Activation of PKM2 Protects against Diabetic Kidney Disease from Mice to Men

We have reported that up-regulation of PKM2 in renal glomeruli isolated from patients with more than 50 years of type 1 diabetes (Joslin Medalist Study) correlated with preservation of renal function even in the presence of chronic hyperglycemia. Further, pharmacological activation of PKM2 in T1D mice and podocyte-specific deletion of PKM2 in cultured cells and in vivo strongly showed that PKM2 activation protects renal glomeruli from hyperglycemia/diabetes induced damage (Nat. Med 2017). To confirm these findings in type 1 and type 2 diabetes, we performed the following: 1. We showed the protein expressions of glycolytic (PKM1, PKM2, ENO1) and mitochondrial (MTCO2) enzymes to be significantly elevated in glomeruli of post mortem kidneys in people with T2D without DN compared to those with DN, or nondiabetic controls. 2. Plasma PKM2 levels (SomaLogic aptamer assay) in the Medalists (n=180) correlated with albumin-to-creatinine ratio (ACR;p=0.03) and eGFR (p=0.0002) at baseline. In a replication cohort (n=219) of patients with T1D in the longitudinal Joslin Kidney Study (JKS) baseline plasma PKM2 also correlated with ACR (p=0.0001). High baseline plasma PKM2 in JKS was independently associated with a slower decline in eGFR (p=0.004) and a slower progression to end-stage renal disease (p=0.0002). 3. TEPP-46, a PKM2 activator, prevented diabetes induced increases in mRNA expression of pro-fibrotic (Col3a1, Fn1, TGFb1) and inflammatory (Ccl2) genes, and enhanced key mitochondrial protein (Ppargc1a) in uninephrectomized T2D db/db mice. No differences in ACR were observed between TEPP-46 treated and untreated diabetic mice. These findings support the hypothesis that PKM2 activation may protect or even reverse the initiation and progression of diabetic glomerular dysfunction and pathology in both T1D and T2D, suggesting that activating PKM2 could be a clinically effective therapeutic target to stop the progression of DN. Disclosure D. Gordin: None. T. Shinjo: None. R. St-Louis: None. W. Qi: None. L.J. Tinsley: None. D.M. Pober: None. M.J. Brissett: None. M. Niewczas: None. J. Dreyfuss: None. H. Pan: None. T. Sadowski: Employee; Self; Sanofi. A. Kannt: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. H. Shah: None. H.A. Keenan: Research Support; Self; Sanofi. Employee; Self; Sanofi Genzyme. A. Krolewski: None. G.L. King: Research Support; Self; Sanofi-Aventis.