Hypouricemic agents reduce indoxyl sulfate excretion by inhibiting the renal transporters OAT1/3 and ABCG2

Sci Rep. 2021 Mar 31;11(1):7232. doi: 10.1038/s41598-021-86662-9.

Abstract

Indoxyl sulfate (IS) accumulates in the body in chronic kidney disease (CKD). In the renal proximal tubules, IS excretion is mediated by OAT1/3 and ABCG2. These transporters are inhibited by some hypouricemic agents; OATs by probenecid and benzbromarone, ABCG2 by febuxostat and benzbromarone. Thus, we evaluated whether hypouricemic agents including dotinurad, a novel selective urate reabsorption inhibitor with minimal effect on OATs or ABCG2, affect IS clearance in rats. Intact and adenine-induced acute renal failure rats were orally administered hypouricemic agents, and both endogenous IS and exogenously administered stable isotope-labeled d4-IS in the plasma and kidney were measured. Our results demonstrated that OATs inhibitors, such as probenecid, suppress IS uptake into the kidney, leading to increased plasma IS concentration, whereas ABCG2 inhibitors, such as febuxostat, cause renal IS accumulation remarkably by suppressing its excretion in intact rats. The effects of these agents were reduced in adenine-induced acute renal failure rats, presumably due to substantial decrease in renal OAT1/3 and ABCG2 expression. Dotinurad did not significantly affected the clearance of IS under both conditions. Therefore, we suggest that hypouricemic agents that do not affect OATs and ABCG2 are effective therapeutic options for the treatment of hyperuricemia complicated by CKD.

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily G, Member 2 / antagonists & inhibitors*
  • ATP Binding Cassette Transporter, Subfamily G, Member 2 / metabolism
  • Acute Kidney Injury* / blood
  • Acute Kidney Injury* / chemically induced
  • Acute Kidney Injury* / drug therapy
  • Animals
  • Indican / blood*
  • Male
  • Organic Anion Transport Protein 1 / antagonists & inhibitors*
  • Organic Anion Transport Protein 1 / metabolism
  • Organic Anion Transporters, Sodium-Independent / antagonists & inhibitors*
  • Organic Anion Transporters, Sodium-Independent / metabolism
  • Rats
  • Rats, Wistar
  • Uricosuric Agents / pharmacology*

Substances

  • ATP Binding Cassette Transporter, Subfamily G, Member 2
  • Abcg2 protein, rat
  • Organic Anion Transport Protein 1
  • Organic Anion Transporters, Sodium-Independent
  • Slc22a6 protein, rat
  • Uricosuric Agents
  • organic anion transport protein 3
  • Indican