The effect of growth differentiation factor 11 on sepsis-associated acute kidney injury

Patients with sepsis often experience severe renal dysfunction and damage and accelerate to end-stage renal failure with high mortality, which currently lacks effective therapeutic approaches. Growth differentiation factor 11 (GDF11), a member of the transforming growth factor-β (TGF-β) superfamily, has been proven to have therapeutic properties for a variety of acute and chronic inflammatory diseases. However, the role of GDF11 in sepsis-associated acute kidney injury (SAKI) remains elusive. Here, we aimed to investigate the role of GDF11 in SAKI and identify the signaling pathways modulated by GDF11. In a mouse model of cecal ligation and puncture (CLP)-induced SAKI, GDF11 was found to be highly expressed in tubular epithelial cells and macrophages in the kidney. Moreover, gene silencing of GDF11 using adeno-associated virus (AAV) aggravated renal dysfunction, increased tubular damage, and augmented renal apoptosis in CLP-induced SAKI mice. In contrast, replenishment of recombinant GDF11 (rGDF11) significantly mitigated these adverse effects. Further investigation revealed that GDF11 activated the nuclear factor erythroid 2-related factor 2 (Nrf2)-regulated antioxidative pathways, mainly through induction of peroxisome proliferator-activated receptor-γ coactivator (PGC)-1α expression, which, in turn, inhibited overactivated inflammation and coagulation both in vivo and in vitro. Additionally, these beneficial effects of GDF11 were largely diminished by AAV-mediated PGC-1α knockdown and depletion of Nrf2 in CLP-induced SAKI mice. Overall, these findings demonstrate that GDF11 represents a promising therapeutic approach for SAKI and reveal the important role of PGC-1α/Nrf2 signaling in GDF11-mediated renal protection during SAKI.