A murine ex vivo 3D kidney proximal tubule model predicts clinical drug-induced nephrotoxicity

  • Dorina Diekjürgen
  • David W. GraingerEmail author
In vitro systems


Drug attrition and clinical product withdrawals due to nephrotoxicity remain major challenges for pharmaceutical drug development pipelines. Currently, no reliable high-throughput in vitro screening models are available that provide reliable, predictive toxicology data for clinical nephrotoxicity. Drug screens to predict toxicity and pharmacology assessments are compromised by standard two-dimensional (2D) cell monoculture models. Here we extend a previously reported murine three-dimensional (3D) kidney-derived intact proximal tubule model to provide ex vivo drug toxicity data that reliably compare to clinical experiences and improve nephrotoxicity predictions over current 2D cell assays. Proximal tubule cytotoxicity was monitored by ATP depletion for 12 compounds (acarbose, acetylsalicylic acid, captopril, cimetidine, cidofovir, cisplatin, doxorubicin, gentamicin, polymyxin B, polymyxin B nonapeptide, probenecid*** and vancomycin) in 3D proximal tubule ex vivo assays. Drug concentration–response curves (1–1000 µM) and IC50, lowest effective concentration (LEC) and AUC values were compared to clinical therapeutic exposure levels (Cmax). The 100-fold Cmax threshold demonstrated best sensitivity (96.9%) and specificity (87.5%) for this assay, with high positive (93.9%) and negative (93.3%) predictive values for nephrotoxicity. IC50 values were superior to LEC. Results also support the model’s capability to predict substrate-inhibitor/competitor interactions, yielding toxicity results similar to those reported in vivo. These 3D proximal tubule-based drug screens provide more reliable nephrotoxicity predictions, and more insight into complex mechanisms implicated in nephrotoxicity than current standard 2D cell assays. This new approach for rapid drug toxicity testing produces more reliable clinical comparisons than current 2D cell culture screening techniques.


Kidney toxicity 3D assay In vitro toxicity assessment Drug development Cytotoxicity Drug safety 



This work was supported by AstraZeneca UK Limited, London, England. We thank Dr. M. Wagoner (AstraZeneca Pharmaceuticals, USA) for valuable discussions. DWG is grateful for support from the George S. and Dolores Doré Eccles Foundation (USA).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest. Both authors made substantial contributions to the manuscript according to the listed criteria in the Author Guidelines.

Ethical standards and study approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pharmaceutics and Pharmaceutical ChemistryUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Biomedical EngineeringUniversity of UtahSalt Lake CityUSA

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