Therapeutic Potential Of Curcuma Longa In Acute Kidney Injury: Mechanisms And Clinical Prospects

Abstract

Acute Kidney Injury (AKI) refers to a rapid (onset within 48 h) deteriorated renal function typically induced by ischemia reperfusion injury, nephrotoxicity or sepsis. Currently, there is only very limited pharmacological treatment with direct impact on the pathophysiological mechanisms of AKI and current treatment strategies are mainly supportive. In this regard, the natural compounds with multitargeted biological activity attract ever greater interest. Turmeric (Curcuma longa) and curcumin, its main bioactive compound exhibited impressive therapeutic potential in AKI management because of their powerful anti inflammatory, antiapoptotic, antioxidant and antifibrotic properties. Curcumin modulates key molecular pathways important for the progression of AKI such as inhibition of nuclear factor-kappa B (NF-κB) and Toll-like receptor 4 (TLR4) signaling and activation of nuclear factor E2-related factor 2 (Nrf2), inhibiting proinflammatory cytokines and protecting against oxidative damage and cell death. Curcumin has been shown, in preclinical studies in a variety of models of AKI, to significantly improve renal function, reduce histological damage and improve survival. In addition, curcumin has the capability of thwarting the escalation of AKI to the chronic kidney disease (CKD) by damping the fibrotic signaling pathway of the transforming growth factor beta (TGF-β)/Smad. While promising, clinical translation of curcumin is hindered by its poor oral bioavailability. To date, there have been ongoing research trying to overcome some of these limitations by look into novel delivery systems and combinational therapies. This review summarizes current knowledge of curcumin on the mechanistic basis for nephroprotective effects of curcumin, provides an assessment of experimental and clinical evidence as to its nephroprotective role and discusses foci for future studies on usage of curcumin in the management of AKI. There is great promise that curcumin, a natural and multi-targeted therapeutic candidate, can provide safe and effective treatment for many renal issues in the changing face of renal medicine.