38585516.

Yang M, Zhang C. The role of innate immunity in diabetic nephropathy and their therapeutic consequences. J Pharm Anal. 2024;14(1):39-51. doi: 10.1016/j.jpha.2023.09.003, PMID 38352948.

Ozbilgin S, Ozkardesler S, Akan M, Boztas N, Ozbilgin M, Ergur BU. Renal ischemia/reperfusion injury in diabetic rats: the role of local ischemic preconditioning. Bio Med Res Int. 2016;2016(1):8580475. doi: 10.1155/2016/8580475, PMID 26925416.

Kopp KO, LI Y, Glotfelty EJ, Tweedie D, Greig NH. Incretin-based multi-agonist peptides are neuroprotective and anti-inflammatory in cellular models of neurodegeneration. Biomolecules. 2024;14(7):872. doi: 10.3390/biom14070872, PMID 39062586.

Tiba AT, Qassam H, Hadi NR. Semaglutide in renal ischemia-reperfusion injury in mice. J Med Life. 2023;16(2):317-24. doi: 10.25122/jml-2022-0291, PMID 36937464.

Boshchenko AA, Maslov LN, Mukhomedzyanov AV, Zhuravleva OA, Slidnevskaya AS, Naryzhnaya NV. Peptides are cardioprotective drugs of the future: the receptor and signaling mechanisms of the cardioprotective effect of glucagon-like peptide-1 receptor agonists. Int J Mol Sci. 2024;25(9):4900. doi: 10.3390/ijms25094900, PMID 38732142.

Guan X, Qian Y, Shen Y, Zhang L, DU Y, Dai H. Autophagy protects renal tubular cells against ischemia-reperfusion injury in a time-dependent manner. Cell Physiol Biochem. 2015;36(1):285-98. doi: 10.1159/000374071, PMID 25967967.

Hassan NF, Ragab D, Ibrahim SG, Abd El Galil MM, Hassan Abd El Hamid AH, Hamed DM. The potential role of tirzepatide as adjuvant therapy in countering colistin-induced nephro and neurotoxicity in rats via modulation of PI3K/p-Akt/GSK3-β/NF-kB p65 hub shielding against oxidative and endoplasmic reticulum stress and activation of p-CREB/BDNF/TrkB cascade. Int Immunopharmacol. 2024 Jun 30;135:112308. doi: 10.1016/j.intimp.2024.112308, PMID 38788447.

Alsaaty EH, Janabi AM. Moexipril improves renal ischemia/reperfusion injury in adult male rats. J Contemp Med Sci. 2024;10(1). doi: 10.22317/jcms.v10i1.1477.

Published

07-03-2025

How to Cite

ALKHAFAJI, G. A., & JANABI, A. M. (2025). GIP/GLP-1 DUAL AGONIST TIRZEPATIDE AMELIORATES RENAL ISCHEMIA/REPERFUSION DAMAGE IN RATS. International Journal of Applied Pharmaceutics, 17(2), 165–173. https://doi.org/10.22159/ijap.2025v17i2.53156

Issue

Section

Original Article(s)

Similar Articles

<< < 2 3 4 5 6 > >> 

You may also start an advanced similarity search for this article.