Febuxostat, a novel inhibitor of xanthine oxidase, reduces ER stress through upregulation of SIRT1-AMPK-HO-1/thioredoxin expression

  • Hyosang Kim
  • Chung Hee Baek
  • Jai Won Chang
  • Won Seok Yang
  • Sang Koo LeeEmail author
Original article



Endoplasmic reticulum (ER) stress has been implicated in the development of various renal diseases. Thus, inhibition of ER stress using pharmacological agents may serve as a promising therapeutic approach. We postulated that febuxostat, a novel xanthine oxidase inhibitor, could suppress the ER stress through upregulation of SIRT1 (silent mating type information regulation 2 homolog 1)-AMPK (AMP activated protein kinase)-HO-1 (heme oxygenase-1)/thioredoxin expression.


We examined the effect of febuxostat on the ER stress induced by a chemical inducer, tunicamycin and non-chemical agents such as angiotensin II, aldosterone, high glucose, and albumin in renal tubular cells. We further examined the in vivo effects of febuxostat using mouse model of kidney disease induced by unilateral ureteral obstruction (UUO). Expression of ER stress was measured by western blot analysis and immunohistochemical stain.


Febuxostat suppressed the ER stress induced by tunicamycin and non-chemical agents, as shown by inhibition of increased GRP78 (glucose-related protein78) and p-eIF2α (phosphospecific-eukaryotic translation initiation factor 2α) expression. Inhibitory effect of febuxostat was mediated through upregulation of SIRT1-AMPK followed by induction of HO-1 and thioredoxin. In animal model of UUO, febuxostat reduced the UUO-induced ER stress, which was abolished by pretreatment with SIRT1 inhibitor (sirtinol) and AMPK inhibitor (compound C).


Febuxostat could suppress the ER stress caused by various ER stress inducers through upregulation of SIRT1-AMPK-HO-1/thioredoxin expression. Targeting these pathways might serve as one of the possible therapeutic approaches in kidney diseases under excessive ER stress.


AMPK ER stress Febuxostat HO-1 SIRT1 Thioredoxin 



Reprints request to Sang Koo Lee M.D., Division of Nephrology, Department of Internal Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. E-mail:


No funding received.

Compliance with ethical standards

Conflict of interest

All the authors have declared no competing interest.

Ethical approval

All procedures performed in animal experiments were approved by Institutional Animal Care and Use Committee of Asan Institute for Life Sciences (Subject No: 2017-13-039).


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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Internal Medicine, Asan Medical Center, Asan Institute for Life SciencesUniversity of UlsanSeoulKorea

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