1 3889 146 KLOTHO RECOVERY BY GENISTEIN VIA PROMOTER HISTONE ACETYLATION AND DNA DEMETHYLATION MITIGATES RENAL FIBROSIS IN MICE. RENAL FIBROSIS IS A COMMON HISTOMORPHOLOGICAL FEATURE OF RENAL AGING AND CHRONIC KIDNEY DISEASES OF ALL ETIOLOGIES, AND ITS INITIATION AND PROGRESSION ARE SUBSTANTIALLY INFLUENCED BY ABERRANT EPIGENETIC MODIFICATIONS OF FIBROSIS-SUSCEPTIBLE GENES, YET WITHOUT EFFECTIVE THERAPY. "EPIGENETIC DIETS" EXHIBIT TISSUE-PROTECTIVE AND EPIGENETIC-MODULATING PROPERTIES; HOWEVER, THEIR ANTI-RENAL FIBROSIS FUNCTIONS AND THE UNDERLYING MECHANISMS ARE LESS UNDERSTOOD. IN THIS STUDY, WE SHOW THAT GENISTEIN, A PHYTOESTROGENIC ISOFLAVONE ENRICHED IN DIETARY SOY PRODUCTS, EXHIBITS IMPRESSIVE ANTI-RENAL FIBROSIS ACTIVITIES BY RECOVERING EPIGENETIC LOSS OF KLOTHO, A KIDNEY-ENRICHED ANTI-AGING AND FIBROSIS-SUPPRESSING PROTEIN. MOUSE FIBROTIC KIDNEYS INDUCED BY UUO (UNILATERAL URETERAL OCCLUSION) DISPLAYED SEVERER KLOTHO SUPPRESSION AND ADVERSE EXPRESSION OF RENAL FIBROSIS-ASSOCIATED PROTEINS, BUT GENISTEIN ADMINISTRATION MARKEDLY RECOVERED THE KLOTHO LOSS AND ATTENUATED RENAL FIBROSIS AND THE PROTEIN EXPRESSION ABNORMALITIES. THE EXAMINATION OF POSSIBLE CAUSES OF THE KLOTHO RECOVERY REVEALED THAT GENISTEIN SIMULTANEOUSLY INHIBITED HISTONE 3 DEACETYLATION OF KLOTHO PROMOTER AND NORMALIZED THE PROMOTER DNA HYPERMETHYLATION BY SUPPRESSING ELEVATED DNA METHYLTRANSFERASE DNMT1 AND DNMT3A. MORE IMPORTANTLY, GENISTEIN'S ANTI-RENAL FIBROSIS EFFECTS ON THE RENAL FIBROTIC LESIONS AND THE ABNORMAL EXPRESSIONS OF FIBROSIS-ASSOCIATED PROTEINS WERE ABROGATED WHEN KLOTHO IS KNOCKDOWN BY RNA INTERFERENCES IN UUO MICE. THUS, OUR RESULTS IDENTIFY KLOTHO RESTORATION VIA EPIGENETIC HISTONE ACETYLATION AND DNA DEMETHYLATION AS A CRITICAL MECHANISM OF GENISTEIN'S ANTI-FIBROSIS FUNCTION AND SHED NEW LIGHTS ON THE POTENTIALS OF EPIGENETIC DIETS IN PREVENTING OR TREATING AGING OR RENAL FIBROSIS-ASSOCIATED KIDNEY DISEASES. KEY MESSAGES: GENISTEIN PREVENTS RENAL FIBROSIS AND THE ASSOCIATED KLOTHO SUPPRESSION IN UUO MICE. GENISTEIN UPREGULATES KLOTHO IN PART BY REVERSING THE PROMOTER HISTONE 3 HYPOACETYLATION. GENISTEIN ALSO PRESERVES KLOTHO VIA RELIEVING KLOTHO PROMOTER HYPERMETHYLATION. GENISTEIN DEMETHYLATES KLOTHO PROMOTER BY INHIBITING ABERRANT DNMT1/3A EXPRESSION. GENISTEIN RESTORATION OF KLOTHO IS ESSENTIAL FOR ITS ANTI-RENAL FIBROSIS FUNCTION. 2019 2 5994 70 TGFBETA-INCURRED EPIGENETIC ABERRATIONS OF MIRNA AND DNA METHYLTRANSFERASE SUPPRESS KLOTHO AND POTENTIATE RENAL FIBROSIS. RENAL FIBROSIS IS A COMMON PATHOLOGICAL FEATURE OF CHRONIC KIDNEY DISEASES (CKD) AND ITS DEVELOPMENT AND PROGRESSION ARE SIGNIFICANTLY AFFECTED BY EPIGENETIC MODIFICATIONS SUCH AS ABERRANT MIRNA AND DNA METHYLATION. KLOTHO IS AN ANTI-AGING AND ANTI-FIBROTIC PROTEIN AND ITS EARLY DECLINE AFTER RENAL INJURY IS REPORTEDLY ASSOCIATED WITH ABERRANT DNA METHYLATION. HOWEVER, THE KEY UPSTREAM PATHOLOGICAL MEDIATORS AND THE MOLECULAR CASCADE LEADING TO EPIGENETIC KLOTHO SUPPRESSION ARE NOT EXCLUSIVELY ESTABLISHED. HERE WE INVESTIGATE THE EPIGENETIC MECHANISM OF KLOTHO DEFICIENCY AND ITS FUNCTIONAL RELEVANCE IN RENAL FIBROGENESIS. FIBROTIC KIDNEYS INDUCED BY UNILATERAL URETERAL OCCLUSION (UUO) DISPLAYED MARKED KLOTHO SUPPRESSION AND THE PROMOTER HYPERMETHYLATION. THESE ABNORMALITIES WERE LIKELY DUE TO DEREGULATED TRANSFORMING GROWTH FACTOR-BETA (TGFBETA) SINCE TGFBETA ALONE CAUSED THE SIMILAR EPIGENETIC ABERRATIONS IN CULTURED RENAL CELLS AND TGFBETA BLOCKADE PREVENTED THE ALTERATIONS IN UUO KIDNEY. FURTHER INVESTIGATION REVEALED THAT TGFBETA ENHANCED DNA METHYLTRANSFERASE (DNMT) 1 AND DNMT3A VIA INHIBITING MIR-152 AND MIR-30A IN BOTH RENAL CELLS AND FIBROTIC KIDNEYS. ACCORDINGLY THE BLOCKADE OF EITHER TGFBETA SIGNALING OR DNMT1/3A ACTIVITIES SIGNIFICANTLY RECOVERED THE KLOTHO LOSS AND ATTENUATED PRO-FIBROTIC PROTEIN EXPRESSION AND RENAL FIBROSIS. MOREOVER, KLOTHO KNOCKDOWN BY RNA INTERFERENCES ABOLISHED THE ANTI-FIBROTIC EFFECTS OF DNMT INHIBITION IN BOTH TGFBETA-TREATED RENAL CELL AND UUO KIDNEY, INDICATING THAT TGFBETA-MEDIATED MIR-152/30A INHIBITIONS, DNMT1/3A ABERRATIONS AND SUBSEQUENT KLOTHO LOSS CONSTITUTE A CRITICAL REGULATORY LOOP THAT ELIMINATES KLOTHO'S ANTI-FIBROTIC ACTIVITIES AND POTENTIATES RENAL FIBROGENESIS. THUS, OUR STUDY ELABORATES A NOVEL EPIGENETIC CASCADE OF RENAL FIBROGENESIS AND REVEALS THE POTENTIAL THERAPEUTIC TARGETS FOR TREATING THE RENAL FIBROSIS-ASSOCIATED KIDNEY DISEASES. 2017 3 6665 34 UPSTREAM AND DOWNSTREAM REGULATORS OF KLOTHO EXPRESSION IN CHRONIC KIDNEY DISEASE. KLOTHO IS A CRITICAL PROTEIN THAT PROTECTS THE KIDNEY. KLOTHO IS SEVERELY DOWNREGULATED IN CHRONIC KIDNEY DISEASE (CKD), AND ITS DEFICIENCY IS IMPLICATED IN THE PATHOGENESIS AND PROGRESSION OF CKD. CONVERSELY, AN INCREASE IN KLOTHO LEVELS RESULTS IN IMPROVED KIDNEY FUNCTION AND DELAYS CKD PROGRESSION, SUPPORTING THE NOTION THAT MODULATING KLOTHO LEVELS COULD REPRESENT A POSSIBLE THERAPEUTIC STRATEGY FOR CKD TREATMENT. NEVERTHELESS, THE REGULATORY MECHANISMS RESPONSIBLE FOR THE LOSS OF KLOTHO REMAIN ELUSIVE. PREVIOUS STUDIES HAVE DEMONSTRATED THAT OXIDATIVE STRESS, INFLAMMATION, AND EPIGENETIC MODIFICATIONS CAN MODULATE KLOTHO LEVELS. THESE MECHANISMS RESULT IN A DECREASE IN KLOTHO MRNA TRANSCRIPT LEVELS AND REDUCED TRANSLATION, THUS CAN BE GROUPED TOGETHER AS UPSTREAM REGULATORY MECHANISMS. HOWEVER, THERAPEUTIC STRATEGIES THAT AIM TO RESCUE KLOTHO LEVELS BY TARGETING THESE UPSTREAM MECHANISMS DO NOT ALWAYS RESULT IN INCREASED KLOTHO, INDICATING THE INVOLVEMENT OF OTHER REGULATORY MECHANISMS. EMERGING EVIDENCE HAS SHOWN THAT ENDOPLASMIC RETICULUM (ER) STRESS, THE UNFOLDED PROTEIN RESPONSE, AND ER-ASSOCIATED DEGRADATION ALSO AFFECT THE MODIFICATION, TRANSLOCATION, AND DEGRADATION OF KLOTHO, AND THUS ARE PROPOSED TO BE DOWNSTREAM REGULATORY MECHANISMS. HERE, WE DISCUSS THE CURRENT UNDERSTANDING OF UPSTREAM AND DOWNSTREAM REGULATORY MECHANISMS OF KLOTHO AND EXAMINE POTENTIAL THERAPEUTIC STRATEGIES TO UPREGULATE KLOTHO EXPRESSION FOR CKD TREATMENT. 2023 4 2001 29 EPIGENETIC AND NON-EPIGENETIC REGULATION OF KLOTHO IN KIDNEY DISEASE. KLOTHO IS A NOVEL RENOPROTECTIVE ANTI-AGING PROTEIN AVAILABLE IN MEMBRANE-BOUND OR SOLUBLE FORM. KLOTHO IS EXPRESSED IN BRAIN, PANCREAS, AND OTHER SOLID ORGANS BUT SHOWS HIGHEST EXPRESSION LEVELS IN THE KIDNEY. KLOTHO SUSTAINS NORMAL KIDNEY PHYSIOLOGY BUT KLOTHO REGULATION ALSO CONTRIBUTES TO THE PROGRESSION OF KIDNEY DISEASE. SYSTEMIC AND INTRARENAL LEVELS OF KLOTHO FALL DRASTICALLY DURING ACUTE KIDNEY INJURY, KIDNEY FIBROSIS, DIABETIC NEPHROPATHY, AND OTHER FORMS OF CHRONIC KIDNEY DISEASE, ETC. MOREOVER, EXOGENOUS SUPPLEMENTATION OR OVEREXPRESSION OF ENDOGENOUS KLOTHO ATTENUATES KIDNEY DISEASE. THE REGULATION OF ENDOGENOUS KLOTHO EXPRESSION INVOLVES EPIGENETIC AS WELL AS NON-EPIGENETIC MECHANISMS. THE EPIGENETIC MODIFICATIONS SUCH AS DNA METHYLATION, POST-TRANSLATIONAL HISTONE MODIFICATIONS, MIRNAS REGULATE THE CHANGE IN KLOTHO EXPRESSION IN KIDNEY DISEASE. NON-EPIGENETIC MECHANISMS SUCH AS ER STRESS, WNT SIGNALING, ACTIVATION OF THE RENIN ANGIOTENSIN SYSTEM (RAS), EXCESSIVE REACTIVE OXYGEN SPECIES AND CYTOKINE GENERATION, ALBUMIN OVERLOAD, AND PPAR-GAMMA SIGNALING ALSO CONTRIBUTE TO KLOTHO REGULATION. EVOLVING EVIDENCE HIGHLIGHT THE CAPACITY OF NATURAL PRODUCTS TO REGULATE KLOTHO EXPRESSION IN KIDNEY DISEASE. ALL THESE PRECLINICAL DATA SUGGEST THAT KLOTHO COULD BE A NOVEL BIOMARKER AS WELL AS THERAPEUTIC TARGET. HERE WE REVIEW THE DIFFERENT MECHANISMS OF KLOTHO REGULATION IN THE CONTEXT OF KLOTHO AS A BIOMARKER AND POTENTIAL THERAPEUTIC AGENT. 2021 5 3887 23 KLOTHO METHYLATION IS LINKED TO UREMIC TOXINS AND CHRONIC KIDNEY DISEASE. EPIGENETIC REGULATION PLAYS A MAJOR ROLE IN UREMIC TOXIN-INDUCED CHRONIC KIDNEY DISEASE (CKD) PROGRESSION. THE KLOTHO PROTEIN IS A KEY MODULATOR OF HOMEOSTASIS IN RENAL FUNCTION. UREMIC TOXIN ACCUMULATION CAN INDUCE DNA METHYLTRANSFERASE (DNMT) PROTEIN EXPRESSION, WHICH IS INVOLVED IN THE SILENCING OF KLOTHO THROUGH HYPERMETHYLATION. TREATMENT WITH DNMT INHIBITORS CAN INDUCE A HYPERMETHYLATED STATUS OF KLOTHO AND SUPPRESS MRNA AND PROTEIN EXPRESSION. EPIGENETIC TARGETING OF SPECIFIC GENES MAY BECOME AN EFFECTIVE STRATEGY TO PREVENT PROGRESSION OF UREMIA-RELATED CKD. 2012 6 3036 61 GENISTEIN AMELIORATES RENAL FIBROSIS THROUGH REGULATION SNAIL VIA M6A RNA DEMETHYLASE ALKBH5. RENAL TUBULE-INTERSTITIAL FIBROSIS IS RELATED TO CHRONIC KIDNEY DISEASE PROGRESSION AND A TYPICAL FEATURE OF THE AGING KIDNEY. EPIGENETIC MODIFICATIONS OF FIBROSIS-PRONE GENES REGULATE THE DEVELOPMENT OF RENAL FIBROSIS. AS A KIND OF "EPIGENETIC DIET", SOY ISOFLAVONE GENISTEIN WAS REPORTED TO HAVE RENAL PROTECTIVE ACTION AND EPIGENETIC-MODULATING EFFECTS. HOWEVER, ITS RENAL PROTECTION ROLE AND UNDERLYING MECHANISMS ARE YET TO BE FULLY CLARIFIED. HEREIN, WE SHOWED THAT GENISTEIN EXHIBITS A DEMONSTRABLE ANTI-FIBROTIC EFFECT ON KIDNEY IN VIVO UUO (UNILATERAL URETERAL OCCLUSION) MODEL AND RENAL EPITHELIAL CELLS IN VITRO MODEL. THE MECHANISM IS STRONGLY ASSOCIATED WITH EPITHELIAL-TO-MESENCHYMAL TRANSITION AND M6A RNA DEMETHYLASE ALKBH5. MOUSE FIBROTIC KIDNEYS INDUCED BY UUO EXHIBITED ADVERSE EXPRESSION OF RENAL FIBROSIS-RELATED PROTEINS AND SIGNIFICANT INCREASES IN THE TOTAL M6A LEVEL. AS AN ERASER, ALKBH5 SHOWED SEVERER SUPPRESSION IN THE RENAL FIBROSIS PROCESS. HOWEVER, GENISTEIN PRETREATMENT RESTORED ALKBH5 LOSS REMARKABLY AND REDUCED RENAL FIBROSIS, ABNORMAL PROTEIN, AND INFLAMMATORY MARKERS. THE EXAMINATION OF POSSIBLE MECHANISMS REVEALED THAT GENISTEIN PROMOTED ALKBH5 AND MAYBE INDUCED THE LEVEL OF MRNA M6A METHYLATION IN SOME EPITHELIAL-TO-MESENCHYMAL TRANSITION-RELATED TRANSCRIPTION FACTORS. WE FOUND SNAIL WAS THE CRITICAL REGULATOR AND CRITICAL FOR THE PROTECTIVE ROLE OF GENISTEIN. TO VERIFY THE RELATIONSHIP BETWEEN ALKBH5 AND SNAIL, WE GENERATED KNOCKDOWN AND OVEREXPRESSION OF ALKBH5 CELLS IN VITRO. ALKBH5 KNOCKDOWN ENHANCED THE MESENCHYMAL PHENOTYPE MARKER ALPHA-SMOOTH MUSCLE ACTIN AND SNAIL EXPRESSION. IN AGREEMENT, OVEREXPRESSION ALKBH5 INCREASED EPITHELIAL ADHESION MOLECULE E-CADHERIN AND REDUCED SNAIL EXPRESSION. IN CONCLUSION, GENISTEIN INCREASED RENAL ALKBH5 EXPRESSION IN UUO-INDUCED RENAL FIBROSIS AND REDUCED RNA M6A LEVELS AND AMELIORATES RENAL DAMAGES. 2020 7 1665 35 DOWNREGULATION OF KIDNEY PROTECTIVE FACTORS BY INFLAMMATION: ROLE OF TRANSCRIPTION FACTORS AND EPIGENETIC MECHANISMS. CHRONIC KIDNEY DISEASE (CKD) IS ASSOCIATED TO AN INCREASED RISK OF DEATH, CKD PROGRESSION, AND ACUTE KIDNEY INJURY (AKI) EVEN FROM EARLY STAGES, WHEN GLOMERULAR FILTRATION RATE (GFR) IS PRESERVED. THE LINK BETWEEN EARLY CKD AND THESE RISKS IS UNCLEAR, SINCE THERE IS NO ACCUMULATION OF UREMIC TOXINS. HOWEVER, PATHOLOGICAL ALBUMINURIA AND KIDNEY INFLAMMATION ARE FREQUENT FEATURES OF EARLY CKD, AND THE PRODUCTION OF KIDNEY PROTECTIVE FACTORS MAY BE DECREASED. INDEED, KLOTHO EXPRESSION IS ALREADY DECREASED IN CKD CATEGORY G1 (NORMAL GFR). KLOTHO HAS ANTI-AGING AND NEPHROPROTECTIVE PROPERTIES, AND DECREASED KLOTHO LEVELS MAY CONTRIBUTE TO INCREASE THE RISK OF DEATH, CKD PROGRESSION, AND AKI. IN THIS REVIEW, WE DISCUSS THE DOWNREGULATION BY MEDIATORS OF INFLAMMATION OF MOLECULES WITH SYSTEMIC AND/OR RENAL LOCAL PROTECTIVE FUNCTIONS, EXEMPLIFIED BY KLOTHO AND PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR GAMMA COACTIVATOR-1ALPHA (PGC-1ALPHA), A TRANSCRIPTION FACTOR THAT PROMOTES MITOCHONDRIAL BIOGENESIS. CYTOKINES SUCH AS TWEAK, TNF-ALPHA, OR TRANSFORMING GROWTH FACTOR -BETA1 PRODUCED LOCALLY DURING KIDNEY INJURY OR RELEASED FROM INFLAMMATORY SITES AT OTHER ORGANS MAY DECREASE KIDNEY EXPRESSION OF KLOTHO AND PGC-1ALPHA OR LEAD TO SUBOPTIMAL RECRUITMENT OF THESE NEPHROPROTECTIVE PROTEINS. TRANSCRIPTION FACTORS (E.G., SMAD3 AND NF-KAPPAB) AND EPIGENETIC MECHANISMS (E.G., HISTONE ACETYLATION OR METHYLATION) CONTRIBUTE TO DOWNREGULATE THE EXPRESSION OF KLOTHO AND/OR PGC-1ALPHA, WHILE HISTONE CROTONYLATION PROMOTES PGC-1ALPHA EXPRESSION. NF-KAPPABIZ FACILITATES THE REPRESSIVE EFFECT OF NF-KAPPAB ON KLOTHO EXPRESSION. A DETAILED UNDERSTANDING OF THESE MEDIATORS MAY CONTRIBUTE TO THE DEVELOPMENT OF NOVEL THERAPEUTIC APPROACHES TO PREVENT CKD PROGRESSION AND ITS NEGATIVE IMPACT ON MORTALITY AND AKI. 2016 8 476 43 ARSENIC INDUCES FIBROGENIC CHANGES IN HUMAN KIDNEY EPITHELIAL CELLS POTENTIALLY THROUGH EPIGENETIC ALTERATIONS IN DNA METHYLATION. ARSENIC CONTAMINATION IS A SIGNIFICANT PUBLIC HEALTH ISSUE, AND KIDNEY IS ONE OF THE TARGET ORGAN FOR ARSENIC-INDUCED ADVERSE EFFECTS. RENAL FIBROSIS IS A WELL-KNOWN PATHOLOGICAL STAGE FREQUENTLY OBSERVED IN PROGRESSIVE CHRONIC KIDNEY DISEASE (CKD). EPIDEMIOLOGICAL STUDIES IMPLICATE ARSENIC EXPOSURE TO CKD, BUT THE ROLE OF ARSENIC IN KIDNEY FIBROSIS AND THE UNDERLYING MECHANISM IS STILL UNCLEAR. IT IS IN THIS CONTEXT THAT THE CURRENT STUDY EVALUATED THE EFFECTS OF LONG-TERM ARSENIC EXPOSURE ON THE CELLULAR RESPONSE IN MORPHOLOGY, AND MARKER GENES EXPRESSION WITH RESPECT TO FIBROSIS USING HUMAN KIDNEY 2 (HK-2) EPITHELIAL CELLS. RESULTS OF THIS STUDY REVEALED THAT IN ADDITION TO INCREASED GROWTH, HK-2 CELLS UNDERWENT PHENOTYPIC, BIOCHEMICAL AND MOLECULAR CHANGES INDICATIVE OF EPITHELIAL-MESENCHYMAL TRANSITION (EMT) IN RESPONSE TO THE EXPOSURE TO ARSENIC. MOST IMPORTANTLY, THE ARSENIC-EXPOSED CELLS ACQUIRED THE PATHOGENIC FEATURES OF FIBROSIS AS SUPPORTED BY INCREASED EXPRESSION OF MARKERS FOR FIBROSIS, SUCH AS COLLAGEN I, FIBRONECTIN, TRANSFORMING GROWTH FACTOR BETA, AND ALPHA-SMOOTH MUSCLE ACTIN. UPREGULATION OF FIBROSIS ASSOCIATED SIGNALING MOLECULES SUCH AS TISSUE INHIBITOR OF METALLOPROTEINASES-3 AND MATRIX METALLOPROTEINASE-2 AS WELL AS ACTIVATION OF AKT WAS ALSO OBSERVED. ADDITIONALLY, THE EXPRESSION OF EPIGENETIC GENES (DNA METHYLTRANSFERASES 3A AND 3B; METHYL-CPG BINDING DOMAIN 4) WAS INCREASED IN ARSENIC-EXPOSED CELLS. TREATMENT WITH DNA METHYLATION INHIBITOR 5-AZA-2'-DC REVERSED THE EMT PROPERTIES AND RESTORED THE LEVEL OF PHOSPHO-AKT. TOGETHER, THESE DATA FOR THE FIRST TIME SUGGEST THAT LONG-TERM EXPOSURE TO ARSENIC CAN INCREASE THE RISK OF KIDNEY FIBROSIS. ADDITIONALLY, OUR DATA SUGGEST THAT THE ARSENIC-INDUCED FIBROTIC CHANGES ARE, AT LEAST IN PART, MEDIATED BY DNA METHYLATION AND THEREFORE POTENTIALLY CAN BE REVERSED BY EPIGENETIC THERAPEUTICS. 2019 9 3367 27 HISTONE METHYLTRANSFERASE EZH2: A POTENTIAL THERAPEUTIC TARGET FOR KIDNEY DISEASES. ENHANCER OF ZESTE HOMOLOG 2 (EZH2) IS A HISTONE-LYSINE N-METHYLTRANSFERASE ENZYME THAT CATALYZES THE ADDITION OF METHYL GROUPS TO HISTONE H3 AT LYSINE 27, LEADING TO GENE SILENCING. MUTATION OR OVER-EXPRESSION OF EZH2 HAS BEEN LINKED TO MANY CANCERS INCLUDING RENAL CARCINOMA. RECENT STUDIES HAVE SHOWN THAT EZH2 EXPRESSION AND ACTIVITY ARE ALSO INCREASED IN SEVERAL ANIMAL MODELS OF KIDNEY INJURY, SUCH AS ACUTE KIDNEY INJURY (AKI), RENAL FIBROSIS, DIABETIC NEPHROPATHY, LUPUS NEPHRITIS (LN), AND RENAL TRANSPLANTATION REJECTION. THE PHARMACOLOGICAL AND/OR GENETIC INHIBITION OF EZH2 CAN ALLEVIATE AKI, RENAL FIBROSIS, AND LN, BUT POTENTIATE PODOCYTE INJURY IN ANIMAL MODELS, SUGGESTING THAT THE FUNCTIONAL ROLE OF EZH2 VARIES WITH RENAL CELL TYPE AND DISEASE MODEL. IN THIS ARTICLE, WE SUMMARIZE THE ROLE OF EZH2 IN THE PATHOLOGY OF RENAL INJURY AND RELEVANT MECHANISMS AND HIGHLIGHT EZH2 AS A POTENTIAL THERAPEUTIC TARGET FOR KIDNEY DISEASES. 2021 10 3890 29 KLOTHO, PHOSPHATE AND INFLAMMATION/AGEING IN CHRONIC KIDNEY DISEASE. EVIDENCE IS EMERGING FOR THE INFLAMMATORY NATURE OF MANY AGEING-ASSOCIATED DISEASES, INCLUDING ATHEROSCLEROSIS, VASCULAR CALCIFICATION, DIABETES AND CHRONIC KIDNEY DISEASE (CKD), AMONG OTHERS. AGEING ITSELF RESULTS IN CHRONIC LOW-GRADE INFLAMMATION THAT PROMOTES END-ORGAN DAMAGE. INFLAMMATORY ORGAN DAMAGE, IN TURN, MAY CONTRIBUTE TO INFLAMMATION. RECENT RESEARCH HAS IDENTIFIED THE KIDNEY-SECRETED HORMONE KLOTHO AS A CENTRAL PLAYER AT THE AGEING-INFLAMMATION INTERFACE. THUS, SYSTEMIC OR LOCAL RENAL INFLAMMATION DECREASES KIDNEY KLOTHO EXPRESSION. KLOTHO DOWN-REGULATION MAY BE INDUCED BY SPECIFIC CYTOKINES SUCH AS TUMOUR NECROSIS FACTOR-ALPHA OR TWEAK THROUGH THE CANONICAL ACTIVATION OF THE INFLAMMATORY TRANSCRIPTION FACTOR NUCLEAR FACTOR KAPPA B (NFKAPPAB) AND, SPECIFICALLY RELA. IN ADDITION, INFLAMMATORY CYTOKINES LEAD TO THE EPIGENETIC INACTIVATION OF KLOTHO TRANSCRIPTION. KLOTHO ITSELF HAS ANTIOXIDANT AND ANTI-INFLAMMATORY PROPERTIES AND THE CANONICAL NFKAPPAB COMPONENT RELA IS ONE OF ITS TARGETS. KLOTHO IS A KEY REGULATOR OF PHOSPHATE BALANCE AND A ROLE OF PHOSPHATE IN AGEING HAS BEEN SHOWN. HOWEVER, THE POTENTIAL RELATIONSHIP BETWEEN PHOSPHATE AND INFLAMMATION REQUIRES FURTHER CLARIFICATION. A CORRECT UNDERSTANDING OF THESE INTERACTIONS MAY LEAD TO THE DESIGN OF NOVEL THERAPEUTIC APPROACHES TO CKD AND CKD-RELATED INFLAMMATORY AND AGEING FEATURES AS WELL AS TO INFLAMMATION/AGEING IN GENERAL. 2012 11 3326 49 HISTONE DEACETYLASE 3 (HDAC3) AS AN IMPORTANT EPIGENETIC REGULATOR OF KIDNEY DISEASES. DEVELOPMENT AND PROGRESSION OF MANY KIDNEY DISEASES ARE SUBSTANTIALLY INFLUENCED BY ABERRANT PROTEIN ACETYLATION MODIFICATIONS OF GENE EXPRESSION CRUCIAL FOR KIDNEY FUNCTIONS. HISTONE DEACETYLASE (HDAC) EXPRESSION ALTERATIONS ARE DETECTED FROM RENAL SAMPLES OF PATIENTS AND ANIMAL MODELS OF VARIOUS KIDNEY DISEASES, AND THE ADMINISTRATIONS OF HDAC INHIBITORS DISPLAY IMPRESSIVE RENAL PROTECTIVE EFFECTS IN VITRO AND IN VIVO. HOWEVER, WHEN THE EXPRESSION ALTERATIONS OF MULTIPLE HDACS OCCUR, NOT ALL THE HDACS CAUSALLY AFFECT THE DISEASE ONSET OR PROGRESSION. IDENTIFICATION OF A SINGLE HDAC AS A DISEASE-CAUSING FACTOR WILL ALLOW SUBTYPE-TARGETED INTERVENTION WITH LESS SIDE EFFECT. HDAC3 IS A UNIQUE HDAC WITH DISTINCT STRUCTURAL AND SUBCELLULAR DISTRIBUTION FEATURES AND CO-REPRESSOR DEPENDENCY. HDAC3 IS REQUIRED FOR KIDNEY DEVELOPMENT AND ITS ABERRATIONS ACTIVELY PARTICIPATE IN MANY PATHOLOGICAL PROCESSES, SUCH AS CANCER, CARDIOVASCULAR DISEASES, DIABETES, AND NEURODEGENERATIVE DISORDERS, AND CONTRIBUTE SIGNIFICANTLY TO THE PATHOGENESIS OF KIDNEY DISEASES. THIS REVIEW WILL DISCUSS THE RECENT STUDIES THAT INVESTIGATE THE CRITICAL ROLES OF HDAC3 ABERRATIONS IN KIDNEY DEVELOPMENT, RENAL AGING, RENAL CELL CARCINOMA, RENAL FIBROSIS, CHRONIC KIDNEY DISEASE, POLYCYSTIC KIDNEY DISEASE, GLOMERULAR PODOCYTE INJURY, AND DIABETIC NEPHROPATHY. THESE STUDIES REVEAL THE DISTINCT CHARACTERS OF HDAC3 ABERRATIONS THAT ACT ON DIFFERENT MOLECULES/SIGNALING PATHWAYS UNDER VARIOUS RENAL PATHOLOGICAL CONDITIONS, WHICH MIGHT SHED LIGHTS INTO THE EPIGENETIC MECHANISMS OF RENAL DISEASES AND THE POTENTIALLY THERAPEUTIC STRATEGIES. 2022 12 6321 24 THE ROLE AND MECHANISM OF LYSINE METHYLTRANSFERASE AND ARGININE METHYLTRANSFERASE IN KIDNEY DISEASES. METHYLATION CAN OCCUR IN BOTH HISTONES AND NON-HISTONES. KEY LYSINE AND ARGININE METHYLTRANSFERASES UNDER INVESTIGATION FOR RENAL DISEASE TREATMENT INCLUDE ENHANCER OF ZESTE HOMOLOG 2 (EZH2), G9A, DISRUPTOR OF TELOMERIC SILENCING 1-LIKE PROTEIN (DOT1L), AND PROTEIN ARGININE METHYLTRANSFERASES (PRMT) 1 AND 5. RECENT STUDIES HAVE SHOWN THAT METHYLTRANSFERASES EXPRESSION AND ACTIVITY ARE ALSO INCREASED IN SEVERAL ANIMAL MODELS OF KIDNEY INJURY, SUCH AS ACUTE KIDNEY INJURY(AKI), OBSTRUCTIVE NEPHROPATHY, DIABETIC NEPHROPATHY AND LUPUS NEPHRITIS. THE INHIBITION OF MOST METHYLTRANSFERASES CAN ATTENUATE KIDNEY INJURY, WHILE THE ROLE OF METHYLTRANSFERASE IN DIFFERENT ANIMAL MODELS REMAINS CONTROVERSIAL. IN THIS ARTICLE, WE SUMMARIZE THE ROLE AND MECHANISM OF LYSINE METHYLTRANSFERASE AND ARGININE METHYLTRANSFERASE IN VARIOUS KIDNEY DISEASES AND HIGHLIGHT METHYLTRANSFERASE AS A POTENTIAL THERAPEUTIC TARGET FOR KIDNEY DISEASES. 2022 13 2230 38 EPIGENETIC MODIFICATIONS OF KLOTHO EXPRESSION IN KIDNEY DISEASES. DEVELOPMENTS OF MANY RENAL DISEASES ARE SUBSTANTIALLY INFLUENCED BY EPIGENETIC MODIFICATIONS OF NUMEROUS GENES, MAINLY MEDIATED BY DNA METHYLATIONS, HISTONE MODIFICATIONS, AND MICRORNA INTERFERENCE; HOWEVER, NOT ALL GENE MODIFICATIONS CAUSALLY AFFECT THE DISEASE ONSET OR PROGRESSION. KLOTHO IS A CRITICAL GENE WHOSE REPRESSIONS IN VARIOUS PATHOLOGICAL CONDITIONS REPORTEDLY INVOLVE EPIGENETIC REGULATORY MECHANISMS. KLOTHO IS ALMOST UNEXCEPTIONALLY REPRESSED EARLY AFTER ACUTE OR CHRONIC RENAL INJURIES AND ITS LEVELS INVERSELY CORRELATED WITH THE DISEASE PROGRESSION AND SEVERITY. MOREOVER, THE STRATEGIES OF KLOTHO DEREPRESSION VIA EPIGENETIC MODULATIONS BENEFICIALLY CHANGE THE PATHOLOGICAL COURSES BOTH IN VITRO AND IN VIVO. HENCE, KLOTHO IS NOT ONLY CONSIDERED A BIOMARKER OF THE RENAL DISEASE BUT ALSO A POTENTIAL OR EVEN AN IDEAL TARGET OF THERAPEUTIC EPIGENETIC INTERVENTION. HERE, WE SUMMARIZE AND DISCUSS STUDIES THAT INVESTIGATE THE KLOTHO REPRESSION AND INTERVENTION IN RENAL DISEASES FROM AN EPIGENETIC POINT OF VIEW. THESE INFORMATION MIGHT SHED NEW SIGHTS INTO THE EFFECTIVE THERAPEUTIC STRATEGIES TO PREVENT AND TREAT VARIOUS RENAL DISORDERS. 2021 14 5925 34 TARGETING EPIGENETIC DNA AND HISTONE MODIFICATIONS TO TREAT KIDNEY DISEASE. EPIGENETICS REFERS TO HERITABLE CHANGES IN GENE EXPRESSION PATTERNS NOT CAUSED BY AN ALTERED NUCLEOTIDE SEQUENCE, AND INCLUDES NON-CODING RNAS AND COVALENT MODIFICATIONS OF DNA AND HISTONES. THIS REVIEW FOCUSES ON FUNCTIONAL EVIDENCE FOR THE INVOLVEMENT OF DNA AND HISTONE EPIGENETIC MODIFICATIONS IN THE PATHOGENESIS OF KIDNEY DISEASE AND THE POTENTIAL THERAPEUTIC IMPLICATIONS. THERE IS EVIDENCE OF ACTIVATION OF EPIGENETIC REGULATORY MECHANISMS IN ACUTE KIDNEY INJURY (AKI), CHRONIC KIDNEY DISEASE (CKD) AND THE AKI-TO-CKD TRANSITION OF DIVERSE AETIOLOGIES, INCLUDING ISCHAEMIA-REPERFUSION INJURY, NEPHROTOXICITY, URETERAL OBSTRUCTION, DIABETES, GLOMERULONEPHRITIS AND POLYCYSTIC KIDNEY DISEASE. A BENEFICIAL IN VIVO EFFECT OVER PRECLINICAL KIDNEY INJURY HAS BEEN REPORTED FOR DRUGS THAT DECREASE DNA METHYLATION BY EITHER INHIBITING DNA METHYLATION (E.G. 5-AZACYTIDINE AND DECITABINE) OR ACTIVATING DNA DEMETHYLATION (E.G. HYDRALAZINE), DECREASE HISTONE METHYLATION BY INHIBITING HISTONE METHYLTRANSFERASES, INCREASE HISTONE ACETYLATION BY INHIBITING HISTONE DEACETYLASES (HDACS, E.G. VALPROIC ACID, VORINOSTAT, ENTINOSTAT), INCREASE HISTONE CROTONYLATION (CROTONATE) OR INTERFERE WITH HISTONE MODIFICATION READERS [E.G. INHIBITS OF BROMODOMAIN AND EXTRA-TERMINAL PROTEINS (BET)]. MOST PRECLINICAL STUDIES ADDRESSED CKD OR THE AKI-TO-CKD TRANSITION. CROTONATE ADMINISTRATION PROTECTED FROM NEPHROTOXIC AKI, BUT EVIDENCE IS CONFLICTING ON DNA METHYLATION INHIBITORS FOR PRECLINICAL AKI. SEVERAL DRUGS TARGETING EPIGENETIC REGULATORS ARE IN CLINICAL DEVELOPMENT OR USE, MOST OF THEM FOR MALIGNANCY. THE BET INHIBITOR APABETALONE IS IN PHASE 3 TRIALS FOR ATHEROSCLEROSIS, KIDNEY FUNCTION BEING A SECONDARY ENDPOINT, BUT NEPHROTOXICITY WAS REPORTED FOR DNA AND HDAC INHIBITORS. WHILE RESEARCH INTO EPIGENETIC MODULATORS MAY PROVIDE NOVEL THERAPIES FOR KIDNEY DISEASE, CAUTION SHOULD BE EXERCISED BASED ON THE CLINICAL NEPHROTOXICITY OF SOME DRUGS. 2018 15 4463 32 MOLECULAR MECHANISMS OF HISTONE DEACETYLASES AND INHIBITORS IN RENAL FIBROSIS PROGRESSION. RENAL FIBROSIS IS A COMMON PROGRESSIVE MANIFESTATION OF CHRONIC KIDNEY DISEASE. THIS PHENOMENON OF SELF-REPAIR IN RESPONSE TO KIDNEY DAMAGE SERIOUSLY AFFECTS THE NORMAL FILTRATION FUNCTION OF THE KIDNEY. YET, THERE ARE NO SPECIFIC TREATMENTS FOR THE CONDITION, WHICH MARKS FIBROSIS AS AN IRREVERSIBLE PATHOLOGICAL SEQUELA. AS SUCH, THERE IS A PRESSING NEED TO IMPROVE OUR UNDERSTANDING OF HOW FIBROSIS DEVELOPS AT THE CELLULAR AND MOLECULAR LEVELS AND EXPLORE SPECIFIC TARGETED THERAPIES FOR THESE PATHOGENIC MECHANISMS. IT IS NOW GENERALLY ACCEPTED THAT RENAL FIBROSIS IS A PATHOLOGICAL TRANSITION MEDIATED BY EXTRACELLULAR MATRIX (ECM) DEPOSITION, ABNORMAL ACTIVATION OF MYOFIBROBLASTS, AND EPITHELIAL-MESENCHYMAL TRANSITION (EMT) OF RENAL TUBULAR EPITHELIAL CELLS UNDER THE REGULATION OF TGF-BETA. HISTONE DEACETYLASES (HDACS) APPEAR TO PLAY AN ESSENTIAL ROLE IN PROMOTING RENAL FIBROSIS THROUGH NON-HISTONE EPIGENETIC MODIFICATIONS. IN THIS REVIEW, WE SUMMARIZE THE MECHANISMS OF RENAL FIBROSIS AND THE SIGNALING PATHWAYS THAT MIGHT BE INVOLVED IN HDACS IN RENAL FIBROSIS, AND THE SPECIFIC MECHANISMS OF ACTION OF VARIOUS HDAC INHIBITORS (HDACI) IN THE ANTI-FIBROTIC PROCESS TO ELUCIDATE HDACI AS A NOVEL THERAPEUTIC TOOL TO SLOW DOWN THE PROGRESSION OF RENAL FIBROSIS. 2022 16 141 40 ABERRANT DNA METHYLATION OF MTOR PATHWAY GENES PROMOTES INFLAMMATORY ACTIVATION OF IMMUNE CELLS IN DIABETIC KIDNEY DISEASE. DNA METHYLATION HAS BEEN IMPLICATED IN THE PATHOGENESIS OF DIABETIC KIDNEY DISEASE (DKD), BUT THE UNDERLYING MECHANISMS REMAIN UNCLEAR. IN THIS STUDY, WE TESTED THE HYPOTHESIS THAT ABERRANT DNA METHYLATION IN PERIPHERAL IMMUNE CELLS CONTRIBUTES TO DKD PROGRESSION. WE SHOWED THAT LEVELS OF DNA METHYLTRANSFERASE 1 (DNMT1), A KEY ENZYME FOR DNA METHYLATION, WERE INCREASED ALONG WITH INFLAMMATORY ACTIVITY OF PERIPHERAL BLOOD MONONUCLEAR CELLS IN DKD PATIENTS. INHIBITION OF DNMT1 WITH 5-AZA-2'-DEOXYCYTIDINE (5-AZA) MARKEDLY INCREASED THE PROPORTION OF CD4(+)CD25(+) REGULATORY T CELLS IN PERIPHERAL BLOOD MONONUCLEAR CELLS IN CULTURE AND IN DIABETIC ANIMALS. ADOPTIVE TRANSFER OF IMMUNE CELLS FROM 5-AZA-TREATED ANIMALS SHOWED BENEFICIAL EFFECTS ON THE HOST IMMUNE SYSTEM, RESULTING IN A SIGNIFICANT IMPROVEMENT OF DKD. USING GENOME-WIDE DNA METHYLATION ASSAYS, WE IDENTIFIED THE DIFFERENTIALLY METHYLATED CYTOSINES IN THE PROMOTER REGIONS OF MAMMALIAN TARGET OF RAPAMYCIN (MTOR) REGULATORS IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF DIABETIC PATIENTS. FURTHER, MRNA ARRAYS CONFIRMED THE CONSISTENT INDUCTION OF GENES EXPRESSED IN THE MTOR PATHWAY. IMPORTANTLY, DOWN-REGULATION OF DNMT1 EXPRESSION VIA RNA INTERFERENCE RESULTED IN PROMINENT CYTOSINE DEMETHYLATION OF MTOR NEGATIVE REGULATORS AND SUBSEQUENT DECREASE OF MTOR ACTIVITY. LASTLY, MODULATION OF MTOR RESULTED IN CHANGES IN THE EFFECT OF 5-AZA ON DIABETIC IMMUNE CELLS. THUS, UP-REGULATION OF DNMT1 IN DIABETIC IMMUNE CELLS INDUCES ABERRANT CYTOSINE METHYLATION OF THE UPSTREAM REGULATORS OF MTOR, LEADING TO PATHOGENIC ACTIVATION OF THE MTOR PATHWAY AND CONSEQUENT INFLAMMATION IN DIABETIC KIDNEYS. HENCE, THIS STUDY HIGHLIGHTS THERAPEUTIC POTENTIAL OF TARGETING EPIGENETIC EVENTS IN IMMUNE SYSTEM FOR TREATING DKD. 2019 17 4900 38 OXIDATIVE STRESS-INDUCED EPIGENETIC CHANGES ASSOCIATED WITH MALIGNANT TRANSFORMATION OF HUMAN KIDNEY EPITHELIAL CELLS. RENAL CELL CARCINOMA (RCC) IN HUMANS IS POSITIVELY INFLUENCED BY OXIDATIVE STRESS STATUS IN KIDNEYS. WE RECENTLY REPORTED THAT ADAPTIVE RESPONSE TO LOW LEVEL OF CHRONIC OXIDATIVE STRESS INDUCES MALIGNANT TRANSFORMATION OF IMMORTALIZED HUMAN RENAL TUBULAR EPITHELIAL CELLS. EPIGENETIC ALTERATIONS IN HUMAN RCC ARE WELL DOCUMENTED, BUT ITS ROLE IN OXIDATIVE STRESS-INDUCED MALIGNANT TRANSFORMATION OF KIDNEY CELLS IS NOT KNOWN. THEREFORE, THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THE POTENTIAL ROLE OF EPIGENETIC CHANGES IN CHRONIC OXIDATIVE STRESS-INDUCED MALIGNANT TRANSFORMATION OF HK-2, HUMAN RENAL TUBULAR EPITHELIAL CELLS. THE RESULTS REVEALED ABERRANT EXPRESSION OF EPIGENETIC REGULATORY GENES INVOLVED IN DNA METHYLATION (DNMT1, DNMT3A AND MBD4) AND HISTONE MODIFICATIONS (HDAC1, HMT1 AND HAT1) IN HK-2 CELLS MALIGNANTLY TRANSFORMED BY CHRONIC OXIDATIVE STRESS. ADDITIONALLY, BOTH IN VITRO SOFT AGAR ASSAY AND IN VIVO NUDE MICE STUDY SHOWING DECREASED TUMORIGENIC POTENTIAL OF MALIGNANTLY TRANSFORMED HK-2 CELLS FOLLOWING TREATMENT WITH DNA DE-METHYLATING AGENT 5-AZA 2' DC FURTHER CONFIRMED THE CRUCIAL ROLE OF DNA HYPERMETHYALTION IN OXIDATIVE STRESS-INDUCED MALIGNANT TRANSFORMATION. CHANGES OBSERVED IN GLOBAL HISTONE H3 ACETYLATION (H3K9, H3K18, H3K27 AND H3K14) AND DECREASE IN PHOSPHO-H2AX (SER139) ALSO SUGGEST POTENTIAL ROLE OF HISTONE MODIFICATIONS IN INCREASED SURVIVAL AND MALIGNANT TRANSFORMATION OF HK-2 CELLS BY OXIDATIVE STRESS. IN SUMMARY, THE RESULTS OF THIS STUDY SUGGEST THAT EPIGENETIC REPROGRAMMING INDUCED BY LOW LEVELS OF OXIDATIVE STRESS ACT AS DRIVER FOR MALIGNANT TRANSFORMATION OF KIDNEY EPITHELIAL CELLS. FINDINGS OF THIS STUDY ARE HIGHLY RELEVANT IN POTENTIAL CLINICAL APPLICATION OF EPIGENETIC-BASED THERAPEUTICS FOR TREATMENTS OF KIDNEY CANCERS. 2017 18 1474 30 DISTINCT PATTERNS OF TRANSCRIPTIONAL AND EPIGENETIC ALTERATIONS CHARACTERIZE ACUTE AND CHRONIC KIDNEY INJURY. ACUTE KIDNEY INJURY (AKI) AND CHRONIC KIDNEY DISEASE (CKD) ARE CONSIDERED EARLY AND LATE PHASES OF A PATHOLOGIC CONTINUUM OF INTERCONNECTED DISEASE STATES. ALTHOUGH CHANGES IN GENE EXPRESSION PATTERNS HAVE RECENTLY BEEN ELUCIDATED FOR THE TRANSITION OF AKI TO CKD, THE EPIGENETIC REGULATION OF KEY KIDNEY INJURY RELATED GENES REMAINS POORLY UNDERSTOOD. WE USED MULTIPLEX RT-QPCR, CHIP-QPCR AND INTEGRATIVE ANALYSIS TO COMPARE TRANSCRIPTIONAL AND EPIGENETIC CHANGES AT RENAL DISEASE-ASSOCIATED GENES ACROSS MOUSE AKI AND CKD MODELS. THESE STUDIES SHOWED THAT: (I) THERE ARE SUBSETS OF GENES WITH DISTINCT TRANSCRIPTIONAL AND EPIGENETICALLY PROFILES SHARED BY AKI AND CKD BUT ALSO SUBSETS THAT ARE SPECIFIC TO EITHER THE EARLY OR LATE STAGES OF RENAL INJURY; (II) DIFFERENCES IN EXPRESSION OF A SMALL NUMBER OF GENES IS SUFFICIENT TO DISTINGUISH AKI FROM CKD; (III) TRANSCRIPTION PLAYS A KEY ROLE IN THE UPREGULATION OF BOTH AKI AND CKD GENES WHILE POST-TRANSCRIPTIONAL REGULATION APPEARS TO PLAY A MORE SIGNIFICANT ROLE IN DECREASED EXPRESSION OF BOTH AKI AND CKD GENES; AND (IV) SUBSETS OF TRANSCRIPTIONALLY UPREGULATED GENES SHARE EPIGENETIC SIMILARITIES WHILE DOWNREGULATED GENES DO NOT. COLLECTIVELY, OUR STUDY SUGGESTS THAT IDENTIFIED COMMON TRANSCRIPTIONAL AND EPIGENETIC PROFILES OF KIDNEY INJURY LOCI COULD BE EXPLOITED FOR THERAPEUTIC TARGETING IN AKI AND CKD. 2018 19 5988 26 TGF-BETA/SMAD AND RENAL FIBROSIS. RENAL FIBROSIS IS CHARACTERIZED BY EXCESSIVE DEPOSITION OF EXTRACELLULAR MATRIX (ECM) THAT DISRUPTS AND REPLACES FUNCTIONAL PARENCHYMA, WHICH LEADS TO ORGAN FAILURE. IT IS KNOWN AS THE MAJOR PATHOLOGICAL MECHANISM OF CHRONIC KIDNEY DISEASE (CKD). ALTHOUGH CKD HAS AN IMPACT ON NO LESS THAN 10% OF THE WORLD POPULATION, THERAPEUTIC OPTIONS ARE STILL LIMITED. REGARDLESS OF ETIOLOGY, ELEVATED TGF-BETA LEVELS ARE HIGHLY CORRELATED WITH THE ACTIVATED PRO-FIBROTIC PATHWAYS AND DISEASE PROGRESSION. TGF-BETA, THE KEY DRIVER OF RENAL FIBROSIS, IS INVOLVED IN A DYNAMIC PATHOPHYSIOLOGICAL PROCESS THAT LEADS TO CKD AND END-STAGE RENAL DISEASE (ESRD). IT IS BECOMING CLEAR THAT EPIGENETICS REGULATES RENAL PROGRAMMING, AND THEREFORE, THE DEVELOPMENT AND PROGRESSION OF RENAL DISEASE. INDEED, RECENT EVIDENCE SHOWS TGF-BETA1/SMAD SIGNALING REGULATES RENAL FIBROSIS VIA EPIGENETIC-CORRELATED MECHANISMS. THIS REVIEW FOCUSES ON THE FUNCTION OF TGF-BETA/SMADS IN RENAL FIBROGENESIS, AND THE ROLE OF EPIGENETICS AS A REGULATOR OF PRO-FIBROTIC GENE EXPRESSION. 2019 20 347 28 ALTERED DNA METHYLATION IN KIDNEY DISEASE: USEFUL MARKERS AND THERAPEUTIC TARGETS. RECENT STUDIES HAVE DEMONSTRATED THE ASSOCIATION OF ALTERED EPIGENOMES WITH LIFESTYLE-RELATED DISEASES. EPIGENETIC REGULATION PROMOTES BIOLOGICAL PLASTICITY IN RESPONSE TO ENVIRONMENTAL CHANGES, AND SUCH PLASTICITY MAY CAUSE A 'MEMORY EFFECT', A SUSTAINED EFFECT OF TRANSIENT TREATMENT OR AN INSULT IN THE COURSE OF LIFESTYLE-RELATED DISEASES. WE INVESTIGATED THE SIGNIFICANCE OF EPIGENETIC CHANGES IN SEVERAL GENES REQUIRED FOR RENAL INTEGRITY, INCLUDING THE NEPHRIN GENE IN PODOCYTES, AND THE SUSTAINED ANTI-PROTEINURIC EFFECT, FOCUSING ON THE TRANSCRIPTION FACTOR KRUPPEL-LIKE FACTOR 4 (KLF4). WE FURTHER REPORTED THE ROLE OF THE DNA REPAIR FACTOR LYSINE-ACETYL TRANSFERASE 5 (KAT5), WHICH ACTS COORDINATELY WITH KLF4, IN PODOCYTE INJURY CAUSED BY A HYPERGLYCEMIC STATE THROUGH THE ACCELERATION OF DNA DAMAGE AND EPIGENETIC ALTERATION. IN CONTRAST, KAT5 IN PROXIMAL TUBULAR CELLS PREVENTS ACUTE KIDNEY INJURY VIA GLOMERULAR FILTRATION REGULATION BY AN EPIGENETIC MECHANISM AS WELL AS PROMOTION OF DNA REPAIR, INDICATING THE CELL TYPE-SPECIFIC ACTION AND ROLES OF DNA REPAIR FACTORS. THIS REVIEW SUMMARIZES EPIGENETIC ALTERATIONS IN KIDNEY DISEASES, ESPECIALLY DNA METHYLATION, AND THEIR UTILITY AS MARKERS AND POTENTIAL THERAPEUTIC TARGETS. FOCUSING ON TRANSCRIPTION FACTORS OR DNA DAMAGE REPAIR FACTORS ASSOCIATED WITH EPIGENETIC CHANGES MAY BE MEANINGFUL DUE TO THEIR CELL-SPECIFIC EXPRESSION OR ACTION. WE BELIEVE THAT A BETTER UNDERSTANDING OF EPIGENETIC ALTERATIONS IN THE KIDNEY WILL LEAD TO THE DEVELOPMENT OF A NOVEL STRATEGY FOR CHRONIC KIDNEY DISEASE (CKD) TREATMENT. 2022