Diabetic nephropathy (DN) is the major microvascular complication of type 1 diabetes mellitus (T1DM). Impairment in adenosine monophosphate-activated protein kinase (AMPK) activity was shown to mediate the pro-oxidant and inflammatory mechanisms underlying DN. Isosteviol (ISV), isolated from Stevia rebaudiana, has antioxidant and anti-inflammatory properties and alleviates non-alcoholic fatty liver disease and lethal septic shock by activating AMPK. The effect of ISV on DN is unknown. This study examined if ISV alleviates DN in T1DM in adult male rats by activating AMPK. Diabetes was induced in rats by a single intraperitoneal (i.p.) injection of streptozotocin (STZ) (65 mg/kg). Five groups of rats (n=8 each) were designed and included: control, ISV (20 mg/kg orally), STZ (diabetic), STZ + ISV (20 mg/kg orally), STZ + ISV + CC (compound C/an AMPK inhibitor) (0.2 mg/kg, i.p). Fasting glucose and insulin levels, assessment of kidney function tests, lipid profile analysis, measurements of markers of oxidative stress and inflammation, PCR and Western blotting analysis, and histological studies of the kidneys were conducted. With no effect on fasting glucose or insulin levels (p>0.05), ISV reduced serum levels of cholesterol, triglycerides (TGs), and low-density lipoprotein cholesterol (LDL-c) (p<0.01). ISV also increased urinary creatinine excretion, reduced urinary albumin levels, and alleviated tubular and glomerular damage of STZ-diabetic kidneys. ISV also lowered the renal levels of malondialdehyde (MDA) (p<0.01), tumor necrosis factor-alpha (TNF-α) (p<0.01), interleukin-6 (IL-6) (p<0.01), and mRNA and nuclear protein levels of nuclear factor kappaB (NF-κB) in both the control and diabetic rats. Concomitantly, ISV increased the phosphorylation of AMPK (p<0.05), levels of superoxide dismutase (SOD) (p<0.01), catalase (CAT) (p<0.01), total glutathione (GSH) (p<0.01), and mRNA and nuclear protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2) (p<0.01) in the kidneys of the control and diabetic rats. Co-administration of CC prevented all renal protective effects of ISV and reversed all these effects. In conclusion, AMPK-induced inhibition of NF-κB and activation of Nrf2 entails the nephroprotective effect of ISV in STZ-diabetic rats.
