Escherichia coli-derived
verotoxins (VT;
Shiga toxins) are causally related to the pathogenesis of enteropathic
hemolytic uremic syndrome (HUS). Profound
hemolysis is a defining feature of the disease, but it is not known whether the acute intravascular release of
heme proteins contributes to HUS pathology. This study examined the biologic effects of
hemin and VT by means of tubular epithelial-derived ACHN cells.
Hemin at concentrations >/=200 microM caused cell rounding, spike formation, and detachment that was morphologically distinct from verocytotoxicity. VT caused apoptosis at concentrations >100 pM, as demonstrated by nuclear segmentation and
poly(ADP-ribose) polymerase cleavage, whereas
hemin-mediated injury of ACHN cells grown in serum-containing medium lacked attributes of programmed cell death. Pretreatment of ACHN monolayers with sublethal concentrations (1 to 10 pM) of VT for 12 to 18 h led to superadditive
hemin-mediated cytotoxicity. This effect was not limited to ACHN cells, but was similarly noted in microvascular endothelial cells.
Heme catabolism is regulated by (inducible)
heme oxygenase-1 (HO-1). VT abrogated HO-1 expression in ACHN cells. Stimulation of cells for 6 h with CdCl(2), which markedly increased HO-1 expression before the addition of VT, blunted subsequent
hemin injury. In conclusion, VT augments
hemin-induced toxicity in renal tubular epithelial cells that can be reversed by prior induction of HO-1. It is proposed that VT subverts the physiologic defense against
heme proteins by interfering with the regulated expression of HO-1 and that this mechanism contributes to the renal pathology in patients with Escherichia coli-associated HUS.