myo-Inositol Oxygenase Overexpression Accentuates Generation of Reactive Oxygen Species and Exacerbates Cellular Injury following High Glucose Ambience

Diabetic nephropathy (DN) is characterized by perturbations in metabolic/cellular signaling pathways with generation of reactive oxygen species (ROS). The ROS are regarded as a common denominator of various pathways, and they inflict injury on renal glomerular cells. Recent studies indicate that tubular pathobiology also plays a role in the progression of DN. However, the mechanism(s) for how high (25 mm) glucose (HG) ambience induces tubular damage remains enigmatic. myo-Inositol oxygenase (MIOX) is a tubular enzyme that catabolizes myo-inositol to d-glucuronate via the glucuronate-xylulose (G-X) pathway. In this study, we demonstrated that G-X pathway enzymes are expressed in the kidney, and MIOX expression/bioactivity was up-regulated under HG ambience in LLC-PK1 cells, a tubular cell line. We further investigated whether MIOX overexpression leads to accentuation of tubulo-interstitial injury, as gauged by some of the parameters relevant to the progression of DN. Under HG ambience, MIOX overexpression accentuated redox imbalance, perturbed NAD+/NADH ratios, increased ROS generation, depleted reduced glutathione, reduced GSH/GSSG ratio, and enhanced adaptive changes in the profile of the antioxidant defense system. These changes were also accompanied by mitochondrial dysfunctions, DNA damage and induction of apoptosis, accentuated activity of profibrogenic cytokine, and expression of fibronectin, the latter two being the major hallmarks of DN. These perturbations were largely blocked by various ROS inhibitors (Mito Q, diphenyleneiodonium chloride, and N-acetylcysteine) and MIOX/NOX4 siRNA. In conclusion, this study highlights a novel mechanism where MIOX under HG ambience exacerbates renal injury during the progression of diabetic nephropathy following the generation of excessive ROS via an unexplored G-X pathway.

Diabetic nephropathy (DN) 2 is characterized by metabolic changes with perturbed cellular signaling events in renal cells followed by an increased synthesis of extracellular matrices (ECMs) and mitochondrial dysfunctions (1,2). These changes are related to accentuation of cellular flux of glucose intermediaries (3), polyols (4), protein kinase C activity (5,6), expression of TGF-␤ (7), GTP-binding and cell cycle proteins (6,8), and generation of advanced glycation end products and reactive oxygen species (ROS) (9,10). The latter are regarded as central to the pathogenesis of DN with glomerulosclerosis and tubulointerstitial fibrosis in the kidney (11,12). With respect to glomerulosclerosis, Hascall and co-workers (13,14) have proposed a novel paradigm suggesting hyperglycemia-induced hyaluronan synthesis that leads to autophagy and influx of monocytes causing inflammatory damage to the renal glomerulus. Such complex interrelated cellular signaling events, involving also various forms of MAP/ERK kinases and Smad proteins, have been investigated largely in glomerular cells (1-3, 15, 16), and the information concerning tubulo-interstitial cells is limited (17,18). Of note is that all of the cellular elements of the kidney respond to hyperglycemia by activation of more or less similar intracellular signaling events with some variations depending on the expression of a given molecule (e.g. aldose reductase (ALR) and myo-inositol oxygenase (MIOX) in medullary and cortical tubular cells, respectively, and PKC-␣ and -␤ isoforms in glomeruli (19 -21)). ALR is known to be involved in the pathogenesis of diabetic nephropathy, where an accentuated activity of the "polyol pathway" is seen with perturbed NADPH/ NADP ϩ and NAD ϩ /NADH ratios, and as a result, the medullary tubular cells undergo a "redox imbalance" and notable oxidant stress. Along these lines, MIOX has been described to be up-regulated in high glucose ambience and hyperglycemic states (20,22). Interestingly, in our exploratory studies on renal biopsies of patients with DN, we noted that up-regulation of MIOX is concomitantly associated with increased NADPH oxidase 4 (NOX4) expression confined preferentially to proximal cortical tubular cells (Fig. 1), which would underscore an enormous significance of MIOX in terms of "redox imbalance" in the pathogenesis of tubulo-interstitial injury in diabetic nephropathy.
Previously, we identified a renal "tubular specific" protein in mice with STZ-induced diabetes, namely renal specific oxidoreductase (23). Later, it was found to be a glycolytic enzyme, MIOX (24), which catabolizes myo-inositol to D-glucuronate via the glucuronate-xylulose (G-X) pathway as originally described in the eye lens (25), whereas it has been proposed to be operative in the kidney as well, and its metabolites enter into the pentose pathway (26,27). Past studies indicate that the promoter region of MIOX includes osmotic, carbohydrate, and oxidant/antioxidant response elements and that its transcription is heavily regulated by organic osmolytes, high glucose ambience, and oxidant stress (20,28,29). Because the oxidant stress or ROS are believed to be common denominators in the pathogenesis of DN, the question that we addressed was whether MIOX also contributes further to the ROS-mediated injury in DN, especially to the proximal cortical tubular compartment.
With the assumption that G-X pathway enzymes are also expressed in tubules, one can envision the following sequence of events in the accentuation of tubular injury. First, the G-X pathway initiated by MIOX/ALR1 under high glucose ambience would lead to "redox imbalance" with perturbed NADPH/ NADP ϩ and NAD ϩ /NADH ratios at multiple steps, akin to the polyol pathway (27) (Fig. 2A). The redox imbalance in the tubules would be accompanied by mitochondrial dysfunctions and initiation of apoptotic events, whereas there would also be simultaneous activation of fibrogenic cytokine TGF-␤ with consequential fibrosis; in concert, both would probably exacerbate tubulo-interstitial injury in DN. We used these two major readouts (i.e. cellular apoptosis and excessive ECM synthesis) to assess the effects of MIOX overexpression because they are regarded as the known final outcomes in the progression of diabetic nephropathy.
Animal Studies-Three-month-old male CD1 mice were obtained from Harlan Laboratories. Kidneys were harvested for dissection of cortices, where MIOX is expressed. A portion of the dissected cortices was processed for immunohistochemical studies. The remainder of the renal cortices was processed for tubular enrichment using a sieving method (6). The tubular enriched fraction was used to isolate mRNA for gene expression studies. All animal and human biopsy studies were approved by the institutional committees of Northwestern University (Chicago, IL) and Central South University (Changsha, China).
Immunohistochemical Studies on Kidney Tissues-For these studies, the ABC (avidin-biotin complex) method (Vector Laboratories) was employed. Four-m-thick kidney sections were deparaffinized by xylene treatment and then hydrated in graded series of decreasing concentrations of ethanol. They were then successively incubated with rabbit anti-MIOX, anti-NADPH oxidase 4 (NOX4), or anti-ALR1 (Abgent), biotinylated antirabbit IgG, and streptavadin conjugated with horseradish peroxidase (HRP) with interspersed brief washes with PBS. In some experiments, a heat-induced epitope retrieval (antigen retrieval) method, using R-buffers (EM sciences), was employed to enhance the detection of antigens expressed in the kidney. The sections were then treated with SIGMAFAST TM 3Ј,3Ј-diaminobenzidine solution for 3-5 min at 22°C to develop the HRP reaction product. The sections were counterstained with hematoxylin, coverslip-mounted, and examined.
Cell Culture Studies-The LLC-PK1 cell line (a renal tubular cell line) was purchased from ATCC. The pcDNA3.1 vector, Lipofectamine 2000, G418, Zeocin, and psiRNA-h7SKGFPzeo G1 vector were obtained from Invitrogen and InvivoGen Corp. The cells were grown in M199 medium with basal low concentration of D-glucose (5 mM) supplemented with 5% heatinactivated fetal bovine serum (FBS), 100 units/ml penicillin, and 100 g/ml streptomycin. They were maintained in a humidified atmosphere of 5% CO 2 and 95% air at 37°C. For high glucose ambience experiments, the cells were exposed to 5-25 mM D-glucose for 12-15 h, whereas L-glucose served as a control. In some experiments, the time period was extended up to 24 -30 h.
RT-PCR Analyses of Kidney Tissues and LLC-PK1 Cells-Total RNA was isolated from tubular enriched fractions of 10 murine kidney cortices free of medulla by the acid guanidinium isothiocyanate-phenol-chloroform extraction method (32). Similarly, total RNA was also isolated from LLC-PK1 cells maintained in culture Petri dishes. The extracted RNA was precipitated in the presence of RNase-free glycogen (20 mg/ml) and then pelleted by centrifugation at 10,000 ϫ g. The pellet was resuspended in 0.5 ml of DNase buffer (0.1 M sodium acetate, 5 mM MgSO 4 , pH 5.0) and digested with 100 units of RNase-free DNase (U.S. Biochemical Corp.) in the presence of RNasin (1 unit/l; Promega). Following another phenol-chloroform extraction, the RNA was reprecipitated with ethanol. About 2 g of total RNA was subjected to the first strand cDNA synthesis using Moloney murine leukemia virus-RT and oligo(dT) 25 as a primer. The cDNA was suspended in 250 l of 10 mM Tris-EDTA buffer, pH 7.4, and kept at Ϫ70°C until further use. PCR was performed using 2 l of cDNA and Taq DNA polymerase (5 units/l) by employing standard protocol conditions provided by the vendor (Invitrogen). Respective sense and antisense primers for various enzymes of the G-X pathway were as follows: 5Ј-AGA CCC TTC CCT GGT CTA TCG A-3Ј and 5Ј-TAA AGA CAC GAT CCA GCA GCG-3Ј (MIOX, PCR product ϳ93 bp); 5Ј-ATG AGC CAG TCC TGC TTG AAG A-3Ј and 5Ј-TTT CCG CTG AAC CTG CCA T-3Ј (ALR1; PCR product ϳ100 bp); 5Ј-GGC TCA TGT GAA GCA GTG CAT-3Ј and 5Ј-TTC TGT CCA TTG TGG CTG GAG-3Ј (L-gu-lonate dehydrogenase; PCR product ϳ109 bp); 5Ј-TCA ATG  TCG TTC CGG TGC TT-3Ј and 5Ј-CGG CGG TGT TGA  CGT AGT ATT T-3Ј (D-xylulose reductase; PCR product ϳ100  bp); 5Ј-GGT GTC TCA GAT TGT GGC CAA G-3Ј and  5Ј-TAT GGT TGG TCA GTG CAC GTT G-3Ј (L-xylulose  reductase; PCR product ϳ100 bp); 5Ј-TCA GCA CGC AGC  AGG TTA AAG-3Ј and 5Ј-CCT GAG TTC CAA ATT CCG  GAA-3Ј (xylulose kinase; PCR product ϳ104 bp).
Generation of Prokaryotic Constructs and Stable Transfectants-A porcine MIOX cDNA was generated by RT-PCR using sense (5Ј-GGCGGGGAATTCATGAAGGACCCAGA-CCCTTC-3Ј) and antisense (5Ј-GGCGGGGAATTCTCACC-AGCACAGGACACCGGGGC-3Ј) primers, and it was cloned into pcDNA3.1 digested with EcoRI. Sense orientation of pcDNA3.1-RSOR/MIOX vector was identified by nucleotide sequencing. For MIOX in vitro gene disruption experiments, primer sequences of complementary cDNA strands were designed using the siRNA Wizard program. The respective primer sequences were 5Ј-ACC TCG GGT GCA GGA GTT CAA CAA GTT CAA GAG ACT TGT TGA ACT CCT GCA CCC TT-3Ј and 5Ј-CAA AAA GGG TGC AGG AGT TCA ACA AGT CTC TTG AAC TTG TTG AAC TCC TGC ACC CG-3Ј. Control primer sequences of scrambled oligonucleotides were as follows: 5Ј-ACC TCG AAA CCG CGT GTA GTG  GTA GAT CAA GAG TCT ACC ACT ACA CGC GGT TTC  TT-3Ј and 5Ј-CAA AAA GAA ACC GCG TGT AGT GGT  AGA CTC TTG ATC TAC CAC TAC ACG CGG TTT CG-3Ј. Oligonucleotides were synthesized by IDT Technologies. Following annealing of complementary strands, dsDNA was cloned into psiRNA-h7SKGFPzeo G1 plasmid digested with BbsI/BbsI (InvivoGen). RSOR/MIOX siRNA was designated as psiRNA-h7SKGFPzeo G1-RSOR/MIOX. The empty plasmid served as control. The empty plasmid and the one containing siRNA construct were then transfected into LLC-PK1 cells, and stable transfectants were selected by growing cells in the presence of 800 g/ml G418 for pcDNA3.1-MIOX or 200 g/ml Zeocin (Invitrogen) for psiRNA-h7SKGFPzeo G1-MIOX. Selected transfectants were then propagated in the presence of a relatively low concentration of G418 (400 g/ml) or Zeocin (50 g/ml) and used for further studies. Stable MIOX transfectants and non-transfected LLC-PK1cells or those transfected with empty vectors were exposed to 5-25 mM D-glucose. For gene disruption studies, cells were transfected with siRNA and processed for various biochemical, morphological, and molecular biology studies.
Western Blotting Studies-Cells subjected to various treatments were lysed with ice-cold radioimmune precipitation assay lysis buffer, containing 150 mM NaCl, 50 mM Tris-HCl, pH 7.4, 1% Nonidet P-40, 2 mM Na 3 VO 4 , 5 mM Na 4 P 2 O 7 containing protease inhibitor mixture (Sigma-Aldrich), for 30 min at 4°C. Lysates were homogenized in a Dounce homogenizer for 4 -5 min, followed by centrifugation at 12,000 ϫ g at 4°C for 10 min. Supernatants were collected for protein expression studies, and the protein concentration of each sample was measured using the Bradford method. After adjusting protein concentration (100 g/100 l) in each of the samples, equal amounts of protein (20 g) from each of the experiments were dissolved in SDS sample buffer, boiled, and subjected to SDS-PAGE. Colored protein standards (Bio-Rad, catalogue no. 161-0374) were included in a flanking lane of the gel in each SDS-PAGE run. Fractionated proteins were then electroblotted onto nitrocellulose/PVDF membranes. The blots were then probed with various antibodies, followed by detection of bands using an ECL kit (Amersham Biosciences). The molecular weight of a given detected band was authenticated by superimposing x-ray film over the transfer membrane containing colored molecular weight markers. The membrane blots were stripped and reprobed with anti-␤-actin antibody.
Densitometric analysis of the band was performed using National Institutes of Health Scion Image software. First, the x-ray film was scanned, and the image was converted into a Tiff format. The image was opened in the Scion software, and a rectangular box was drawn encompassing the band and intensity of each band measured. The box size was kept constant throughout the analyses of various bands. Then the background intensity was measured using the same box in an area without any band. Absolute band intensity was calculated after subtracting the background value from the intensity value of each band. Likewise, the intensity of each of the corresponding ␤-actin bands was calculated. Finally, the ratio of a given protein band intensity was normalized to the respective ␤-actin protein band intensity. Because no significant change in the expression of ␤-actin was observed in various experimental conditions, as gauged by immunoblotting, the ratio was considered reliably reflective of the expression of a given protein.
Determination of MIOX Activity-LLC-PK1 cells were scraped from Petri dishes and suspended in a buffer containing 50 mM sodium acetate, 1 mM ferrous ammonium sulfate, 2 mM L-cysteine, 1 mM glutathione, 1 mM PMSF, 0.2 mM sodium orthovanadate, and 50 mM sodium fluoride. This was followed by sonication for 5 min at 4°C. After centrifugation at 10,000 ϫ g for 5 min at 4°C, the supernatant was collected, and the protein concentration was adjusted to 100 g/ml. MIOX assays were carried out at 30°C for 30 min in a 500-l reaction volume containing 50 mM sodium acetate, 1 mM ferrous ammonium sulfate, 2 mM L-cysteine, and 60 mM myo-inositol. To this reaction mixture, 100 l (100 g/ml) of LLC-PK1 cell supernatants were added, and then the mixture was vigorously shaken. The reaction was terminated by boiling, which was followed by precipitation with TCA with a final concentration of 3%. The precipitate was sedimented by centrifugation at 1,000 ϫ g for 5 min. Concentration of D-glucuronate was determined in the supernatant by the addition of double volume of freshly prepared Orcinol reagent (40 mg of Orcinol, 9 mg of FeCl 3 ⅐6H 2 O dissolved in 10 ml of concentrated HCl) (33). Colorimetric readings were made at OD 660 nm . MIOX activity was averaged from four different experiments.
Determination of NAD ϩ /NADH Ratio-LLC-PK1 cells, after having undergone various experimental treatments, were processed to determine the cytosolic NAD ϩ /NADH ratio by following the vendor's instructions provided in the NAD/NADH colorimetric assay kit (Abcam, Cambridge, MA). The assay is based on the enzymatic cycling reaction. Briefly, 2 ϫ 10 6 cells per variable were harvested from 60-mm culture dishes with cold PBS and pelleted after centrifuging at 1,000 ϫ g for 5 min. Cells were lysed in 400 l of ice-cold NAD/NADH extraction buffer by two freeze/thaw cycles (20 min on dry ice followed by 10 min at 22°C). They were then vortexed for 10 -15 s. The cells were centrifuged at 16,000 ϫ g for 5 min at 4°C. The supernatant was filtered through a 10,000 molecular weight cut-off microspin column to remove internal NADH-consuming enzymes. To measure NADH, NAD was decomposed by heating 200 l of extracted sample at 60°C for 30 min. 50 l of NAD decomposed sample was used for the assay with NADH in 96-well plates. Likewise, total NADt (total NAD and NADH) was measured by adding 50 l of unheated sample extract into 96-well plates. Then 100 l of NADH cycling enzyme/buffer reaction mix was added to each well, mixed thoroughly by a transfer pipette, and incubated at 22°C for 5 min to convert NAD into NADH. 10 l of NADH developer was added to each well and mixed. The mixture was left at room temperature for 4 h to allow for color development. Spectrometric readings were then recorded at A 450 nm . An NADH standard was prepared by following the protocol provided in the kit. The NAD/ NADH ratio was calculated as (NADt Ϫ NADH)/NADH. Each sample reaction was performed in duplicates, and experiments were repeated four times.
Detection of Intracellular ROS and GSH-LLC-PK1 cells that had undergone various treatments were grown to near confluence in coverglass chambers and then made quiescent by serum starvation for 24 h. They were incubated with Hanks' balanced salt solution for 30 min. For detection of ROS, the cells were incubated with 10 M H 2 O 2 -sensitive DCF-DA probe for 30 min at 37°C and then subjected to microscopic examination, as described previously (34). The intracellularly generated H 2 O 2 oxidizes DCF-DA to fluorescent DCF (green fluorescence), which is detected by UV light or confocal laser microscopy with excitation at 488 nm and emission at 520 nm. For detection of GSH, the cells were stained with 10 M MBB. MBB reacts nonenzymatically with GSH and binds to thiol groups, and it is excited by UV light and then emits bluish fluorescence at 450 nm with an intensity that is proportional to the intracellular GSH content (35,36). GSH and GSSG levels were also measured using a glutathione assay kit as per the manufacturer's instructions (37). Briefly, 2 ϫ 10 7 cells from various experiments were collected in 500 l of cold 50 M MES buffer and sonicated. The lysed cells were then centrifuged in a microcentrifuge, and supernatant was collected. Protein concentration in the supernatant was measured by using Bio-Rad reagent. An equal volume of meta-phosphoric acid reagent was added to the supernatant and mixed by vortexing and kept at 22°C for 5 min to precipitate proteins. Solution was recentrifuged at 3,000 ϫ g for 2 min, and supernatant was collected. 50 l of triethanolamine reagent was added and mixed by brief vortexing. 50 l of the sample was used for determination of GSH. For GSSH measurement, 10 l of 1 M 2-vinylpyridine was added to 1 ml of triethanolamine reagent mixed sample, incubated at 22°C for 1 h, and used. Measurements were made in a 96-well plate. 50 l of sample was added to 150 l of assay mixture solution provided in the kit in each well and mixed in the dark by using an orbital shaker. Spectrometer readings were then made from four experiments at 410 nm, and concentrations of GSH and GSSG were calculated using a standard curve.
Determination of the Source of Intracellular ROS Generation in MIOX-overexpressing Cell Line and the Effect of NOX siRNA on ROS under High Glucose Ambience-ROS generation was measured using fluoroprobe CM-H 2 DCF-DA as indicated above. The dye following its diffusion into the cell becomes deacetylated by cellular esterase and then oxidized by intracellular ROS into a fluorescent compound, DCF, which was detected by a flow cytometer. About 2 ϫ 10 5 LLC-PK1 cells or MIOX-overexpressing LLC-PK1 cells were seeded into 6-well plates and allowed to attach overnight. MIOX-overexpressing LLC-PK1 cells were then treated with ROS inhibitors Mito Q (1 M) or DPI (10 M) for 6 h. These inhibitors have been described to inhibit the mitochondrial and NADPH oxidase ROS generation, respectively (38 -40). In another set of experiments, cells were transfected with either NOX4 siRNA, scramble oligonucleotide, or NAC (10 mM). They were then maintained in culture for 24 h under high glucose ambience. Cells were gently scraped off from the plate with a rubber policeman and transferred into FACS tubes for staining. A 5 mM stock of CM-H 2 DCF-DA in DMSO was diluted in PBS to make a final concentration of 5 M. Cells were then stained with 5 M CM-H 2 DCF-DA for 15 min at 37°C in dark. They were washed twice with PBS and resuspended into 300 l of PBS and processed for acquisition of fluorescence by a flow cytometer. Flow cytometric analyses were performed using standard operational procedures, and the fluorescence of a total of 10,000 cells was acquired for each sample. Mean fluorescence intensity of the CM-H 2 DCF-DA was determined by employing FACSDiva software (BD Biosciences).
Assessment of Cellular Distribution of Cytochrome c-Confocal microscopy was employed to delineate the distribution of cytochrome c, as described previously (41). Cells were incubated with 25 nM Mitotracker dye (Mitotracker Red, Molecular Probes, Inc.) at 37°C for 10 min. Slides were washed with PBS and fixed in 4% formaldehyde. They were then incubated with primary anti-cytochrome c antibody followed by incubation with FITC-labeled secondary antibody. Cells were also subjected to DAPI staining to visualize the nuclei. Images were taken using different excitation filters and merged.
In addition, confocal microscopy was performed for co-localization of cytochrome c and COX IV. The COX IV is considered a marker of mitochondria that does not dissociate from this organelle following oxidant stress or H 2 O 2 treatment (42,43). Briefly, 2 ϫ 10 5 cells were seeded on coverslips in a 6-well plate and allowed to attach overnight. Cells that had undergone various treatments were fixed with 4% paraformaldehyde for 5 min in PBS and washed three times with PBS. They were then permeabilized with ice-cold methanol for 10 min at Ϫ20°C. Cells were rewashed twice in PBS and incubated in a blocking solution (1ϫ PBS, 1% BSA, 0.3% Triton X-100) for 1 h. After blocking, fixed cells were immersed in a solution containing rabbit anti-COX IV or mouse anti-cytochrome c antibody diluted in blocking solution for 2 h at 22°C. Cells were then washed three times with PBS and incubated in FITC or rhodamine-conjugated secondary antibodies for 1 h in the dark. FITC-conjugated anti-rabbit IgG was used for labeling COX IV, and rhodamine-conjugated anti-mouse IgG was used for labeling cytochrome c. Cells were then washed three times with PBS. Cellular nuclei were stained with 0.5 g/ml DAPI for 5 min. Cells were rewashed twice with PBS. Coverslips were then mounted with a drop of DAKO fluorescent mounting medium, and images were obtained using a Nikon A1R spectral confocal microscope.
Assessment of Mitochondrial Membrane Potential (⌬⌿ m )-To measure the loss of ⌬⌿ m , confocal microscopy of cells stained with TMRE was employed (44). For these analyses, LLC-PK1 cells subjected to various treatments, high glucose versus low glucose, and those overexpressing MIOX and subjected to siRNA treatments were plated onto 35-mm glass bottom culture dishes (MatTak Corp.) and maintained at 37°C in a defined medium. After high glucose treatment, the cells were placed in a phenol red-free DMEM (Life Technologies, Inc.) containing 50 nM TMRE for 30 min and examined by confocal microscopy. To visualize the nuclei, cells were stained with DAPI.
Assessment of Mitochondrial Ultrastructural Morphology-Electron microscopy was employed to delineate the ultrastructural integrity of the mitochondria of LLC-PK1 cells subjected to various treatments. Treated cells were immediately immersion-fixed in Karnovsky's paraformaldehyde-glutaraldehyde fixative for 4 h at 22°C. They were then gently scraped from the culture Petri dishes, following which, a pellet was prepared by centrifugation at 10,000 ϫ g for 10 min. The pellet was treated with OsO 4 and uranyl acetate, dehydrated in a graded series of ethanol, and then processed for embedding in EPON (44). About 0.5-m-thick sections were prepared and stained with 1% toluidine blue. The area representing a maximum number of cells with en face view were selected for thin sectioning with an average thickness of 60 nm and examined with an electron microscope at 80 kV. Ten cells/variable were photographed at a magnification of ϫ5,000, and 25 mitochondria were measured along the long axis. We designated intactness of mitochondria based on the morphology of a majority of mitochondria (Ͼ70%) that were more than 1 m in length along the long axis in control cells, as described previously (45).
Detection of Mitochondrial DNA (mtDNA) Damage-Damage to high and low molecular weight mtDNA was evaluated by PCR amplification procedures, as described previously (46). Long range PCR was used to co-amplify high and low molecular weight mtDNA fragments in LLC-PK1 cell culture samples. For high molecular weight DNA, PCR primers used were as follows: 5Ј-ATT GCG AGA CGC TGG AGC CG-3Ј (sense) and 5Ј-TAC CCC CGG TCG TGT AGC GG-3Ј (antisense). Primers for low molecular weight DNA were as follows: 5Ј-GGG GGT ATG CAC GCG ATA GCA-3Ј (sense) and 5Ј-GGA TGG GCG GGG GTT GTA TTG-3Ј (antisense). PCR products were electrophoresed on 1.5% agarose gels and stained with ethidium bromide to visualize the ϳ8and ϳ0.45-kb DNA products. Band intensity was measured with a PhosphorImager (Molecular Dynamics).
Assessment of Apoptosis-Samples from LLC-PK1 cells having undergone various treatments were evaluated for the extent of apoptosis. An in situ cell death detection kit (Roche Applied Sciences) was employed, in which nicked or blunt ends of the DNA strands or the 3Ј-OH ends of the genomic DNA are labeled with fluorescein-dUTP, and the reaction is catalyzed by terminal deoxynucleotidyltransferase. This procedure is also known as the TUNEL method. For these studies, the cells were immersion-fixed in 4% phosphate-buffered (pH 7.4) paraformaldehyde solution for 20 min at 22°C. They were then permeabilized with 0.1% Triton X-100 at 4°C for 1 min and processed for the TUNEL reaction as per instructions provided by the manufacturer and examined with a UV microscope equipped with epi-illumination.
Caspase-3 Activity Assay-The assay was performed using a colorimetric caspase-3 assay kit (Sigma). The assay is based on hydrolysis of peptide substrate acetyl-Asp-Glu-Val-Asp p-nitroanalide by caspase-3 into p-nitroaniline, which has maximum absorbance at 405 nm. Briefly, 5 ϫ 10 6 empty vectortransfected LLC-PK1 and MIOX-transfected LLC-PK1 cells were seeded overnight. Cells were treated with HG (25 mM) and NAC (10 mM) for 24 h. Cells were scraped off from plates and pelleted by centrifugation. The pellet was washed with PBS and suspended in 100 l of 1ϫ supplied lysis buffer. Cells were then incubated on ice for 20 min with intermittent gentle vortexing. Lysed cells were then centrifuged at 16,000 ϫ g for 10 min at 4°C. Supernatants were transferred into a new tube and used for the caspase-3 activity assay. Each sample was assayed in duplicate in a 96-well plate in a 200-l reaction volume. 10 l of lysate containing 100 g of protein/sample, 170 l of 1ϫ assay buffer, and 20 l of caspase-3 substrate were added and mixed by gentle shaking. Wells were then covered with adhesive film and incubated at 37°C for 6 h. Absorbance was read at 405 nm after 6 h.
Measurement of Fibronectin and TGF-␤ in Culture Medium and Cellular Expression of Fibronectin-Quantitative measurements of both of the parameters was performed using cell culture medium. Fibronectin in the culture supernatants of conditioned medium was measured by using a quantitative competitive ELISA kit according to the vendor's instructions (Assaypro), and it was expressed as ng/mg of total cellular protein. TGF-␤1 in culture supernatants of conditioned medium (100 l) was first activated by the addition of 20 l of 1 N HCl and then incubated at 25°C for 10 min, followed by neutralization with 20 l of 1 N NaOH. Total TGF-␤1 was measured using a sandwich ELISA kit according to the manufacturer's instructions (Assaypro), and its amount in the samples was expressed as pg/mg of total cell protein. In addition to the amount of TGF-␤1 in the culture medium, its bioactivity was determined using a mink lung epithelial cell line stably transfected with plasminogen activator-inhibitor-1 promoter linked to the luciferase reporter gene (30). Mink cells were seeded onto a 96-well tissue culture plate (1.6 ϫ 10 4 /well) and allowed to adhere for 3 h. A serial dilution of TGF-␤1 standard or conditioned medium from LLC-PK1 cells (1:1 dilution) was added to the medium of the mink cells and incubated for 15 h. Luciferase activity was determined using Promega Luciferase assay reagent, as described previously (31). Values obtained in various samples were compared with TGF-␤1 standards. For cellular fibronectin expression, cells were treated with cold methanol at Ϫ20°C for 4 min and rinsed twice with PBS solution. After blocking in 3% of bovine serum albumin, the cells were incubated with mouse monoclonal anti-fibronectin at 4°C for 12 h, washed with PBS twice, and then re-incubated with anti-mouse IgG conjugated with FITC at 22°C for 4 h. Then sections were rewashed with PBS and counterstained with TO-PRO-3-iodide to demarcate the nuclei.
Statistical Analysis-All results are depicted as mean or mean Ϯ S.D. Data were analyzed by one-way analysis of variance, and a p value of Ͻ0.05 was considered statistically significant.

Results
The findings described here include events that indicate that following increased expression of MIOX in tubular cells under high glucose ambience, there is an accentuated perturbation in cellular redox and mitochondrial homeostasis, leading to cellular apoptosis. In addition, there is an increased synthesis of ECM proteins, reflective of tubulo-interstitial injury in diabetic nephropathy.
Expression of G-X Pathway Enzyme-By immunohistochemical and RT-PCR analyses, the existence of a G-X pathway in kidney cortical tubular cells was explored. Antibodies to the first two enzymes (i.e. MIOX and ALR1) are available, and by immunohistochemical analyses, their expression was seen primarily confined to the renal cortex, especially in the renal proximal tubules (Fig. 2, B and C). By RT-PCR analysis, expression of five enzymes (i.e. MIOX, ALR1, gulonate dehydrogenase, xylulose reductase, and xylulose kinase) could be demonstrated in kidney tissues (Fig. 2D), which confirmed the existence of a G-X pathway in the kidney cortical tubules, as it has been described in the eye lens previously and is akin to the polyol pathway (25)(26)(27)(28).
Expression and Activity of MIOX following Transfection in High Glucose Ambience-The expression of MIOX increased in response to various D-glucose concentrations (5-25 mM) in a dose-dependent manner, as assessed by Western blotting analyses (Fig. 3, A (a) and B). Exposure of cells to various concentrations of D-glucose in the presence of pcDNA (empty vector; EV) exhibited a negligible increase in the expression of MIOX. Treatment with MIOX-specific siRNA caused a notable reduction in the expression of MIOX (Fig. 3, A (a) and B). Transfection of LLC-PK1 cells with MIOX-pcDNA increased the expression of MIOX at basal as well as high concentration (5-25 mM glucose) (Fig. 3, A (b) and C). This increased expression was normalized to almost basal levels following the treatment of transfected cells with MIOX siRNA in high glucose ambience (Fig. 3, A (b) and C). The exposure with L-glucose, serving as a control, induced no significant change in the expression of MIOX with or without pcDNA transfection or siRNA treatment (Fig. 3, A (c) and D). The expression of ␤-actin, another control, exhibited no notable change in its expression following transfection, exposure to HG ambience, or siRNA treatment, compared with LLC-PK1 cells maintained under low glucose (LG; 5 mM) basal conditions. Band density normalized to respective ␤-actin band density of four blots of each variable is shown in bar graphs in Fig. 3, B-D.
Basal MIOX enzyme activity in the cellular extract from cells maintained at LG was designated as 100%, and a relative percentage increase in various samples was calculated. A dose-dependent increase in the enzyme activity was observed at various concentrations of D-glucose (5, 15, and 25 mM) (Fig. 3E, col-umns 1-3). At 25 mM (HG), a Ͼ50% increase in enzyme activity was observed. No increase in activity was observed in the presence of L-glucose (Fig. 3E, column 4). With the transfection of EV, no further increase was observed compared with that seen under high D-glucose (25 mM) ambience (Fig. 3E, column 5). However, MIOX-pcDNA transfection led to an almost doubling of the enzyme activity even at low D-glucose concentration (Fig. 3E, column 6). Interestingly, transfection of MIOX-pcDNA led to another ϳ25% increase in MIOX activity in the presence of high D-glucose (25 mM) ambience (Fig. 3E, column  7). This increase in MIOX activity in the transfectants was largely unaffected with the treatment of nonspecific scramble oligonucleotide under HG ambience (Fig. 3E, column 8). Treatment of MIOX-transfected cells with MIOX-specific siRNA led to a substantial decrease in MIOX activity under high glucose ambience (Fig. 3E, column 9). Although the changes in MIOX activity under various conditions were not as impressive as its expression, it was nevertheless considered significant.
Effect of Glucose on H 2 O 2 Generation and Relative Depletion of Cellular Reduced Glutathione following MIOX Transfection-For determination of H 2 O 2 production, LLC-PK1 cells were grown under various conditions and then made quiescent by transferring to culture medium containing 0.1% FBS. The medium was replaced with Hanks' balanced salt solution containing H 2 O 2 -sensitive fluorophore DCF-DA (10 M) and examined by a microscope equipped with UV illumination. Under basal LG ambience, a mild DCF-associated green fluorescence was observed, and no significant change in the fluorescence was observed in cells transfected with EV ( Fig. 4A (a)). Treatment with high glucose induced a robust increase in DCFassociated fluorescence (Fig. 4A (b)). DCF fluorescence was markedly enhanced in cells transfected with MIOX-pcDNA under high glucose ambience, HG (Fig. 4A (c)), suggesting that MIOX transfection boosts the generation of H 2 O 2 . Treatment of such transfected cells with MIOX siRNA markedly reduced the fluorescence (Fig. 4A (d)), indicating a substantial contribution of MIOX in the generation of H 2 O 2 .
For determination of cellular GSH, cultured medium of treated cells was replaced with Hanks' balanced salt solution containing MBB (10 M), and cells were then examined. Under basal conditions of LG, a bright MBB-associated bluish fluorescence was observed, whereas no differences in the intensity of fluorescence were noted with the transfection of empty vector ( Fig. 4B (a)), suggesting that there are sufficient amounts of GSH present under LG ambience. Treatment with high glucose induced a notable decrease in MBB-associated fluorescence (Fig. 4B (b)). A further decrease in the intensity of fluorescence was observed in cells transfected with MIOX-pcDNA under high glucose ambience (Fig. 4B (c)), indicating that MIOX transfection led to a marked depletion of cellular GSH, whereas the treatment of cells with MIOX siRNA largely restored the intensity of MBB fluorescence (Fig. 4B (d)), suggesting that MIOX transfection itself also contributes to the depletion of cellular GSH. In addition, the GSH/GSSG ratio was also determined (Fig. 4C). Under high glucose ambience, the ratio was decreased, and a further decrease was seen in cells overexpressing MIOX, whereas siRNA treatment prevented such a decrease to a certain extent, suggesting that depletion of reduced glutathione is accentuated with overexpression of MIOX.
Perturbation in NAD ϩ /NADH Ratio following MIOX Transfection under High Glucose Ambience-Because perturbation in the NAD ϩ /NADH ratio conceivably reflects the state of "cellular redox" and both NADH and NAD ϩ are intricately involved in the MIOX-initiated pathway, their status was investigated in cells subjected to LG versus HG ambience and following transfection of LLC-PK1 cells in the absence of FBS for 18 h. About a 50% decrease in the NAD ϩ /NADH ratio was observed under HG ambience (Fig. 4D, column 1 versus column 3). Transfection of pcDNA (EV) produced a negligible change in the NAD ϩ / NADH ratio in cells, maintained either under LG or HG ambience, as compared with non-transfected cells (Fig. 4D, columns  2 and 4). The ratio in cells transfected with MIOX-pcDNA3.1 was also reduced under LG ambience (Fig. 4D, column 5). Interestingly, the ratio in MIOX-pcDNA3.1 transfectants was markedly reduced (ϳ3-fold) in the presence of HG ambience, indicating that cells under these conditions have a remarkable relative deficiency of NAD ϩ (Fig. 4D, column 6). Treatment with siRNA partially normalized the NAD ϩ /NADH ratio in MIOX-transfected cells maintained under high glucose ambience, whereas scramble oligonucleotide had no significant effect (Fig. 4D, columns 7 and 8), suggesting that there are certain similarities with respect to the perturbation in the "cellular redox" that is seen with MIOX and aldose reductase, an enzyme expressed in renal tubules that plays a key role in glucose metabolism (26,27). The intimate relationship of MIOX with glucose metabolism and the pentose pathway gave us the impetus to investigate the cellular redox and the adaptive responses that are associated with such a scenario and the signaling events that lead to mitochondrial dysfunctions related to the pathogenesis of diabetic nephropathy. Adaptive Changes in the Profile of Antioxidant Defense System and Oxidant Stress-responsive Enzymes in Response to Perturbation in the Intracellular Redox-In view of the generation of oxygen radicals and depletion of cellular GSH with MIOX transfection under HG ambience, expression of various molecules relevant to the antioxidant defense system was investigated by Western blotting analyses. Expression of six key proteins intimately related to the antioxidant systems and oxidant stress responsiveness was investigated. They were as follows: SOD1, SOD2, NOX4, heme oxygenase-1, catalase, and glutathione peroxidase. By Western blotting analyses, a variable low level expression of each of these proteins was observed under LG ambience or in cells transfected with EV (Fig. 4E, lane 1). In general, a similar trend for the change in the expression of all six proteins in response to different treatments was observed, although the degree of increase/decrease was somewhat vari-able. With HG treatment, a notable increase in their expression was observed, whereas concomitant transfection with EV led to no further increase in the expression (Fig. 4E, lanes 2 and 3). Transfection with MIOX-pcDNA also yielded a notable increase in the expression of all the proteins, and it was higher compared with that seen with HG treatment (Fig. 4E, lane 4  versus lane 2). A tremendous increase in the expression of proteins was observed with the transfection of MIOX-pcDNA in cells maintained under HG ambience up to 15 h (Fig. 4E, lane  5). Treatment of these transfectants with MIOX siRNA in the presence of HG significantly reduced their expression, although the restoration was still much above the basal levels (Fig. 4E, lane 6), suggesting that MIOX transfection also contributed to HG-induced adaptive up-regulation of the antioxidant defense system. Interestingly, at the 30 h time point, the expression of various enzymes was reduced (Fig. 4E, lane 7), suggesting exhaustion of redox defense mechanisms. Band densities normalized to respective ␤-actin band densities of each set of the above experiments in Fig. 4E are shown in bar graphs in Fig. 4, F-K, corresponding to the lanes depicting expression of SOD1, SOD2, NOX4, heme oxygenase-1, catalase, and glutathione peroxidase, respectively.

Delineation of the Source of Intracellular ROS Generation in MIOX-overexpressing Cell Line and Effect of NOX siRNA on ROS under High Glucose Ambience-To delineate the source of ROS in MIOX-overexpressing cells, they were treated with
Mito Q and DPI, compounds that are known inhibitors of ROS generated from mitochondria and NADPH oxidase, respectively (38 -40). Both Mito and DPI inhibited DCF-DA-associated fluorescence, as gauged by flow cytometric analyses (Fig. 5, A-E). Although mean fluorescence intensity decreased with individual treatments of these inhibitors, neither of them could completely inhibit the fluorescence, suggesting that the ROS in MIOX-overexpressing cells are derived from both intracellular sources. Because we observed in our previous experiments (Fig.  4E) that there were perturbations in expression of renal tubular NOX4 and in view of the fact that its modulation is influenced by the diabetic state (30), the following question we addressed. Can NOX4-specific inhibition reduce the generation of ROS in MIOX-overexpressing cells under high glucose ambience? NOX4 siRNA did inhibit the generation of ROS, both under basal conditions and under high glucose ambience (Fig. 5, F-L).
However, siRNA treatment did not reduce the DCF-DA-associated fluorescence to basal levels, indicating that there are additional sources of ROS generation (e.g. mitochondria) in MIOX-overexpressing cells under high glucose ambience.
Perturbation in Mitochondrial Homeostasis following MIOX Transfection under High Glucose Ambience-Because ROS were found to be derived from both NADPH and mitochondrial sources following MIOX overexpression under HG ambience, we proceeded to delineate changes that would be reflective of mitochondrial dysfunctions relevant to cellular redox imbalance. LLC-PK1 cells were stained with Mitotracker (red fluorescence) to localize the mitochondria and were then stained with anti-cytochrome c antibody (green fluorescence) and counterstained with DAPI (blue) to outline the nuclei by confocal microscopy. Under basal conditions of LG ambience, cytochrome c and Mitotracker co-localized to mitochondria and yielded a deep orange-colored fluorescence (Fig. 6A (a)). Treatment with HG led to a moderate degree of leakage of cytochrome c into the cytosolic compartment ( Fig. 6A (b), bluish arrowheads). However, MIOX transfection under high glucose ambience led to a marked diffusion of cytochrome c into the cytosol (Fig. 6A (c), red arrowheads). On the other hand, siRNA treatment of MIOX-pcDNA-transfected cells maintained under HG ambience largely restored the co-localization of cytochrome c and Mitotracker, yielding an orange-colored fluorescence (Fig. 6A (d)), suggesting preservation of mitochondrial integrity. Cytochrome c release experiments were also repeated with the use of another mitochondrial marker, COX IV, which does not dissociate from mitochondria under oxidant stress (42,43). Following various treatments, cells were stained with anti-COX IV (green fluorescence) and anti-cytochrome c (red fluorescence). Under low glucose conditions, cytochrome c and COX IV co-localized in the mitochondria and yielded a yellow-colored fluorescence ( Fig. 6B (a)), and HG treatment led to a moderate degree of leakage of cytochrome c ( Fig. 6B (b), bluish arrowheads). Whereas MIOX transfection under HG ambience led to a marked diffusion of cytochrome c into the cytosol (Fig. 6B (c), bluish arrowheads), siRNA treatment largely restored the co-localization of cytochrome c and COX IV, yielding a yellow-colored fluorescence (Fig. 6B (d)), as observed under control low glucose conditions.  b and c)). Fluorescence was markedly reduced with MIOX siRNA treatment (A (d)). B, effect of HG on the relative depletion of cellular GSH following MIOX transfection. A bright MBB-associated blue fluorescence was observed under LG ambience in the presence or absence of EV (B (a)). HG significantly reduced fluorescence, which was further decreased with the transfection of MIOX-pcDNA (B (b and c)), and it was restored with treatment with MIOX siRNA (B (d)). In addition, the GSH/GSSG ratio was also determined (C). Under HG, the ratio was decreased, and a further decrease was seen in cells overexpressing MIOX. MIOX siRNA treatment prevented such a decrease to a large extent. D, perturbation in NAD ϩ /NADH ratio following MIOX transfection in HG ambience. About a 50% decrease in the NAD ϩ /NADH ratio was observed under HG ambience compared with LG concentration, and no further decrease was seen with transfection of EV (columns 1-4). A comparable decrease in the ratio was observed following MIOX-pcDNA transfection alone under LG ambience, and it further decreased in the presence of HG ambience (columns 5 and 6). Treatment with siRNA improved the NAD ϩ /NADH ratio in MIOX-transfected cells maintained under HG ambience, whereas scramble oligonucleotide had no significant effect (columns 7 and 8). E, profile of antioxidant defense system and oxidant-responsive enzymes in response to perturbation in the intracellular redox. Western blotting analyses of antioxidant enzymes (i.e. SOD1, SOD2, NOX4, heme oxygenase-1 (HO-1), catalase, and glutathione peroxidase (GPX)) revealed a variable increase in their expression up to 15 h of the culture period under HG ambience. Concomitant transfection with EV did not cause any further increase in their expression, as compared with that observed at LG concentration (lanes 1-3). Transfection with MIOX-pcDNA yielded a comparable increase, and it was notably increased under HG ambience, whereas it was reduced to basal levels by MIOX siRNA treatment (lanes 4 -6). Interestingly, the expression of various enzymes of the scavenging system was reduced in the 30 h time frame of the culture. Band densities normalized to respective ␤-actin band densities of various blots of each variable (i.e. SOD1, SOD2, NOX4, heme oxygenase-1, catalase, and glutathione peroxidase) compared with their respective controls at the 15 h time point are shown in bar graphs in corresponding panels F-K (n ϭ 4; *, p Ͻ 0.01; #, p Ͻ 0.05). Error bars, S.D.
In view of cytochrome c leakage from mitochondria under HG ambience and MIOX overexpression, mitochondrial integrity was investigated by measuring their membrane potential, as assessed by confocal microscopy after staining with TMRE followed by counterstaining nuclei with DAPI. Normally, under LG ambience, TMRE is seen uniformly localized to mitochondria ( Fig. 6C (a)). A significant loss of TMRE staining was observed with treatment with HG ( Fig. 6C (b)). Transfection of cells with MIOX-pcDNA under HG ambience caused a marked loss of ⌬⌿ m , as indicated by loss of TMRE fluorescence in LLC-PK1 cells (Fig. 6C (c)), whereas siRNA treatment of cells transfected with MIOX-pcDNA largely restored the cellular TMRE fluorescence (Fig. 6C (d)), indicating a recovery of ⌬⌿ m from HG-MIOX-pcDNA injury.
Perturbations observed in the integrity of mitochondria led us to directly examine their ultrastructure by electron microscopy. Cells maintained in medium containing 5 mM glucose (LG) had tubular morphology of mitochondria with intact inner and outer membranes and cristae ( Fig. 6D (a)). Cells grown in medium containing HG had constrictions in the main body of mitochondria with a certain degree of deformation of their cristae (Fig. 6D (b), arrowhead). Overexpression of MIOX induced further deformations of mitochondria under HG ambience. Mitochondria were highly deformed with an increased number of constrictions and a relative loss of cristae (Fig. 6D (c), arrowheads), suggesting that mitochondria are undergoing a tremendous degree of fission. Constrictions were significantly lessened following siRNA treatment of these transfected cells, and they regained their cristae structures and tubular morphology (Fig. 6D (d)), indicating that an adverse effect on morphology of mitochondria to a large extent was also contributed to by MIOX overexpression. Quantitative measurements indicated that under basal conditions, about 70% of intact mitochondria were Ͼ1 m in length along the long axis, which was decreased to 47 and 35% under HG ambience and HG ϩ MIOX overexpression, respectively. The population of intact mitochondria was restored to 63% following siRNA treatment, whereas mild constrictions still persisted in some of the mitochondria (Fig. 6D (d)).

Impairment of Mitochondrial DNA and Induction of Apoptosis following MIOX Transfection under High Glucose
Ambience-In view of the deformations of mitochondria observed by electron microscopy, we proceeded to investigate whether MIOX overexpression and high glucose can induce mitochondrial DNA damage. Under basal conditions of low glucose ambience, bands corresponding to high molecular DNA (ϳ7.8 kb) and low molecular DNA (ϳ0.4 kb) were visualized by PCR analyses (Fig. 7A, lane 1). Transfection of empty vector resulted  LG ambience, TMRE staining is seen uniformly localized to the mitochondria (C (a)). A moderate loss of TMRE staining was observed with the treatment with HG (C (b)). Transfection of cells with MIOX-pcDNA under HG ambience caused a loss of staining (i.e. loss of ⌬⌿ m ) (C (c)), whereas siRNA treatment restored the cellular TMRE fluorescence to basal levels (C (d)). D, effect of MIOX overexpression on mitochondrial ultrastructure under HG ambience. By electron microscopy, cells maintained in medium containing LG showed normal morphology in the majority (ϳ70%) of mitochondria (Ͼ1 m in length along the long axis) with intact inner and outer membranes and cristae (D (a)). Under HG ambience, the population of tubular mitochondria decreased to 47%, and there were constrictions in the body of the mitochondria accompanied by a relative loss of their cristae (D (b), arrowhead). Overexpression of MIOX further decreased the population of intact mitochondria to 35% and induced marked constrictions and at times U-shaped angulation or other deformations of mitochondria in the presence of HG ambience (D (c), arrowheads), suggesting that mitochondria are undergoing a significant degree of fission. MIOX siRNA treatment significantly lessened the constrictions, and a majority (ϳ63%) of mitochondria regained their tubular morphology (D (d)).
in a mild increase in the expression of a high molecular band (Fig. 7A, lane 2). Cells subjected to HG ambience in the presence or absence of empty vector showed a notable decrease in the intensity of the band of high molecular weight DNA (Fig.  7A, lanes 3 and 4 versus lanes 1 and 2). Transfection of cells with MIOX-pcDNA also caused a significant decrease in the intensity of the high molecular weight (Fig. 7A, lane 5 versus lanes 1  and 2), whereas additional exposure of MIOX-pcDNAtransfected cells to HG ambience resulted in a marked decrease in the intensity of high molecular weight DNA (Fig. 7A, lane 6 (asterisk) versus lanes 1 and 2). Treatment of transfected cells maintained in HG ambience with MIOX siRNA restored the integrity of high molecular weight DNA, as indicated by the intensity of the band (Fig. 7A, lane 7 versus lane 6), suggesting that MIOX overexpression in the presence of HG is readily injurious to the integrity of high molecular weight DNA.
Like the mitochondrial DNA impairment nuclear DNA damage was also observed, as reflected by the extent of apoptosis. Under basal conditions, no significant apoptosis was observed ( Fig. 7B (a)). HG ambience induced a moderate degree of apoptosis ( Fig. 7B (b), arrows), which was markedly accentuated upon transfection with MIOX-pcDNA (Fig. 7B (c), arrows). With treatment of MIOX siRNA, the apoptosis was remarkably reduced, and only a few tiny nuclear fragments were seen (Fig.  7B (d), arrowheads). The above findings indicated that morphologic deformations in the mitochondria are accompanied by damage to both mitochondrial and nuclear DNA.
Effect of NAC on MIOX-and HG-induced Apoptosis and Expression of Bax, Bcl2, and Cleaved Caspase-3 and Activity of Caspase-3-Cells under HG ambience or transfected with MIOX-pcDNA had increased expression of apoptogenic pro-tein Bax (Fig. 8A (a), lanes 2 and 4 versus lane 1). The expression was further increased following concomitant treatment with HG and MIOX transfection (Fig. 8A (a), lane 5). Treatment with NAC (10 mM) reduced the expression of Bax (Fig. 8A (a),  lanes 3 and 6). Expression of anti-apoptogenic protein Bcl2 decreased with HG treatment as well as by MIOX transfection (Fig. 8A (b)). Furthermore, there was a marked decrease of Bcl2 expression with concomitant treatment with HG and MIOX transfection ( Fig. 8A (b), lane 5). The decreased expression was restored to a large extent by NAC treatment (Fig. 8A (b)). Band densities normalized to respective ␤-actin band densities of various lanes of Fig. 8A (a and b) are shown in bar graphs in Fig.  8, B and C. Because ROS induce apoptosis via modulating the mitochondrial release of cytochrome c and activation of caspase-3, levels of cleaved caspase-3 were assessed. Both HG treatment and MIOX transfection led to an increased expression and activity of caspase-3 (Fig. 8, D (lanes 2 and 4 versus lane  1) and F (columns 2 and 4 versus column 1)). The expression and activity were markedly increased with concomitant treatment with HG and transfection of MIOX (Fig. 8, D (lane 5) and F (column 5)). Treatment with NAC reduced the expression and activity of caspase-3 (Fig. 8, D (lanes 3 and 6) and E (columns 3 and 6)). Band densities normalized to respective ␤-actin band densities of various lanes of Fig. 8D are shown in bar graphs in Fig. 8E. Because NAC modulated the expression of Bax, Bcl2, and cleaved caspase-3, this led us to investigate the status of apoptosis following MIOX transfection under HG ambience and treatment with the ROS inhibitor NAC. No significant apoptosis was observed under LG ambience in cells transfected with EV ( Fig. 8G (a)). MIOX transfection induced a moderate degree of apoptosis (Fig. 8G (b)). HG ambience also induced a   lanes 2 and 4 versus lane 1). The increase was augmented following concomitant treatment with HG and MIOX transfection (A (a), lane 5), and NAC treatment reduced the expression of Bax (A (a), lanes 3 and 6). Expression of anti-apoptogenic protein Bcl2 decreased with HG treatment as well as by MIOX transfection (A (b)). The decrease was augmented with the concomitant treatment with HG and MIOX transfection (A (b), lane 5), and it was restored by NAC treatment (A (b), lane 6). Band densities normalized to respective ␤-actin band densities of Western blots are shown in bar graphs in B and C. D-F, both HG treatment and MIOX transfection induced an increased expression and activity of cleaved caspase-3 (D (a), lanes 2 and 4 versus lane 1; F, columns 2 and 4 versus column 1). They were further increased with concomitant treatment with HG and transfection of MIOX (D (lane 5) and F (column 5)). NAC treatment reduced the expression and activity of cleaved caspase-3 (D (lanes 3 and 6) and E (columns 3 and 6)). Band density normalized to respective ␤-actin band density is included in E. G, no significant apoptosis was seen under LG ambience in cells transfected with EV (G (a)). MIOX transfection or HG ambience induced a moderate degree of apoptosis (G (b and c)). Apoptosis was accentuated following MIOX-pcDNA transfection under HG ambience (G (d)). Apoptosis was reduced with NAC treatment (G (e and f)), suggesting that ROS modulate the events related to apoptosis. Band density normalized to respective ␤-actin band density of various blots and caspase-3 activity, compared with their respective controls, is shown in bar graphs in B, C, E, and F (n ϭ 4; *, p Ͻ 0.01; #, p Ͻ 0.05). notable degree of apoptosis (Fig. 8G (c)), which was markedly accentuated upon transfection with MIOX-pcDNA (Fig. 8G  (d)). With the treatment with NAC, apoptosis was remarkably reduced both in cells maintained under HG ambience and in those transfected with MIOX-pcDNA (Fig. 8G (e and f)). These findings suggested that MIOX-or HG-induced modulation of apoptogenic and anti-apoptogenic proteins is modulated via ROS.
Increased Expression and Bioactivity of TGF-␤1 following Overexpression of MIOX under HG Ambience in LLC-PK1 Cells-Various signaling kinases have been shown to modulate the activity and expression of TGF-␤1; however, information in regard to the modulation of this profibrogenic cytokine by ROS in the context of MIOX biology has not been reported. In view of the perturbations in the "cellular redox," the effect of MIOX and HG on the expression and activity of TGF-␤1 was investigated. The amount of TGF-␤1 was expressed as pg/mg protein, whereas its bioactivity was expressed as a percentage increase, considering 100% as basal level (i.e. LG ambience). No significant increase in expression or bioactivity was observed with transfection of empty vector (pcDNA) under LG ambience (Fig.  9, A and B (columns 1 and 2)). Exposure of cells to HG ambience induced an almost 2-fold increase in bioactivity and expression of TGF-␤1 (Fig. 9, A and B, column 3). There was no significant further increase with transfection of empty vector (Figs. 9, A  and B (column 4)). Interestingly, transfection of MIOX-pcDNA under LG ambience increased the bioactivity or expression of profibrogenic cytokine to levels comparable with those seen following exposure of LLC-PK1 cells to HG (Fig. 9, A and B (column 5)). However, overexpression of MIOX in the presence of HG had an additive effect, and an almost 3-fold increase in the bioactivity and expression of TGF-␤1 was seen, compared with basal levels (Fig. 9, A and B (column 6)). Treatment of MIOX siRNA under these experimental conditions resulted in a marked reduction of this profibrogenic cytokine (Fig. 9, A and  B, column 7), authenticating the specificity of MIOX in modulating the expression or bioactivity of TGF-␤1.

Modulation of Fibronectin Expression by MIOX under High
Glucose Ambience-Because TGF-␤1 modulates the transcription of a number of ECM proteins, we investigated the expression of fibronectin. By immunofluorescence microscopy, a very low level of fibronectin expression was observed under LG ambience, and no significant change was seen in cells transfected with EV ( Fig. 9D (a)). An increased expression of fibronectin was observed in LLC-PK1 cells under HG ambience ( Fig. 9D (b)). A remarkable increase in the expression of fibronectin was observed following overexpression of MIOX under HG ambience (Fig. 9D (c)). To assess the specificity of MIOX effects, cells were treated with RSOR siRNA. Under HG ambience, the cells treated with MIOX siRNA had a notable reduction of immunofluorescence (Fig. 9D (d)), which suggested that the induction of fibronectin expression is also mediated by MIOX.
Fibronectin expression was also measured in culture medium by ELISA and expressed as ng/mg protein. The culture medium of cells maintained in LG conditions or transfected with EV pcDNA had ϳ10 ng/mg fibronectin (Fig. 9C, columns 1  and 2). The cells subjected to HG ambience had a ϳ3-fold increase in the de novo synthesis/expression of fibronectin, which was unaffected by the transfection of EV (Fig. 9C, columns 3 and 4). The cells transfected with MIOX-pcDNA and maintained in LG ambience also had a significantly increased expression of fibronectin (Fig. 9C, column 5). However, those maintained in HG ambience had a marked increase in the de novo synthesis/expression of fibronectin (Fig. 9C, column 6). The specificity of this MIOX effect on the expression of fibronectin was authenticated by treating the cells with MIOX siRNA, where a remarkable decrease in the expression was observed (Fig. 9C, column 7). These results indicated that the culture medium findings accurately reflect those observed in intact cells by immunofluorescence microscopy (Fig. 9C  (ad)). In order to ensure that MIOX-mediated fibronectin expression was modulated via ROS, experiments utilizing the ROS inhibitor NAC were carried out. An increased expression of fibronectin was seen in cells transfected with MIOX-pcDNA, and it was markedly increased with the concomitant exposure of cells to HG ambience ( Fig. 9D (ac)). With the treatment with NAC, the expression of fibronectin was reduced in cells transfected with MIOX and those concomitantly exposed to HG ambience, confirming that MIOX transfection alone increased the fibronectin expression via ROS ( Fig. 9D (bd)).

Discussion
The observations made in this investigation suggest that a G-X pathway enzyme system exists in the kidney (Figs. 1 and 2), and overexpression of MIOX in LLC-PK1 cells, a proximal tubular cell line, induces a number of perturbations that are mainly related to oxidant stress under HG ambiance. Besides the oxidant stress, mitochondrial homeostasis and activity of profibrogenic cytokines were also perturbed, and that led to an increased expression of ECM proteins like fibronectin, as has been described in the various kidney compartments in diabetic nephropathy (1).
Diabetic nephropathy has been the subject matter of intense investigation for half a century, especially the work carried out on the glomerular compartment because the latter highlights the prototypic morphologic changes seen in human renal biopsies (Fig. 1). These morphologic changes are basically reflective of preceding disturbances in various metabolic/cellular signaling pathways with generation of ROS leading to increased synthesis and amassing of ECM proteins in the glomerulus. The ROS are believed to be central to the pathogenesis of DN, as has been thoroughly documented in the glomerular compartment in various animal models and isolated glomerular cells in in vitro culture systems (1)(2)(3). The oxidant stress in hyperglycemic states may not be solely confined to the glomerular cells but also to the tubules, an idea marshaled by Bonventre (47) a few years ago. In support of this contention are our preliminary immunohistochemical studies on human biopsy material showing a highly accentuated expression of NOX4 with identical co-distribution and marked up-regulation of MIOX in diabetic nephropathy (Fig. 1). Interestingly, NOX4 expression was marginally increased in the glomerular compartment in diabetic nephropathy, suggesting that the oxidant stress may be a dominant feature of the tubular compartment where the MIOX is co-expressed.
In order to study tubular pathobiology under high glucose ambience, we utilized LLC-PK1 cells and an MIOX-overexpressing cell line. Both exhibited an increased dose-dependent expression and activity of MIOX under high glucose ambience, and the response was much more accentuated in the overexpressing cell lines. Both expression and activity were notably reduced following MIOX siRNA treatment of cells (Fig. 3), indicating that the culture system is well suited for the delineation of the mechanism(s) related to generation of ROS via the G-X pathway in the tubular compartment. The generation of ROS with altered redox state of pyridine nucleotides (NADPH/ NADP ϩ and NADH/NAD ϩ ratios) has been well described in glomerular cells in diabetic nephropathy with a comparable sequence of events in in vitro systems under high glucose ambience (1, 2, 16). However, whether ROS generation could occur by MIOX via a G-X pathway has not been described, but it is  1 and 2). HG ambience induced a moderate increase in the bioactivity and expression of TGF-␤1, and no significant further increase was seen with EV transfection (columns 3 and 4). Interestingly, transfection of MIOX-pcDNA under LG ambience increased the bioactivity and expression of TGF-␤1 comparable with those seen under HG ambience (column 5). Overexpression of MIOX in the presence of HG markedly increased the bioactivity and expression of TGF-␤1, and it was significantly reduced with MIOX siRNA treatment (columns 6 and 7). C-E, modulation of fibronectin expression by MIOX under high glucose ambience. Under LG ambience, fibronectin expression was quite low in the "cell culture medium" with no significant change following EV transfection (C, columns 1 and 2). Under HG ambience, a ϳ3-fold increase in fibronectin expression was seen, which was unaffected by EV transfection (C, columns 3 and 4). MIOX-pcDNA transfection in LG ambience also caused a comparable increase in fibronectin expression (C, column 5), whereas MIOX-pcDNA transfection under HG ambience caused a marked increase in fibronectin expression, which was significantly reduced by MIOX siRNA treatment (C, columns 6 and 7). At the cellular level, a low level of fibronectin expression was observed under LG ambience, and no significant change was seen in cells transfected with EV (D (a)). A moderate increase in expression of fibronectin was observed in cells under HG ambience (D (b)). A marked increase in fibronectin expression was observed with MIOX overexpression under HG ambience (D (c)), which was restored to basal levels following MIOX siRNA treatment (D (d)). In order to affirm that MIOX-mediated fibronectin expression was modulated via ROS, the cells were treated with NAC. With the treatment with NAC, expression of fibronectin was reduced in cells transfected with MIOX as well as in those concomitantly exposed to HG ambience, confirming that MIOX transfection alone increased the fibronectin expression via ROS (D, a and c versus b and d) (n ϭ 4; *, p Ͻ 0.01; #, p Ͻ 0.05).
conceivable. MIOX is a non-heme di-iron enzyme that oxidizes myo-inositol to glucuronic acid via a G-X pathway (48), which also oxidizes the less abundant chiro isomer of inositol, and its metabolites enter the pentose pathway (24). MIOX is predominantly expressed in kidneys of pigs and humans (26,49); however, it remains to be investigated whether this enzyme is responsible for causing oxidant stress, particularly in the renal proximal tubules. After review of the G-X pathway ( Fig. 2A) and confirmation of its existence in the renal tubules (Fig. 2, B-D), it seems that there would be a redox imbalance once the events are initiated by high glucose ambience. In support of this contention are our studies, which suggest an altered NAD ϩ /NADH ratio following transfection of MIOX-pcDNA under high glucose ambience (Fig. 4D). The altered ratio could be seen in MIOX-transfected cells alone, and the fact the ratio was partially normalized by siRNA treatment would suggest that these redox perturbations may be specific to MIOX-initiated G-X pathway. Certainly, one needs to keep in perspective also other pathways that could alter the pyridine nucleotides (NADPH/ NADP ϩ and NAD ϩ /NADH) ratios. MIOX-induced redox imbalance was further substantiated by staining the cells with DCF-DA. A markedly increased intensity of DCF staining was observed in cells overexpressing MIOX under high glucose ambience, suggesting intracellular generation of ROS (Fig. 4A). Most likely, the generation of H 2 O 2 is mediated through transcriptional mechanisms because the MIOX promoter includes carbohydrate response binding as well as oxidant response elements (29). This increase in the generation of ROS was attributable to being mediated through MIOX because its siRNA could notably decrease DCF fluorescence. Concomitant with the increase in ROS, there was a decrease of intracellular GSH, which could be readily appreciated in MIOX-overexpressing cells subjected to high glucose ambience (Fig. 4B). Like the reduced antioxidant GSH content, the GSH/GSSG ratio was reduced (Fig. 4C), which seems to be attributable to MIOXmediated cellular events, because, following its siRNA treatment, the intensity of fluorogenic MBB and the ratio were largely restored. Such changes in the GSH/GSSG ratio have been described in diabetic patients as well (50).
In view of the antioxidant GSH content, we proceeded to examine the profile of some of the ROS-scavenging oxidant stress-responsive enzyme systems at various time intervals of the cell culture. The enzyme profile could vary, depending upon the interval during which cells undergo oxidant stress or the extremes of reduction/oxidation ROS scavenging systems (phosphorylated NADPH/NADP and reduced/oxidized GSH/ GSSG) (51,52). Overall, the basal levels of various scavenging enzymes, SOD1, SOD2, catalase, and glutathione peroxidase, and their induction profiles were more or less similar (Fig. 4E). During the early time frame, they were notably increased under high glucose ambience with accentuated response in cells transfected with MIOX, and similar increased expression of NOX4 and heme oxygenase was observed. The responsiveness of these scavenging and responsive enzymes was related to the MIOX-mediated pathway because siRNA treatment led to a decrease in their protein expression. Interestingly, during the early time frame, the adaptive response to the oxidant stress was quite striking. However, following 30 h of culture, their expression began to decline remarkably, suggesting exhaustion of the defensive systems, as has been known in diabetic states in other culture systems (52). The prototype of adaptive increase followed by decline in the expression of heme oxygenase-1 following high glucose ambience has also been highlighted in recent studies on retinal endothelial cells (53). Of note, the ROS generated in MIOX-overexpressing cells are derived from both mitochondria and the NADPH oxidase system, as assessed by flow cytometric analysis (Fig. 5). The fact that NOX4 siRNA treatment partially blocked the generation of ROS would also suggest that ROS are derived from dual sources in MIOX-overexpressing cells under high glucose ambience, as has been described in various investigations related to diabetic nephropathy in various animal models (1,3,9,10,50).
To further support the notion that ROS are mitochondrially derived in cells overexpressing MIOX under high glucose ambience, we proceeded to examine morphologic perturbations in mitochondria. Previously, we have described that high glucose induces perturbations in the mitochondrial homeostasis (41).
Here we document that some of these mitochondrial abnormalities are also related to events distinct to the G-X pathway. First, we observed that there is a tremendous degree of translocation of cytochrome c from the mitochondrial to the cytosolic compartment, which was largely reduced following MIOX siRNA treatment (Fig. 6, A and B). The cytosolic translocation would be expected to lead to activation of caspases and eventually cellular apoptosis. The translocation may be related to the compromise in the ⌬⌿ m or cristolysis of the membrane cristae (Fig. 6C). Likewise, these alterations were dampened by siRNA treatment, suggesting a potential role of MIOX in the evolution of such mitochondrial events. More importantly, mitochondrial morphologic changes, as highlighted by electron microscopy, were quite remarkable, where a marked degree of constrictions along their longitudinal axis were observed in cells transfected with MIOX and subjected to high glucose treatment (Fig. 6D). Interestingly, these mitochondrial constrictions were reduced by siRNA treatment. Such deformations are probably related to the imbalance in the expression or activity of various mitofusion (Mfn, Opa1) and mitochondrial fission (Drp1) proteins (54). For the mitochondrial changes described above, one also needs to take into account ROS generated in the mitochondria during various forms of cellular stresses. In fact, some of the ROS are believed to be generated in this critical metabolic organelle when there are perturbations in the electron flow, membrane potential, and NADH pool (55). Also, the fact that we observed changes in the mitochondrial Mn-SOD, SOD2 (Fig. 4E), would suggest that ROS generation in the present scenario is derived from more than one source, which eventually would be expected to damage some of the other downstream critical molecules (e.g. DNA, including mitochondrial DNA), leading to apoptosis. Such damage to the mitochondrial DNA is underscored in our PCR studies, where a notable reduction in the intensity of the high molecular weight DNA band was observed (Fig. 7A). Similarly, marked damage to the nuclear DNA was observed, as reflected by accentuated apoptosis in MIOX-overexpressing cells (Fig. 7B). The fact that apoptosis was lessened and there was a partial recovery of mitochondrial high molecular weight DNA would indicate a substantial contribution of the G-X pathway in the generation of ROS and oxidant stress under high glucose ambience.
Apoptosis is regarded as one of the final morphologic readouts in diabetic nephropathy, as highlighted by various in vitro and in vivo studies (56,57). Apoptosis was associated with increased activity of caspase-3, and it was mainly confined to proximal tubular cells. Caspase-3 activity and apoptosis were reduced with the diminution of oxidant stress, indicating that the proximal tubular injury was caused by ROS. To establish a causal relationship between MIOX-induced injury to LLC-PK1 cells (a tubular cell line) and apoptosis under high glucose ambience, experiments with the ROS inhibitor NAC were carried out. Our data suggested that there is an increased activity of caspase-3 and apoptosis in LLC-PK1 cells under high glucose ambience, and the cellular injury was accentuated with the concomitant transfection of MIOX-pcDNA (Fig. 8). The fact that both apoptosis and caspases-3 activity/expression were reduced with NAC treatment would suggest that MIOX-induced ROS generation is causally linked to such injurious cellular perturbations. Likewise, a reduced expression of anti-apoptogenic Bcl2 by MIOX under HG ambience and normalization of Bcl2 following NAC treatment would lend further support to the idea that apoptosis is directly related to excessive generation of ROS (Fig. 8). Also, increased expression of apoptogenic Bax (Fig. 8) along with the release of cytochrome c (Fig. 6) observed in this investigation would strengthen the notion that MIOX-mediated generation of ROS is directly related to accentuated apoptosis. Besides ROS-induced apoptosis and mtDNA damage, an association between ROS and TGF-␤1-mediated fibrosis has been described in the literature in other organ systems, such as in the lung (58). Indeed, an intricate interplay between TGF-␤1 and ROS has been reported in various studies (reviewed in Ref. 59). Even in the kidney, increased caspase-3 activity, apoptosis, and ROS are seen in the setting of experimental chronic renal scarring or fibrosis (60).
With respect to renal fibrosis, another important final readout of diabetic nephropathy is nodular glomerulosclerosis and tubulo-interstitial fibrosis, as highlighted in the Fig. 1. In regard to glomerulosclerosis, the contribution of ROS, PKC, and advanced glycation end products, involving complex signaling pathways, is very well known, and this process of fibrosis is mediated via a critical profibrogenic cytokine, TGF-␤1 (1-3). ROS may directly modulate the expression and activity of TGF-␤1 (59). Alternatively, redox imbalance can also lead to activation of PKC, which then would modulate expression of TGF-␤1. For instance, PKC activation is reversed by antioxidants and by administration of PKC inhibitors, and that reduces TGF-␤-mediated expression of ECM proteins and thereby ameliorates microvascular complications of diabetes (61,62). However, at this point, it is unknown whether the pathogenetic role of the G-X pathway in tubulo-interstitial fibrosis is mediated by the profibrogenic cytokine, TGF-␤1. Without going into a detailed exploration of known complex signaling pathways that are involved in the process of fibrosis, we mainly investigated the status of TGF-␤1 following MIOX transfection and siRNA treatment in the high glucose milieu. Interestingly, expression as well as activity of TGF-␤1 were markedly boosted in MIOX-overexpressing cells in the presence of high glucose, and they were significantly reduced following siRNA treatment (Fig. 9, A and B). This suggested that, most likely, ROS generated during the G-X pathway, directly or indirectly, modulated TGF-␤1 levels. Conceivably, this profibrogenic cytokine via Smad and MAPK pathways modulates the transcription of various ECM proteins (e.g. collagen and fibronectin) and eventually their cellular or tissue levels (63,64). In line with the TGF-␤1 activity/expression, there was a parallel increase in the expression of fibronectin in the cellular and culture medium compartments of MIOX-overexpressing cells subjected to high glucose treatment (Fig. 9, C and D). The fact that the increased de novo synthesis of fibronectin could be reduced by siRNA treatment would suggest that this enhanced ECM protein expression is reasonably correlative with MIOX-initiated G-X pathway events. This excessive cellular expression of fibronectin and its secretion are reminiscent of the amassing of ECM in the extracellular space, as observed in the tubulo-interstitial compartment in diabetic nephropathy. To authenticate that ECM amassing or excessive synthesis of fibronectin is ROSmediated by MIOX under HG ambience, ROS inhibitor (NAC) experiments were carried out. NAC could substantially decrease the de novo synthesis of fibronectin in cells overexpressing MIOX or in cells concomitantly exposed to HG ambience FIGURE 10. Mechanism(s) leading to excessive generation of ROS following overexpression of MIOX under HG with ensuing increased apoptosis and synthesis of ECM fibronectin. MIOX overexpression (pcDNA transfection) in tubular cells generates excessive generation of ROS from dual sources (i.e. the NADPH oxidase system (NOX4) and mitochondria). ROS can activate TGF-␤ with consequential increased synthesis of ECM proteins, a process reminiscent of tubulo-interstitial fibrosis, whereas mitochondrial perturbations lead to MtDNA damage, leakage of cytochrome c, activation of caspase-3, and consequential apoptosis, changes that are reflective of tubular cell injury. Fibrosis and apoptosis are regarded as the major hallmarks of diabetic nephropathy. (Fig. 9E). These data strongly support the notion that ROS generated in the MIOX initiated pathway are responsible for excessive synthesis of ECM proteins, an injury reminiscent of tubulointerstitial fibrosis. It is anticipated that future studies using animal model systems would delineate the pathogenetic role of this G-X pathway in various renal disease processes with the ultimate goal to devise various therapeutic strategies for the amelioration of diabetic tubulopathy.
In summary, observations made in this investigation underscore the relevance of the G-X pathway in renal tubulo-interstitial injury. Importantly, this study demonstrates the existence of enzymes pertinent to the G-X pathway in murine kidney, and MIOX initiation of this pathway leads to altered NAD ϩ /NADH ratios, activation of the NADPH oxidase system, and perturbations in mitochondrial homeostasis with accentuated generation of ROS. All of these perturbations eventually lead to increased apoptosis, bioactivity of TGF-␤1, and accentuated synthesis of ECM proteins (Fig. 10), the events reflective of tubulo-interstitial injury, as described in in vivo pathologic states, such as in diabetic nephropathy.