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Defective glycolysis and the use of 2-deoxy-d-glucose in polycystic kidney disease: from animal models to humans

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Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by bilateral renal cyst formation. ADPKD is one of the most common rare disorders, accounting for ~10% of all patients with end-stage renal disease (ESRD). ADPKD is a chronic disorder in which the gradual expansion of cysts that form in a minority of nephrons eventually causes loss of renal function due to the compression and degeneration of the surrounding normal parenchyma. Numerous deranged pathways have been identified in the cyst-lining epithelia, prompting the design of potential therapies. Several of these potential treatments have proved effective in slowing down disease progression in pre-clinical animal studies, while only one has subsequently been proven to effectively slow down disease progression in patients, and it has recently been approved for therapy in Europe, Canada and Japan. Among the affected cellular functions and pathways, recent investigations have described metabolic derangement in ADPKD as a major trait offering additional opportunities for targeted therapies. In particular, increased aerobic glycolysis (the Warburg effect) has been described as a prominent feature of ADPKD kidneys and its inhibition using the glucose analogue 2-deoxy-d-glucose (2DG) proved effective in slowing down disease progression in preclinical models of the disease. At the same time, previous clinical experiences have been reported with 2DG, showing that this compound is well tolerated in humans with minimal and reversible side effects. In this work, we review the literature and speculate that 2DG could be a good candidate for a clinical trial in humans affected by ADPKD.

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Acknowledgements

We are grateful to several colleagues and friends for helpful discussions, to Angela Pesenti Gritti for careful and essential collection of the literature, to the Italian Association for Reasearch on PKD (AIRP), to all the patients and to Dr. S. Bramani for her generous and continuous support.

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Authors and Affiliations

  1. Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina, 58, 20132, Milan, Italy

    Riccardo Magistroni & Alessandra Boletta

  2. Division of Nephrology and Hypertension, San Raffaele Hospital, Milan, Italy

    Riccardo Magistroni

  3. Division of Nephrology and Dialysis, AOU Policlinico di Modena, Università di Modena e Reggio Emilia, Modena, Italy

    Riccardo Magistroni

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  1. Riccardo Magistroni
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Correspondence to Alessandra Boletta.

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Conflict of interest

Dr. Boletta is co-inventor on a patent for the use of inhibitors of glycolysis including 2DG, for the treatment of Polycystic Kidney Disease.

Funding

The following agencies have provided funding: Italian Association for Polycystic Kidney Disease and their patients (AIRP, http://www.renepolicistico.it); the Italian Ministry of Health (RF2011-02351840 to AB and RF2013-02356802 to RM); the PKD Foundation (http://www.pkdcure.org) (RFA2013 187G14a/b to AB).

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Magistroni, R., Boletta, A. Defective glycolysis and the use of 2-deoxy-d-glucose in polycystic kidney disease: from animal models to humans. J Nephrol 30, 511–519 (2017). https://doi.org/10.1007/s40620-017-0395-9

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