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Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches
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Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: closed (20 February 2026) | Viewed by 3927

Special Issue Editor

Prof. Dr. Bin Yang

E-Mail Website
Guest Editor
Department of Cardiovascular Sciences, College of Life Sciences University of Leicester, Leicester, UK
Interests: acute kidney injury; repair; biomarker; immunoresponse; targeted therapy; precision medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute kidney injury (AKI) is a critical illness with a high mortality rate and often progresses to chronic kidney disease, without cause-specific treatment. It is imperative to understand the mechanisms of AKI and its chronic progression in order to identify potential biomarkers for early diagnosis, intervention, and monitoring prognosis. In particular, gene therapy, including siRNA, specifically silencing target genes via complimentary sequences, has been studied in numerous disease models, with some agents/approaches developing into clinical trials. However, delivering gene-modifying agents to the desired cells has proved to be very challenging.

We invite colleagues in the field to share their updated knowledge, research data, and unique experiences related to the above themes by submitting review papers, original research articles, or case reports to this Special Issue, entitled “Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches”, of the International Journal of Molecular Sciences. Preclinical studies will form the basis for potential human applications in native AKI and transplant kidney injury to limit injury, promote repair, and prevent chronic progression in order to improve the outcome of kidney disease and the care of kidney patients. Intervention principles and validated methods in different research projects will also be applicable to a broad range of genes and organs to facilitate precision medicine.

Prof. Dr. Bin Yang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Molecular Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. There is an Article Processing Charge (APC) for publication in this open access journal. For details about the APC please see here. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • kidney injury
  • repair
  • immunoresponse
  • biomarker
  • targeted therapy
  • precision medicine

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Published Papers (3 papers)

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Research

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18 pages, 1034 KB  
Article
Evaluation of a Novel Biomarker Panel for Acute Kidney Injury Following Endovascular Aortic Repair
by Konrad Zuzda, Paulina Walczak-Wieteska, Paweł Andruszkiewicz and Jolanta Małyszko
Int. J. Mol. Sci. 2025, 26(22), 11156; https://doi.org/10.3390/ijms262211156 - 18 Nov 2025
Viewed by 880
Abstract
Acute Kidney Injury (AKI) following endovascular aortic repair (EVAR) is often diagnosed too late using conventional markers, limiting opportunities for timely intervention in this high-risk population. We investigated whether a mechanism-based biomarker panel could provide improved early AKI detection in EVAR patients. This [...] Read more.
Acute Kidney Injury (AKI) following endovascular aortic repair (EVAR) is often diagnosed too late using conventional markers, limiting opportunities for timely intervention in this high-risk population. We investigated whether a mechanism-based biomarker panel could provide improved early AKI detection in EVAR patients. This prospective, single-center study enrolled 68 consecutive EVAR patients between April 2022 and June 2024. AKI was diagnosed using KDIGO 2012 criteria. Seven novel biomarkers, including Proenkephalin A 119-159 (penKid), Semaphorin-3A (SEMA-3A), Retinol Binding Protein-4 (RBP-4), Kidney Injury Molecule-1 (KIM-1), Netrin-1, Tissue Inhibitor of Metalloproteinases-2, and Insulin-Like Growth Factor Binding Protein-7, were measured at baseline, immediate postoperative, 24 h, and 48 h time points, and selected based on distinct nephron locations and release mechanisms. AKI occurred in 18 (26.5%) patients. Top-performing individual biomarkers included serum SEMA-3A (AUC 0.88), serum RBP-4 (AUC 0.81), and penKid (AUC 0.76). A three-biomarker panel combining serum penKid, serum SEMA-3A, and urinary KIM-1 achieved robust discriminatory performance (AUC 0.89, 95% CI 0.77–1.00), superior to individual biomarkers. An alternative panel with serum RBP-4 demonstrated comparable performance (AUC 0.81, 95% CI 0.65–0.99). Multi-biomarker panels combining functional, stress, and injury markers demonstrate promising performance for early AKI detection in EVAR patients. External validation in independent, multi-center cohorts is required before clinical implementation. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches)
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17 pages, 2848 KB  
Article
Zileuton Attenuates Acute Kidney Injury in Glycerol-Induced Rhabdomyolysis by Regulating Myeloid-Derived Suppressor Cells in Mice
by Tae Won Lee, Eunjin Bae, Jin Hyun Kim, Myeong Hee Jung and Dong Jun Park
Int. J. Mol. Sci. 2025, 26(17), 8353; https://doi.org/10.3390/ijms26178353 - 28 Aug 2025
Viewed by 1705
Abstract
Rhabdomyolysis is characterized by the breakdown of skeletal muscle tissue, frequently leading to acute kidney injury (AKI). Traditional conservative treatments have shown limited effectiveness in modifying the disease course, thereby necessitating targeted pharmacological approaches. Zileuton (Z), a selective inhibitor of 5-lipoxygenase (5-LOX), has [...] Read more.
Rhabdomyolysis is characterized by the breakdown of skeletal muscle tissue, frequently leading to acute kidney injury (AKI). Traditional conservative treatments have shown limited effectiveness in modifying the disease course, thereby necessitating targeted pharmacological approaches. Zileuton (Z), a selective inhibitor of 5-lipoxygenase (5-LOX), has demonstrated efficacy in enhancing renal function recovery in animal models of AKI induced by agents such as cisplatin, aminoglycosides, and polymyxins. The present study aimed to evaluate the therapeutic potential of a single dose of Z in mitigating rhabdomyolysis-induced AKI (RI-AKI) via modulation of myeloid-derived suppressor cells (MDSCs). Male C57BL/6 mice were assigned to four experimental groups: Sham (intraperitoneal administration of 0.9% saline), Z (single intraperitoneal injection of Z at 30 mg/kg body weight), glycerol (Gly; single intramuscular dose of 50% glycerol at 8 mL/kg), and glycerol plus Z (Z + Gly; concurrent administration of glycerol intramuscularly and Z intraperitoneally). Animals were sacrificed 24 h post-glycerol injection for analysis. Zileuton administration significantly improved renal function, as indicated by reductions in blood urea nitrogen (BUN) levels (129.7 ± 17.9 mg/dL in the Gly group versus 101.7 ± 6.8 mg/dL in the Z + Gly group, p < 0.05) and serum creatinine (Cr) levels (2.2 ± 0.3 mg/dL in the Gly group versus 0.9 ± 0.3 mg/dL in the Gly + Z group p < 0.05). Histopathological assessment revealed a marked decrease in tubular injury scores in the Z + Gly group compared to the Gly group. Molecular analyses demonstrated that Z treatment downregulated mRNA expression of macrophage-inducible C-type lectin (mincle) and associated macrophage infiltration-related factors, including Areg-1, Cx3cl1, and Cx3CR1, which were elevated 24 h following glycerol administration. Furthermore, the expression of NLRP-3, significantly upregulated post-glycerol injection, was attenuated by concurrent Z treatment. Markers of mitochondrial biogenesis, such as mitochondrial DNA (mtDNA), transcription factor A mitochondrial (TFAM), and carnitine palmitoyltransferase 1 alpha (CPT1α), were diminished 24 h after glycerol injection; however, their expression was restored upon simultaneous Z administration. Additionally, Z reduced protein levels of BNIP3, a marker of mitochondrial autophagy, while enhancing the expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), suggesting that Z ameliorates RI-AKI severity through the regulation of mitochondrial quality control mechanisms. Zileuton also decreased infiltration of CD11b(+) Gr-1(+) MDSCs and downregulated mRNA levels of MDSC-associated markers, including transforming growth factor-beta (TGF-β), arginase-1 (Arg-1), inducible nitric oxide synthase (iNOS), and iron regulatory protein 4 (Irp4), in glycerol-injured kidneys relative to controls. These markers were elevated 24 h post-glycerol injection but were normalized following concurrent Z treatment. Collectively, these findings suggest that Zileuton confers reno-protective effects in a murine model of RI-AKI, potentially through modulation of mitochondrial dynamics and suppression of MDSC-mediated inflammatory pathways. Further research is warranted to elucidate the precise mechanisms by which Z regulates MDSCs and to assess its therapeutic potential in clinical contexts. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches)
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Review

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18 pages, 1391 KB  
Review
Secretory Leukocyte Protease Inhibitor: A Pleiotropic Molecule for the Potential Diagnosis of and Therapy for Acute Kidney Injury
by Rui Chen, Shiyun Gu, Fenfen Xiong, Lili Ji, Zhi-Jun Zhang, Bin Yang and Yuanyuan Wu
Int. J. Mol. Sci. 2025, 26(23), 11631; https://doi.org/10.3390/ijms262311631 - 30 Nov 2025
Viewed by 770
Abstract
Acute kidney injury (AKI) remains a common clinical syndrome associated with high morbidity and mortality. However, effective diagnostic biomarkers and specific therapeutic interventions are still lacking. Secretory leukocyte protease inhibitor (SLPI), a serine protease inhibitor with pleiotropic functions, has emerged as an early [...] Read more.
Acute kidney injury (AKI) remains a common clinical syndrome associated with high morbidity and mortality. However, effective diagnostic biomarkers and specific therapeutic interventions are still lacking. Secretory leukocyte protease inhibitor (SLPI), a serine protease inhibitor with pleiotropic functions, has emerged as an early diagnostic and prognostic biomarker for AKI. Clinical studies reveal significant elevation of serum SLPI in AKI patients compared to non-AKI patients at the acute phase following post-cardiovascular surgery, supporting its diagnostic potential. Furthermore, evidence also suggests that SLPI showed prognostic value for kidney transplantation and chronic kidney disease progression associated with diverse etiology, including diabetes. In addition, current evidence highlights the biological functions of SLPI in inhibiting NF-κB activities, suppressing neutrophil extracellular trap formation, modulating phagocytosis, regulating cell apoptosis, proliferation, differentiation, and potentially fibrosis across various disease contexts. Preclinical studies demonstrate that administration of recombinant SLPI ameliorates renal dysfunction in multiple AKI models, including ischemia–reperfusion injury and nephrotoxic models induced by gentamicin or cisplatin. Furthermore, the antifibrotic properties of SLPI underscore its therapeutic potential in halting AKI progression to chronic kidney disease. By integrating available evidence, this review aims to elucidate that, as an early acute-phase response molecule, SLPI serves dual roles as not only an early diagnostic and prognostic biomarker for AKI, but also a renoprotective molecule countering kidney injury. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Molecular Mechanism and Targeted Therapeutic Approaches)
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