2026 CONVENTION
A3 adenosine receptor modulates kidney fibrosis through non-canonical pathways in chronic kidney disease
The A3 adenosine receptor (A3AR) is increasingly recognized as a potent therapeutic target in diverse diseases, yet its specific contribution to chronic kidney disease (CKD) progression requires further investigation. Here, we identified a marked upregulation of A3AR in CKD kidneys, a change that inversely correlated with kidney function. Interestingly, our in vivo models demonstrated that although A3AR classically functions as a Gi-coupled receptor to reduce cAMP, its kidney injury-driven upregulation paradoxically triggered the PKA-CREB pathway. Subsequent mechanistic studies revealed that A3AR contributes to kidney fibrosis via non-canonical pathways, specifically by engaging the MAPK-MSK1-CREB pathway and enhancing TGF-β-dependent SMAD and PKA activation independently of the classical cAMP pathway. Pharmacological blockade using FM101, a selective A3AR antagonist, successfully suppressed fibrotic alterations in human proximal tubular epithelial cells. Furthermore, administration of FM101 in CKD mouse models markedly alleviated kidney dysfunction, inflammation, and interstitial fibrosis, corresponding with the suppression of the A3AR-mediated non-canonical signaling pathways. Taken together, these findings suggest that A3AR is a potential modulator of kidney fibrosis, and its pharmacological inhibition by FM101 offers a promising investigative strategy for CKD therapy.