Exercise training ameliorates early diabetic kidney injury by regulating the H 2 S/SIRT1/p53 pathway

Abstract Exercise training exerts protective effects against diabetic nephropathy. This study aimed to investigate whether exercise training could attenuate diabetic renal injury via regulating endogenous hydrogen sulfide (H 2 S) production. First, C57BL/6 mice were allocated into the control, diabetes, exercise, and diabetes + exercise groups. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ). Treadmill exercise continued for four weeks. Second, mice was allocated into the control, diabetes, H 2 S and diabetes + H 2 S groups. H 2 S donor sodium hydrosulfide (NaHS) was intraperitoneally injected once daily for four weeks. STZ‐induced diabetic mice exhibited glomerular hypertrophy, tissue fibrosis and increased urine albumin levels, urine protein‐ and albumin‐to‐creatinine ratios, which were relieved by exercise training. Diabetic renal injury was associated with apoptotic cell death, as evidenced by the enhanced caspase‐3 activity, the increased TdT‐mediated dUTP nick‐end labeling ‐positive cells and the reduced expression of anti‐apoptotic proteins, all of which were attenuated by exercise training. Exercise training enhanced renal sirtuin 1 (SIRT1) expression in diabetic mice, accompanied by an inhibition of the p53‐#ediated pro‐apoptotic pathway. Furthermore, exercise training restored the STZ‐mediated downregulation of cystathionine‐β‐synthase (CBS) and cystathionine‐γ‐lyase (CSE) and the reduced renal H 2 S production. NaHS treatment restored SIRT1 expression, inhibited the p53‐mediated pro‐apoptotic pathway and attenuated diabetes‐associated apoptosis and renal injury. In high glucose‐treated MPC5 podocytes, NaHS treatment inhibited the p53‐mediated pro‐apoptotic pathway and podocyte apoptosis in a SIRT1‐dependent manner. Collectively, exercise training upregulated CBS/CSE expression and enhanced the endogenous H 2 S production in renal tissues, thereby contributing to the modulation of the SIRT1/p53 apoptosis pathway and improvement of diabetic nephropathy.