Early-stage therapeutic efficacy of TNAP inhibition using a novel milder murine model of CKD-MBD

Chronic kidney disease (CKD) is a complicated systemic disease displaying various pathophysiological symptoms including mineral bone disorder (CKD-MBD). Ideally, early intervention for CKD-MBD would be desirable, however, there is not enough evidence regarding treatment of CKD-MBD, especially in its early stages, due to its multifactorial pathophysiology and the difficulty in generating adequate animal models. In this study, we evaluated the efficacy of a tissue nonspecific alkaline phosphatase (TNAP) inhibitor, SBI-425 in a CKD-MBD animal model, produced by a combination of nephrectomy and high inorganic phosphate (P_i) diet. This combination induced renal damage, and significantly elevated blood urea nitrogen (BUN). Plasma levels of fibroblast growing factor 23 (FGF-23), parathyroid hormone (PTH) and phosphate were also elevated, leading to ectopic calcification in the kidneys, particularly in the renal tubules. We orally administered SBI-425 twice daily for 12 weeks at doses of 1 and 10 mg/kg, and this treatment significantly inhibited the progression of calcium deposition in the renal tubules. Furthermore, SBI-425 effectively prevented the deterioration of plasma parameters, BUN, FGF-23, PTH, and phosphate. In conclusion, our findings suggest that TNAP inhibition can effectively slow the progression of CKD-MBD by inhibiting the calcification in the renal tubules. These results may have implications for better clinical care of patients with CKD.