Interleukin-17A Mediates Cardiorenal Injury In Oxalate Nephropathy

Abstract

AimsCardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CKD). While CKD is known to give rise to systemic inflammation, its inciting factors remain poorly defined. Oxalate, long implicated in rare genetic kidney disorders, accumulates with decreased kidney function and has emerged as a driver of inflammation and independent risk factor for CVD. Here, we investigate the immunological mechanisms linking oxalate nephropathy to systemic inflammation, cardiac damage and kidney injury. Methods and ResultsOxalate nephropathy was induced in C57Bl6/N mice via an oxalate-enriched diet. Oxalate induced systemic immune activation, renal fibrosis, and cardiac remodeling, including pulmonary congestion with systolic and diastolic dysfunction. Flow cytometry analysis identified interleukin (IL)-17A as a dominant inflammatory effector, with expansion of Th17 and Th17-like Treg in the kidney, intestine, and spleen. Bulk mRNA sequencing confirmed these findings. Confirming the oxalate-IL-17A relationship, plasma IL-17A was elevated in patients with primary hyperoxaluria. Gut microbiome analysis by 16S amplicon sequencing showed only mild oxalate-induced alterations in mice. However, soluble oxalate directly enhanced Th17 polarization and disrupted mitochondrial respiration in vitro. In vivo, antibody-mediated (clone: 17F3) IL-17A blockade decreased cardiac fibrosis, reduced neutrophil infiltration, and partially restored cardiac function in oxalate-fed mice. ConclusionsOur study identifies oxalate as a systemic immunometabolic stressor and IL-17A as a central mediator of oxalate-induced cardiorenal injury. These findings establish the oxalate-IL-17A axis as a mechanistic link between CKD and CVD and suggest IL-17A inhibition as a potential therapeutic strategy to reduce cardiovascular damage in CKD. Translational PerspectiveThis study advances our understanding of targetable mediators of the cardiovascular risk in chronic kidney disease (CKD). We identify the organic anion oxalate, beyond its traditional role in crystal-induced kidney damage, as a systemic immunometabolic stressor. We demonstrate that oxalate induces IL-17A-mediated inflammation and thereby contributes to maladaptive cardiac remodeling. Therapeutic blockade of IL-17A protects against oxalate-induced cardiorenal injury, highlighting the oxalate-IL-17A axis as a relevant and druggable link between CKD and cardiovascular disease.