1 Effects of Astragalus injection on TGF-β/Smads 2 pathway in kidney in type 2 diabetic mice 3 4 Yanna Nie1, Shuyu Li1, Yuee Yi1, Weilian Su1, Xinlou Chai1, Dexian Jia1 and Qian 5 Wang1 6 7 1 8 Beijing, China. School of Preclinical Medicine, Beijing University of Chinese Medicine, 100029, 9 10 Corresponding author 11 12 Email addresses: 13 YN: love_rapunzel@163.com 14 SL: lishuyu0706@163.com 15 YY:yijin_tao@163.com 16 WS:susulin2005@163.com 17 XC:mmxin3@126.com 18 DJ:jiadexian2002@yahoo.com.cn 19 QW: wangqianchai@163.com 20 1 21 Abstract 22 Background 23 In traditional Chinese medicine, astragalus injection is used to treat diabetic 24 nephropathy. This study was carried out to determine whether astragalus injection has 25 any effects on diabetic nephropathy by modulation of TGF -β/Smads signaling 26 pathway. 27 Methods 28 The 14-week-old diabetic male KKAy mice were randomly divided into model group 29 and astragalus injection treatment group, while the same age male C57BL/6J mice 30 were selected as the normal group. The treatment group received daily intraperitoneal 31 injection of astragalus (0.03 ml/10g.d), while the model group only received an 32 injection of the same amount of saline. Mice were killed at 24th week respectively. 33 The serum of each group were obtained and the blood glucose, creatinine and urea 34 nitrogen were detected. The kidney was used for morphometric studies. The 35 expression of TGF-β1, TGFβ-RⅠand Smad3/7 were detected by reverse 36 transcription-polymerase chain reaction (RT-PCR) and western blot. 37 Results 38 Mice of model group became obese, suffered health disorders such as 39 hyperglycaemia, polyuria and proteinuria. Astragalus injection treatment significantly 40 reduced albuminuria, improved renal function and ameliorated renal histopathologic 41 changes. Moreover, Astragalus injection increased the expression of Smad7, inhibited 2 42 the expression of TGF-β RⅠ,Smad3 and its phosphorylation, TGF-β RⅠand 43 decreased the mRNA level of TGF-β1. 44 Conclusions 45 TGF-β/Smads signal pathway plays an important role in the development of diabetic 46 nephropathy (DN). Astragalus injections can preclude or mitigate DN by rebalancing 47 TGF-β/Smads signalling and possess a protective effect on renal damage of DN in 48 KKay mice. 49 Background 50 Diabetic nephropathy (DN) is a major microvascular complication of diabetes 51 mellitus and the leading cause of end-stage renal disease [1]. A pathological change in 52 diabetic nephropathy is the accumulation of normal and abnormal extracellular matrix 53 components in the glomeruli and the interstitium of kidney [2]. TGF-β is a secreted 54 protein that plays a critical role in the renal fibrosis and the accumulation of ECM [3]. 55 Intraperitoneal injection of TGF-β alone is sufficient to initiate a prominent renal 56 fibrotic response [4]. TGF-β isoforms and their receptors are upregulated in both 57 experimental and human DN [5,6]. We focus on TGF-β1 because it is the most highly 58 expressed isoform in kidney and has been most closely linked to the pathophysiology 59 of DN [6]. It was reported that TGF-β1 is stimulated by high glucose and is mainly 60 expressed in renal tubular epithelial cells of diabetic mice [7]. 61 TGF-β1 binds to the TGFβ-RⅡ which recruits the binding of TGF-β RⅠ to 62 form a heterotetramer. Then the TGF-β RⅠ phosphorylates the Smad proteins [8,9], 63 after which the activated Smad2/Smad3 associate with Smad4 and this complex 3 64 translocates to the nucleus where it is involved in mediating transcriptional responses 65 on target genes [10]. Ultimately, the predominant effect of TGF-β is to promote 66 matrix accumulation. 67 Astragalus (Astragalus membranaceus) has long been known as an 68 immune-modulating herb in traditional Chinese medicine. In clinical practice, it has 69 been widely used in treating diabetes and kidney abnormalities caused by diabetes in 70 the form of astragalus injection[11,12]. There are mainly polysaccharoses, 71 astragaloside, isoflavones, and saponin glycosides extracted from astragalus [13]. 72 Recent studies have shown that astragalus has antifibrotic effect in a rat model and 73 can inhibit the expression of TGF-β1, reduce extracellular matrix (ECM) synthesis 74 and block tubular epithelial-to-mesenchymal transition (EMT) process [14,15]. A 75 meta-analysis results revealed that astragalus injection had more therapeutic effect in 76 DN patients such as reducing urine protein and improving renal function [16]. 77 Astragaloside Ⅳ, one of the main actived ingredients of astragalus, was proved that 78 could ameliorate podocyte apoptosis, prevent acute kidney injury and attenuate 79 glycated albumin-induced EMT in renal proximal tubular cells [17,18]. 80 Therefore, understanding the mechanisms of the astragalus injection to treat DN 81 is essential for clinical therapy. We employs diabetic nephropathy model to 82 investigate the effects of astragalus injection on TGF-β/Smads pathway. 4 83 Methods 84 Chemicals and reagent 85 Astragalus injections were purchased from the Chengdu di’aojiuhong pharmaceutical 86 factory, Chengdu, China. 87 Experimental animals and treatment 88 All experiments were performed in accordance with the guidelines on Ethical 89 Standards for the investigation in animals; the study was approved by the the animal 90 research committee of the Beijing University of Chinese Medicine. Sixteen male 91 KKAy mice (9-11 weeks of age) weighing 25-28 g were used. Eight male C57BL/6J 92 mice (9-11 weeks of age) weighing 23-25 g were also used. All the mice were 93 purchased from Animal Center of Chinese Academy of Medical Science (Beijing, 94 China) and were raised in the Clinical Institute of China-Japan Friendship Hospital 95 (Beijing, China). During the experimental protocol, the KKAy mice were allowed free 96 access to high-fat diet (HFD) and pure water. As a control, the C57BL/6J mice were 97 allocated a normal diet and pure water. 98 99 At 14 weeks of age, the tail blood was taken to measure blood glucose. A mouse whose glucose is higher than 13.9 mM can be seen as a diabetic mouse. Then the 100 KKAy mice were randomly divided into the model group (MG, n=8) and the 101 treatment group (TG, n=8) so that the averages of body weight and blood glucose 102 levels were approximately equal. The C57BL/6J mice were used as the normal group 103 (NG, n=8). The treatment group received daily intraperitoneal injection of astragalus 104 (0.03 ml/10g.d), while the model group only received an injection of the same amount 5 105 of saline. The mice were housed individually in plastic cages with free access to food 106 and water throughout the experimental periods. 107 Weekly measurements of body weight were conducted and no differences were 108 detected among the groups. Samples for determination of the blood glucose were 109 taken from the tip of the tail by using the BREEZE2 Blood Glucose Test Strips (Bayer 110 HealthCare, USA) every four weeks. At 24 weeks of age, all the mice were deprived 111 of food pellets for 10 h. Blood was then collected from the orbital plexus. Samples 112 were kept on ice for 1 h, then the plasma was separated by centrifugation at 2000 rpm 113 for 15 min at 4℃ and subsequently stored in tubes at -20℃ until analysis. Some 114 kidney tissues were excised and instantly frozen in liquid nitrogen for the following 115 polymerase chain reaction (PCR) and Western blotting assay. Others were fixed in 4% 116 buffered paraformaldehyde for HE (hematoxylin and eosin) staining and Masson 117 staining. 118 Biochemical analysis 119 Mice were executed after taking blood samples at 24 weeks of age, The levels of 120 blood urea nitrogen (UREA) and plasma creatinine (CREA) were measured by 121 Automated Biochemical Analyzer (Hitachi, Japan). 122 Albumin urine analysis 123 The metabolic cages method was used to collect the urine samples. The 124 concentrations of albumin urine samples were assessed using an automatic 125 biochemistry analyzer (DADE Xpand, USA). Albuminuria in mice was expressed as 126 milligrams per 24 h. 6 127 Renal histological analysis 128 Kidney sections were fixed in 4% buffered paraformaldehyde, embedded in paraffin 129 and cut into 4-μm thick sections which were prepared for hematoxylin-eosin (HE) and 130 Masson staining. 131 132 Analysis of TGF-β1, TGFβ-RⅠ and Smad3 mRNA expressions by Reverse transcriptase-PCR 133 Total RNA was extracted from the kidney samples using Trizol reagent (Invitrogen, 134 CA, USA). The total RNA concentration and purity were determined by measuring 135 the OD260 and OD280 ratio. RNA was reverse-transcribed using GoScript Reverse 136 Transcription System (Promega, USA) following the manufacturer instructions. 137 Primers for PCR (Table 1)were designed and synthesized by Sangon Biotech Co. , Ltd 138 (Shanghai, China). PCR reaction was performed using a thermal cycler (Bio-Rad 139 Laboratory, USA) by the following contidions: 95℃ for 5 min; 95℃ for 30 s, 50℃ 140 for 30 s, 72℃ for 40 s, repeated for 36 cycles; and 72℃ for 8 min. Then a carefully 141 prepared 1% agarose gel that would present the PCR products clearly was run. The 142 quantity of specific mRNA was normalized as a ratio to the amount of β-actin mRNA. 143 Western blot analysis for TGF-β1, TGFβ-RⅠ, Smad3/7 and p-Smad3 144 The lysates were clarified by centrifugation and supernatants were collected. Protein 145 concentrations were determined using the BCA Protein Assay (Applygen, Beijing, 146 China). Equivalent amounts of tissue protein (80 μg) were resolved on SDS 147 polyacrylamide gels and electroblotted to PVDF. The membranes were bloked in 5% 148 (W/V) nonfat milk at room temperature for 1 h, and then incubated with the primary 149 antibody against Smad3 (dilution 1: 200, Santa cruz, CA, USA), Smad7 (dilution 7 150 1:200, Santa cruz, CA, USA), p-Smad3(dilution1: , epitomics, CA, USA) and β-actin 151 (dilution 1: 1000, Santa cruz, CA, USA) overnight at 4℃ over night. After washing 152 in 0.1% Tween TBS buffer, the membranes were incubated with horseradish 153 peroxidase (HRP)-linked anti-mouse secondary antibody at 1:3000 dilution. 154 Following washing in 0.1% Tween TBS buffer, the immunolabeled proteins were 155 detected by enhanced chemiluminescense detection reagents (Applygen, Beijing, 156 China). The density of bands was analyzed by Quantity One software. 157 Statistical Analysis 158 Numerical data are expressed as means ± standard deviation (SD) of at least three 159 independent experiments. The significance of differences was examined using 160 ANOVA. Values of P <0.05 were considered significant. 161 Results 162 Astragalus injection controls blood glucose levels and body weights 163 The normal group didn’t display any obvious fluctuations in body status. However, 164 the mice in the model group demonstrated retarded spirit, slow activities and 165 lacklustre body hairs, which are typical manifestations of diabetes. Despite 166 exhibitions of the similar symptoms to those of the model group, the treatment group 167 showed much milder sufferings. 168 The body weights of the mice in the model group were significantly higher than 169 those in the normal group (P<0.01, Fig.1A), and the condition persisted during our 170 experiment. Although the body weights of the mice in the treatment group also 171 gradually increased, the mean weight of those was significantly lower than that of 8 172 mice in the model group, as evidenced by measurement at 16,18,20 and 24 weeks 173 respectively (Fig.1A). The blood glucose levels in the model group were also 174 increased as compared with the normal group (P<0.01, Fig.1B), which were 175 sigficantly reduced after the treatment with astragalus injections at 20 and 24 weeks 176 (P<0.01, Fig.1B). However, the astragalus injection treatments were not able to bring 177 glucose back to its normal level. 178 Astragalus injection reduces albuminuria and renal function deterioration 179 At 24 weeks of age, there were significant differences in the concentration of 180 creatinine, blood urea nitrogen and albumin between the normal group and the model 181 group (P<0.01, P<0.01, P<0.01, Fig.2). The treatment group showed significantly 182 lower levels of plasma creatinine, blood urea nitrogen and urinary albumin after being 183 administrated with astragalus injections, as compared to the model group. ( P<0.05, 184 P<0.01, P<0.01, Fig.2). 185 Astragalus injection prevents renal morphological changes in diabetic mice 186 To identify the pathological damage in the kidney and to confirm the protective effect 187 of astragalus injection on DN, HE and masson staining were performed. Compared 188 with the normal group, a variety of damages of DN were detected in renal pathology 189 of the model group, including thickening of basal membrane, vacuolar degeneration in 190 the renal tubular epithelial cells (Fig.3 A-C). Masson staining revealed obvious 191 glomerular sclerosis and interstitial fibrosis in KKay mouse. However, treatment with 192 astragalus injection reversed these changes to a certain degree (Fig.3). 9 193 194 Effects of astragalus injection on the expression of Smad3, Smad7, TGF-β1, TGFβ-RⅠat mRNA level 195 Using Reverse transcriptase-PCR , we found that astragalus injections significantly 196 modulated the mRNA expression of Smad3, Smad7, TGF-β1, TGFβ-RⅠin kidneys of 197 diabetic mice. The relative amounts of Smad3, TGF-β1, TGFβ-RⅠ mRNA were 198 lower in diabetic mice treated with astragalus injections compared with the model 199 group (P<0.01, P<0.01, P<0.05, Fig.4). Inversely, Smad7 expression was lower in 200 KKay mice than in the normal mice (P<0.05, Fig.4), and astragalus injection 201 treatment markedly induced Smad7 expression in diabetic mice (P<0.05, Fig.4). 202 203 Effects of astragalus injection on the expression of Smad3, Smad7, TGF-β1, TGFβ-RⅠ and p-Smad3 at protein level 204 To examine the Smad3/7, TGF-β1 and TGFβ-RⅠexpressions, we employed western 205 blot analysis. The model group showed higher levels of Smad3, TGF-β1, TGFβ-RⅠ 206 (P<0.01, P<0.05, P<0.01, Fig.5 ) and lower level of Smad7 (P<0.01, Fig.5) compared 207 with the normal group. The astragalus injection significantly reversed the increase in 208 Smad3, TGFβ-RⅠ proteins (P<0.01, P<0.05) and the decrease in Smad7(P<0.01) 209 protein in diabetic mice. But it had no effect on TGF-β1 expression (Fig.5). 210 Smad3 is activated by phosphorylation. We then examined the expression of 211 phosphorylated Smad3 by western blot. The results demonstrated that the 212 phosphorylation of Smad3 as a fraction of total Smad3 was significantly increased in 213 kidneys in the model group when compared with the normal group (P<0.01, Fig.6). 214 Conversely, astragalus injection treatment significantly inhibited the Smad3 activation 215 (P<0.01, Fig.6). 216 10 217 Discussion 218 Diabetic nephropathy, one of the most frequent chronic microvascular complications 219 of diabetes mellitus, is the leading cause of end-stage kidney failure [19,20]. Its main 220 pathological changes are ECM accumulation, degeneration of tubular epithelial cells, 221 atrophy even disappearance of some tubules, thickening of basal membrane and 222 infiltration with inflammatory cells in mesenchyme [21,22]. The KKAy mouse, which 223 is known to serve as an excellent model of type-2 diabetes, was produced by 224 transferring the yellow obese gene (Ay alele) into the KK/Ta mouse [23]. In the 225 previous study, KKAy mice had developed obesity, hyperglycaemia and albuminuria 226 by 14-week old. Furthermore, HE staining demonstrated the thickened glomerular 227 basement membrance, vacuolar degeneration in the renal tubular epithelial cells. And 228 Masson staining revealed obvious glomerular sclerosis and interstitial fibrosis in 229 KKay mouse, a finding that is consistent with previous studies [22]. 230 The Chinese herbal astragalus is an effective medical prescription which is 231 clinically used to treat DN [16,24]. All of the major constituents of astragalus have 232 been shown to differentially lower high blood glucose levels and improve impaired 233 glucose tolerance in type 2 diabetic models [25,26]. In this study, astragalus injection, 234 the aqueous extract of astragalus, administration of which for 10 weeks did have a 235 mild hypoglycemic effect as suggested in our data above. However, good glycemic 236 control with insulin has been demonstrated to ameliorate DN in STZ-DM rats [27], 237 suggesting that astragalus injection possesses other renoprotective mechanism beyond 238 the sugar lowering effect. Diabetic albuminuria is an early hallmark of DN and is 11 239 always associated with the development of characteristic histopathologic features. The 240 results that there were aggravated kidney injuries such as albuminuria, glomerular 241 sclerosis and interstitial fibrosis in KKay mice supported this notion. However, 242 astragalus injection treatment attenuated theses changes in diabetic kidneys. 243 Supporting this result may be the idea that astragalus injection can improve renal 244 function through inhibiting EMT process and collagen production [28]. Moreover, it 245 was found that levels of serum creatinine and blood urea nitrogen were elevated 246 significantly in KKay mouse and the treatment group showed milder symptoms than 247 the model group after administration of astragalus injection, indicating that astragalus 248 injection could ameliorate renal function deterioration. Taken together, astragalus 249 injection may be appropriate to control blood glucose levels and body weight. 250 Specifically, it can reverse renal histopathologic changes, attenuate albuminuria, 251 through which renal function may be improved. So there is a need for investigating 252 the molecular mechanism of astragalus injection in treating DN. 253 Then we aimed to investigate the mechanism of the astragalus injection to treat 254 DN by focusing on the TGFβ/Smad pathway. TGF-β, a multifunctional cytokine, 255 which leads to renal fibrosis, plays a crucial role in the pathogenesis of DN. 256 Interestingly, the administration of TGF-β neutralizing antibodies significantly 257 reduced renal fibrosis [9]. In our previous studies, we concluded that TGF-β1 proteins 258 were high in diabetic kidneys of the KKay mice by immunohistochemistry. Moreover, 259 We also found that TGF-β1 was mainly expressed in the cytoplasm of the renal 260 tubular epithelial cells and is rarely expressed in glomeruli [29]. In this study, the 12 261 amount of TGF-β1 expression was higher in the model group than that in the normal 262 group, all of which are consistent with others’ findings [30,31]. Furthermore, 263 astragalus injection treatment significantly reduced mRNA expression of TGF-β1. 264 This finding suggested that it may play a role in downregulation of TGF-β1 at 265 transcriptional level. Our western blot studies confirmed that the model group showed 266 upregulated TGF-β RⅠproteins, however increased TGF-β RⅠwas not significant at 267 mRNA levels. This phenomenon may be ascribed to the possibility that the mRNA of 268 TGF-β RⅠis apt to degrade due to its unstable nature. 269 One of our aims in this experiment was to investigate the effect of astragalus 270 injection on Smad3/7. Smad7, as one of the inhibitory Smads, blocks TGF-β signaling 271 pathway by inhibiting Smad2/3 phosphorylation and thereby exerting its anti-fibrotic 272 effect [32]. Increasing evidence has shown that disruption of Smad7 may accelerate 273 renal fibrosis [33,34], Our results that KKay mice with down-regulated Smad7 274 developed more severe renal dysfunction further confirmed this viewpoint. Besides 275 the inhibitory Smads, there are receptor-regulated Smads that can transduce TGFβ 276 signal, such as Smad2 and Smad3. Smad3 is a critical downstream mediator 277 responsible for renal fibrosis and is proved to function in the diabetes-induced 278 up-regulation of fibronectin and α3 (Ⅳ) collagen, and therefore may play a critical 279 role in the early phase of DN [35,36]. It is well documented that smad3-deficient mice 280 are protected from renal fibrosis by reduced EMT, collagen deposition, and the 281 expression of profibrotic TGF-β target genes [37,38]. As shown in our results, the 282 expression of Smad3 and p-Smad3 were increased in diabetic kidney. Furthermore, 13 283 astragalus injection suppressed Smad3 expression and its phosphorylation and 284 promoted Smad7 expression resulting in improved conditions provides further 285 evidence for its effectiveness in treatment of DN. 286 Conclusions 287 In conclusion, we believe that the diabetic nephropathy is caused by the imbalanced 288 TGF-β/Smad pathway, and as a result, FN increases and assembles, leading to 289 glomerular sclerosis and interstitial fibrosis. In consistent with our expectation, 290 astragalus injection alleviates DN by suppressing Smad3, p-Smad3 and TGF-β RⅠ 291 expression. Concurrently, it also exerts its effect by reducing the mRNA level of 292 TGF-β1 and promoting Smad7 expression, These results demonstrated that astragalus 293 injection could be a potential agent for amelioration of DN via blockade of 294 TGF-β/Smad pathway. 295 Abbreviations 296 TGF-β: transforming growth factor-beta; DN: Diabetic nephropathy; TGFβ-R: 297 transforming growth factor-beta receptor; UREA: blood urea nitrogen; CREA: plasma 298 creatinine. 299 Competing interests 300 The authors have declared that there is no conflict of interest. 14 301 Authors' contributions 302 YN carried out the animal experiments, performed the statistical analysis and drafted 303 the manuscript. YY participated in the western blot assay. WS involved in the 304 extraction of RNA and RT-PCR, XC and DJ participated in the HE staining and 305 discussion of the experiment. SL and QW formulated the original ideas and working 306 hypothesis. QW is the owner of the research grant and revised the draft of manuscript. 307 All authors read and approved the final manuscript. 308 Acknowledgements 309 This study was supported by the National Natural Science Foundation of China (no. 310 30672756; no. 81072926) and innovation team project funded by Beijing university of 311 Chinese medicine (no. 2011-CXD-04). 312 References 313 1. Wild S, Roglic G, Green A, et al: An alarmingly high prevalence of diabetic 314 nephropathy in Asian type 2 diabetic patients: the Microalbuminuria 315 Prevalence (MAP) Study. Diabetologia 2005, 48: 17–26 316 317 318 319 320 2. Wolf G, Ziyadeh FN: Cellular and molecular mechanisms of proteinuria in diabetic nephropathy. Nephron Physiol 2007, 106: 26–31 3. Lan HY: Diverse roles of TGF-beta/Smads in renal fibrosis and inflammation. Int J Biol 2011, 7:1056-1067 4. Ledbetter S, Kurtzberg L, Doyle S, et al: Renal fibrosis in mice treated with 321 human recombinant transforming growth factor-β2. Kidney Int 2000, 58: 322 2367–2376 323 5. Thompson NL, Flanders KC, Smith JM, et al: Expression of transforming 15 324 growth factor-βl in specific cells and tissues of adult and neonatal mice. J 325 Cell Biol 1989, 108: 661–669 326 6. Reeves WB, Andreoli TE: Transforming group factor-β contributes to 327 progressive diabetic nephropathy. Proc. Natl Acad. Sci. USA 2000, 328 97:7667-7669 329 7. Rocco MV, Chen Y, Goldfarb S, Ziyadeh FN: Elevated glucose stimulates 330 TGF-β gene expression and bioactivity in proximal tubule. Kidney Int 331 1992, 41: 107-114 332 8. Wang W, Koka V, Lan HY: Transforming growth factor-beta and Smad 333 signalling in kidney diseases. Nephrology (Carlton) 2005, 10: 48–56 334 335 336 9. Gagliardini E, Benigni A: Role of anti-TGF-β antibodies in the treatment of renal injury. Cytokine Growth Factor Rev 2006, 17: 89–96 10. Ikushima H, Miyazono K: Cellular context-dependent "colors" of 337 transforming growth factor-β signaling. Cancer Sci 2010, 101: 306–312 338 11. Y Feng, L Feng: Protective effect of Astragalus membranaceus on diabetic 339 nephropathy in rats. J Prac Med 2006, 22(21): 2457–2459 340 12. DX Wei, NZ Yu, OZ Ya: Traditional Chinese medicines in treatment of 341 patients with type 2 diabetes mellitus. Evidence-Based Complementary and 342 Alternative Medicine 2011 343 344 345 13. Astragalus. Natural Medicines Comprehensive Database Web site. Accessed at www.naturaldatabase.com on April 21, 2009 14. Wang, H. Y. : Antifibrotic effect of the Chinese herbs Astragalus 346 mongholicus and Angelica sinensis, in a rat model of chronic puromycin 347 aminonucleoside nephrosis. Life Science 2004, 74: 1645-1658 16 348 15. Yujie Li, Yuanyuan Lai, Shuyu Li, Ying Wu, Qian Wang: Influence of 349 huangqi injection on tubular epithelial-mesenchymal transition. J of 350 Beijing University of Traditional Chinese Medicine 2012, 35(2): 109-116 351 16. Mingxin Li, Weixin Wang, Jun Xue, Yong Gu, Shanyan Lin: Meta-analysis of 352 the clinical value of astragalus membranaceus in diabetic nephropathy. J 353 of Ethnopharmacology 2011, 133: 412-419 354 17. Gui D, Huang J, LiuW, GuoY, XiaoW, Wang N: Astragaloside Ⅳ prevents 355 acute kidney injury in two rodent models by inhibiting oxidative stress 356 and apoptosis pathways. Apoptosis 2013, 18: 409–422 357 18. Weiwei Qi, Jianying Niu, Qiaojing Qin, Zhongdong Qiao, Yong Gu: 358 Astragaloside IV attenuates glycated albumin-induced 359 epithelial-to-mesenchymal transition by inhibiting oxidative stress in 360 renal proximal tubular cells. Cell sress and Chaperones 2014, 19: 105-114 361 362 363 19. Tervaert TW, Mooyaart AL: Pathologic classification of diabetic nephropathy. J Am Soc Nephrol 2010, 21: 556–563 20. Whiting DR, Guariguata L: IDF diabetes atlas: global estimates of the 364 prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011, 94: 365 311–321 366 367 368 369 370 371 21. Mason RM, Wahab NA: Extracellular matrix metabolism in diabetic nephropathy. J Am Soc Nephrol 2003, 14: 1358–1373 22. Schena FP, Gesualdo L: Pathogenetic mechanisms of diabetic nephropathy. J Am Soc Nephrol 2005, 16: S30–33 23. Yasuhiko Tomino: Lessons from the KK-Ay Mouse, a spontaneous animal model for the treatment of human type 2 diabetic nephropathy. 17 372 373 Nephro-Urol Mon 2011, 4: 524-525 24. Juqian Zhang, Xisheng Xie, Ping Fu: Systematic review of the renal 374 protective effect of Astragalus (root) on diabetic nephropathy in animal 375 models. J Ethnopharmacol 2009, 126: 189-196 376 25. WP Liao, YG Shi: Effect of astragalus polysaccharides and soy isoflavones 377 on glucose metabolism in diabetic rats. Acta Academiae Medicinae Militaris 378 Tertiae 2007, 29: 416-418 379 26. F Zhou, XQ Mao, et al: Astragalus polysaccharides alleviates glucose 380 toxicity and restores glucose homeostasis in diabetic states via activation 381 of AMPK. Acta Pharmacologica Sinica 2009, 30: 1607-1615 382 383 27. J Petersen, J Ross, R Rabkin: Effect of insulin therapy on established diabetic nephropathy in rats. Diabetes 1988, 37: 1346-1350 384 28. XIAO Min, LI Huijuan, XIE Xisheng, et al: Astragalus Mongholicus may 385 regulate rat renal tubular cell transdifferrentiation induced by TGF-β1 386 through C- met dependent pathway. Chinese Journal Of Integrated 387 Traditional And Western Nephrology 2008, 9: 764-768 388 29. Shuyu Li, Xinlou Chai, Qian Wang, et al: Effects of astragalus injection 389 combined with puerarin injection on expression of BMP-7 and TGF-β1 in 390 type 2 diabetic KKAy mouse kidney. Chinese Journal of Pathophysiology 391 2012, 28: 1802-1806 392 30. Lingyun Li, Nerimiah Emmett, David Mann, Xueying Zhao: Fenofibrate 393 attenuates tubulointerstitial fibrosis and inflammation through 394 suppression of nuclear factor-κB and transforming growth 395 factor-β1/Smad3 in diabetic nephropathy. Exp Biol Med 2010, 235: 396 383-391 18 397 31. SW Hong, M Isono, S Chen, FN Ziyadeh: Increased glomerular and 398 tubular expression of TGF--β1, its type II receptor, and activation of the 399 Smad signaling pathway in the db/db mouse. Am J Pathol 2001, 158: 400 1653–1663 401 32. Schiffer M, Schiffer LE, Gupta A, et al: Inhibitory smads and TGF-beta 402 signaling in glomerular cells. J Am Soc Nephrol 2002, 13: 2657-2666 403 33. Arthur C. K. Chung, Xiao R. Huang, Li Zhou, et al: Disruption of the 404 Smad7 gene promotes renal fibrosis and inflammation in unilateral 405 ureteral obstruction (UUO) in mice. Nephrol Dial Transplant 2009, 24: 406 1443-1454 407 34. Hai Yong Chen, Xiao R. Huang, Wansheng Wang, et al: The protective role 408 of Smad7 in diabetic kidney disease: mechanism and therapeutic 409 potential. Diabetes. 2011, 60: 590-601 410 35. Wang A, Ziyadeh FN, Lee EY, et al: Interference with TGF-beta signaling 411 by Smad3-knockout in mice limits diabetic glomerulosclerosis without 412 affecting albuminuria. Am J Physiol Renal Physiol 2007, 293: F1657–1665 413 36. Fujimoto M, Maezawa Y, Yokote K, et al: Mice lacking Smad3 are 414 protected against streptozotocin-induced diabetic glomerulopathy. 415 Biochem Biophys Res Commun 2003, 305: 1002–1007 416 37. Arany P. R, Flanders KC, DeGraff W, et al: Absence of Smad3 confers 417 radioprotection through modulation of ERK-MAPK in primary dermal 418 fibroblasts. J Dermatol Sci 2007, 48: 35–42 419 38. Inazaki K, Kanamaru Y, Kojima Y, et al: Smad3 deficiency attenuates renal 420 fibrosis, inflammation, and apoptosis after unilateral ureteral obstruction. 421 Kidney Int 2004, 66: 597–604 19 422 Figures 423 Figure 1- Body weights and the blood glucose levels in different weeks (means ± 424 SD, n=6-8). NG: the normal group. MG: the model group. TG: the astragalus 425 injection treatment group. The bargraphs summarize average values for body weight 426 and blood glucose. A: body weights gradually increased in mice in the model group. 427 Astragalus injection treatment could significantly inhibit body weight gains. B: 428 diabetic mice (the model group) remained hyperglycemic and C57BL/6J mice (the 429 normal group) remained normoglycemic throughout the period of study. The tendency 430 for astragalus injection treatment to reduce the blood glucose concentration in diabetic 431 mice was obvious. but the astragalus injection treatments can not return the blood 432 glucose levels to normal. Compared with NG, *P<0.05, **P<0.01.Compared with 433 MG, P<0.05, P<0.01. 434 Figure 2 - The concentration of plasma creatinine, blood urea nitrogen, urine 435 albumin at 24 weeks of age (means ± SD, n=6-8). NG: the normal group. MG: the model 436 group. TG: the astragalus injection treatment group. A: the mean of plasma creatinine was 437 elevated in the model group. The increase in plasma creatinine with diabetes was prevented in 438 the treatment group. B: blood urea nitrogen tracked with the plasma creatinine, increasing in 439 model group but decreasing in the treatment group. C: urine albumin also increased in the 440 model group, which was markedly reduced with astragalus injection treatment. Compared 441 with NG, *P<0.05, **P<0.01. Compared with MG, P<0.05 , P<0.01. 20 442 Figure 3. Renal pathology of different groups (HE , masson ×400). Figures show 443 pathologic damages in KKAy mice at 24 weeks of age. Glomerulosclerosis and interstitial 444 fibrosis are the main pathology in diabetic nephropathy. A-C: HE staining. A: the normal 445 group. B: the model group. HE staining showed thickened basal membrane and vacuolar 446 degeneration in the renal tubular epithelial cells. C: the treatment group. D-F: Masson 447 staining. D: the normal group. E: the model group. Masson staining revealed collagen 448 deposition (blue color) in the interstitium and glomeruli. F: the treatment group. It showed 449 more improved kidney pathological. 450 Figure 4. Astragalus injection has effects on the mRNA expressions of 451 Smad3/7, TGF-β1, TGFβ-RⅠ(means ± SD, n=3). Mice were sacrificed at 24 week. NG: 452 the normal group. MG: the model group. The model group showed decreased 453 expression of Smad7 and increased expression of Smad3, TGFβ-RⅠ, TGF-β1. TG: the 454 astragalus injection treatment group. Compared with NG, *P<0.05, **P<0.01. 455 Compared with MG, P<0.05 , P<0.01. 456 Figure 5. Astragalus injection has effects on the protein expressions of 457 Smad3/7, TGF-β1, TGFβ-RⅠ(means ± SD, n=3). Protein extracts from the renal cortex 458 were analyzed to evaluate the expression of TGF-β/Smad proteins. NG: the normal 459 group. MG: the model group. TG: the astragalus injection treatment group. The 460 reduction in Smad3 and TGFβ-RⅠprotein levels was similarly observed in diabetic 461 mice after astragalus injection treatment, but no significant change was observed in 462 TGF-β1 level. Compared with NG, *P<0.05, **P<0.01. Compared with MG, 463 P<0.05 , P<0.01. 21 464 Figure 6. Smad3 phosphorylation in diabetic mice was suppressed by 465 astragalus injection (means ± SD, n=3). NG: the normal group. MG: the model group. 466 TG: the astragalus injection treatment group. The Smad3 was actived in diabetes. The 467 ratio of phosphorylated Smad3 to total Smad3 was increased in KKay mice. In addition, 468 Smad3 activation were significantly inhibited in astragalus injection treated diabetic mice. 469 Representative western blots of p-Smad3 and total Smad3 are shown in figure6. Compared 470 with NG, *P<0.05, **P<0.01. Compared with MG, P<0.05 , P<0.01. 471 Tables 472 Table 1 - PCR sequences and PCR products name TGF-β1 TGFβ-RⅠ Smad7 Smad3 β-actin length 493bp 172bp 309bp 232bp 243bp Upstream primer(5’-3’) TCCCTCAACCTCAAATTATTCA GGCGAAGGCATTACAGTGTT ACAGAAAGTGCGGAGCAAGAT GGGCCAACAAGTCAACAAGT GAAATCGTGCGTGACATTAAGG Downstream primer(5’-3’) GCGGTCCACCATTAGCAC TGCACATACAAATGGCCTGT CTGATGAACTGGCGGGTGTAG CTGGCTGGCTAAGGAGTGAC CACGTCACACTTCATGATGGAG 473 474 Additional files 475 476 477 478 Additional file 1 – revised manuscript with corrections red-marked A revised version with corrections in red mark is for convenient scrutiny. It is in the formats of MS word. 22