Kidney cyst growth in ADPKD is associated with regional hypoxia, presumably due to a mismatch between enlarged cysts and the peritubular capillary blood supply and compression of peritubular capillaries in cyst walls. Regional hypoxia leads to activation of hypoxia-inducible transcription factors, with the two main HIF isoforms, HIF-1 and HIF-2 expressed in cyst epithelia and pericystic interstitial cells, respectively. While HIF-2 activation is linked to EPO production, mitigating the anemia that normally accompanies chronic kidney disease, HIF-1 promotes cyst growth. HIF-dependent cyst growth is primarily due to an increase in chloride-dependent fluid secretion into the cyst lumen. However, given the broad spectrum of HIF-target genes, additional HIF-mediated pathways may also contribute to cyst progression. Furthermore, hypoxia can influence cyst growth through the generation of reactive oxygen species. Since cyst expansion aggravates regional hypoxia, a feedforward loop is established that accelerates cyst expansion and disease progression. Inhibiting the HIF pathway and/or HIF target genes that are of particular relevance for HIF-dependent cyst fluid secretion may therefore represent novel therapeutic approaches to retard the progression of APDKD.

中文翻译：

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氧气和HIF途径在多囊性肾脏疾病中的作用。

ADPKD中肾脏囊肿的生长与局部缺氧有关，可能是由于肿大的囊肿与肾小管周围毛细血管供血不匹配以及囊壁中的肾小管周围毛细血管受压所致。区域性缺氧导致缺氧诱导型转录因子的激活，两种主要的HIF亚型HIF-1和HIF-2分别在囊肿上皮细胞和囊性间质细胞中表达。虽然HIF-2的激活与EPO的产生有关，从而减轻了通常伴随慢性肾脏疾病引起的贫血，但HIF-1却促进了囊肿的生长。HIF依赖性囊肿的生长主要是由于氯化物依赖性液体向囊腔的分泌增加。但是，鉴于HIF靶基因的广泛范围，其他HIF介导的途径也可能有助于囊肿的进展。此外，缺氧可通过活性氧的产生影响囊肿的生长。由于囊肿扩展加剧了局部缺氧，因此建立了一个前馈环，该环加速了囊肿扩展和疾病进展。因此，抑制与HIF依赖性囊肿液分泌特别相关的HIF途径和/或HIF靶基因可能代表了延缓APDKD进展的新型治疗方法。