Abstract

Diabetic kidney disease (DKD) is characterized by abnormal metabolic profiles. Metabolomics reveals increased serum levels of 3-phosphoglycerate (3-PG) in DKD patients. The protein expression of phosphoglycerate kinase 1 (PGK1), a key rate-limiting enzyme for 3-PG synthesis, is concomitantly upregulated in DKD patients and mice. The development of DKD is significantly mitigated by renal tubular epithelial cell-specific knockout of PGK1 and robustly worsened by PGK1 overexpression. Mechanistically, PGK1-dependent enzymatic production of 3-PG facilitates DKD through inhibiting GPX1 to activate the NLRP3 inflammasome. PGK1 promotes UNC5CL-mediated inflammation by binding to aldehyde dehydrogenase-1 L1 (Aldh1l1) through its non-enzymatic activity. The transcription factor paired box protein 5 (PAX5) mediates the upregulation of PGK1 in DKD. High-throughput screening reveals that C-16 from ChemDiv, the natural product lirinidine, and the Food and Drug Administration (FDA)-approved oxantel pamoate are potent PGK1 antagonists and efficaciously prevent DKD. Overall, blocking PGK1 may be a promising avenue for DKD management.