An in vitro method for the prediction of renal proximal tubular toxicity in humans

Abstract

The kidney is one of the major target organs for drug-induced toxicity. The renal proximal tubule is frequently affected due to its roles in drug transport and in concentrating the glomerular filtrate. Drug-induced kidney injury is associated with increased morbidity and mortality of patients. During drug development, nephrotoxicity is typically detected only late, which leads to high costs for the pharmaceutical industry. A central problem is the lack of pre-clinical models with high predictability. Regulatory accepted or validated in vitro models for the prediction of nephrotoxicity are not available. We developed a novel in vitro model for the prediction of renal proximal tubular toxicity in humans. It employs human primary renal proximal tubular cells and the expression levels of interleukin (IL)-6 and IL-8 were used as the endpoint. The model was evaluated with 41 well-characterized drugs and chemicals. The median values of the major performance metrics (balanced accuracy, sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of the receiver operating characteristic curve) ranged between 0.76 and 0.85. This revealed that the predictability of the model is high and it would be expected that in ∼76%–85% of the cases where compounds were predicted as positives or negatives the predictions would be correct. Altogether, the data suggest that the model would allow the prediction of drug-induced proximal tubular toxicity at early pre-clinical stages during drug development. Future work will aim at further validating this model and adapting it to recently developed renal proximal tubular-like cells derived from human pluripotent stem cells.