Loss of endothelial glucocorticoid receptor accelerates diabetic nephropathy

Endothelial cells play a key role in the regulation of disease and other developmental processes. Defective regulation of endothelial cell homeostasis may cause mesenchymal activation of other endothelial cells by autocrine effects or of neighboring cell types by paracrine effects, and in both cases contribute to organ fibrosis. However, regulatory control of endothelial cell homeostasis, is not well studied. Diabetes induced renal fibrosis in endothelial GR knock out mice ( GR fl/fl ; Tie 1 Cre; GR ECKO ) but not in control mice ( GR fl/fl ); hypercholesterolemia further enhanced severe renal fibrosis in diabetic GR ECKO ; Apoe −/− (DKO) but not in diabetic littermates ( GR fl/fl ; Apoe −/− ). The fibrogenic phenotype in the kidneys of diabetic GR ECKO and diabetic DKO were associated with aberrant cytokine and chemokine reprogramming. Canonical Wnt signaling was identified as new target for the action of endothelial GR. Wnt inhibiton improved kidney fibrosis by mitigating endothelial-to-mesenchymal transition (EndMT) and epithelial-to-mesenchymal transitions (EMT). Similarly, activation of fatty acid oxidation also suppressed kidney fibrosis. Conditioned media from endothelial cells from diabetic GR ECKO stimulated Wnt signaling-dependent epithelial-to-mesenchymal transition in tubular epithelial cells from diabetic controls. These data demonstrate that endothelial GR is an essential antifibrotic core molecule in diabetes.