• Dae-Yeon Lee, Ji-Yeon Kim, Eunyong Ahn, Jin Seong Hyeon, Gyu-Hee Kim, Keon-Jae Park, Youngae Jung, Yoo-Jeong Lee, Mi Kyoung Son, Seung Woo Kim, Sang Youb Han, Jae-Hong Kim, Gu Seob Roh, Dae Ryong Cha, Geum-Sook Hwang, and Won-Ho Kim.
• Division of Cardiovascular Disease Research, Korea National Institute of Health, Cheongju, Republic of Korea; Department of Anatomy and Convergence Medical Science, Bio Anti-aging Medical Research Center, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
• Transl Res. 2022 Nov 1; 249: 8810988-109.

AbstractDuring the progression of diabetic kidney disease (DKD), renal lactate metabolism is rewired. The relationship between alterations in renal lactate metabolism and renal fibrosis in patients with diabetes has only been partially established due to a lack of biopsy tissues from patients with DKD and the intricate mechanism of lactate homeostasis. The role of lactate dehydrogenase A (LDHA)-mediated lactate generation in renal fibrosis and dysfunction in human and animal models of DKD was explored in this study. Measures of lactate metabolism (urinary lactate levels and LDHA expression) and measures of DKD progression (estimated glomerular filtration rate and Wilms' tumor-1 expression) were strongly negatively correlated in patients with DKD. Experiments with streptozotocin-induced DKD rat models and the rat renal mesangial cell model confirmed our findings. We found that the pathogenesis of DKD is linked to hypoxia-mediated lactic acidosis, which leads to fibrosis and mitochondrial abnormalities. The pathogenic characteristics of DKD were significantly reduced when aerobic glycolysis or LDHA expression was inhibited. Further studies will aim to investigate whether local acidosis caused by renal LDHA might be exploited as a therapeutic target in patients with DKD.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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