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<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">UR</journal-id><journal-title-group><journal-title>Urology Research</journal-title></journal-title-group><issn>3083-4910</issn><eissn>2981-8230</eissn><publisher><publisher-name>Bio-Byword Scientific Publishing Pty. Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.26689/UR.v4i3.15712</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title>Identification of Key Targets for Proton Pump Inhibitors Induced Tubulointerstitial Nephritis Based on Pharmacovigilance and Network Toxicology Analysis</title><url>https://artdesignp.com/journal/UR/4/3/10.26689/UR.v4i3.15712</url><author>LiHaolong,WangZhu,LiangHui</author><pub-date pub-type="publication-year"><year>2026</year></pub-date><volume>4</volume><issue>3</issue><history><date date-type="pub"><published-time>2026-10-20</published-time></date></history><abstract>Objective: Although previous studies have demonstrated that proton pump inhibitors (PPIs) can induce tubulointerstitial nephritis (TIN), the specific mechanism of action remains incompletely understood. Methods: We integrated data from Q1 2004 to Q4 2025 in the FAERS database; the associations between PPIs and TIN were quantified by four disproportionality algorithms. The potential targets for PPIs-induced TIN were identified by combining network toxicology and protein-protein interaction networks. Moreover, molecular docking between key targets and PPIs was conducted. Results: Five PPIs had significantly associated with TIN: lansoprazole (ROR = 49.13, 95% CI = 46.51-51.90), pantoprazole (ROR = 33.71, 95% CI = 31.73-35.82), dexlansoprazole (ROR = 32.39, 95% CI = 27.86-37.65), omeprazole (ROR = 30.12, 95% CI = 28.45-31.88), and esomeprazole (ROR = 26.77, 95% CI = 25.58-28.02). Three key targets for PPI-induced TIN were determined: CDC42, PDGFRA, and MAPK8. Among these targets, the binding between CDC42 and esomeprazole was the most stable (binding energy: -7.44 kcal/mol). Conclusion: These findings suggest that PPIs may trigger TIN through multi-target interactions. This study provides potential mechanistic clues and novel targets for the early warning and precise intervention of PPI-related kidney injury.</abstract><keywords>FAERS, Proton pump inhibitors, Tubulointerstitial nephritis, Network toxicology, Key target</keywords></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>[1] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Hyodo T, Hara S, Goto S, et al., 2024, Immunohistological Analysis Reveals IgG1-Dominant Immunophenotype of Tubulointerstitial Nephritis Unassociated with IgG4-Related Diseases. International Urology and Nephrology, 56(7): 2363&amp;ndash;2369.
[2] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Sahutoglu T, Perazella M, 2025, Update on Acute Tubulointerstitial Nephritis: Clinical Features, Immunologic Insights, and Diagnostic and Treatment Approaches. Kidney International Reports, 10(6): 1643&amp;ndash;1656.
[3] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Pan X, Guo Z, Zheng Y, et al., 2025, Effects of Fourteen Essential Minerals and Vitamins on Acute and Chronic Tubulointerstitial Nephritis: A Multivariate Mendelian Randomization Study. Hereditas, 162(1): 63.
[4] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Ho H, Shirakawa H, 2022, Oxidative Stress and Mitochondrial Dysfunction in Chronic Kidney Disease. Cells, 12(1): 88.
[5] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Standardization of Uveitis Nomenclature (SUN) Working Group, 2021, Classification Criteria for Tubulointerstitial Nephritis with Uveitis Syndrome. American Journal of Ophthalmology, 228: 255&amp;ndash;261.
[6] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Torigoe K, Yoshida Y, Sakamoto R, et al., 2023, Improvement in Tubulointerstitial Nephritis with Glucocorticoid Therapy in an Anorexia Nervosa Patient. Journal of Medical Cases, 14(9&amp;ndash;10): 344&amp;ndash;349.
[7] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Yin Y, Shu Y, Zhu J, et al., 2022, A Real-World Pharmacovigilance Study of FDA Adverse Event Reporting System (FAERS) Events for Osimertinib. Scientific Reports, 12(1): 19555.
[8] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Horinouchi Y, Ikeda Y, Fukushima K, et al., 2018, Renoprotective Effects of a Factor Xa Inhibitor: Fusion of Basic Research and a Database Analysis. Scientific Reports, 8(1): 10858.
[9] &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Huang S, 2023, Efficient Analysis of Toxicity and Mechanisms of Environmental Pollutants with Network Toxicology and Molecular Docking Strategy: Acetyl Tributyl Citrate as an Example. Science of the Total Environment, 905: 167904.
[10] &amp;nbsp;&amp;nbsp;&amp;nbsp; Zhao Z, Du J, Wang Q, et al., 2023, An Integrated Strategy Combining Network Toxicology and Feature-Based Molecular Networking for Exploring Hepatotoxic Constituents and Mechanism of Epimedii Folium-Induced Hepatotoxicity In Vitro. Food and Chemical Toxicology, 176: 113785.
[11] &amp;nbsp;&amp;nbsp;&amp;nbsp; Zhang L, Mao W, Liu D, et al., 2023, Risk Factors for Drug-Related Acute Pancreatitis: An Analysis of the FDA Adverse Event Reporting System (FAERS). Frontiers in Pharmacology, 14: 1231320.
[12] &amp;nbsp;&amp;nbsp;&amp;nbsp; Wang J, Zhang Z, Liu X, et al., 2024, Exploring Novel Adverse Events of Nefecon. Kidney International Reports, 9(9): 2705&amp;ndash;2717.
[13] &amp;nbsp;&amp;nbsp;&amp;nbsp; Tveden-Nyborg P, Bergmann T, Jessen N, et al., 2025, BCPT 2026 Policy for Experimental and Clinical Studies. Basic &amp;amp; Clinical Pharmacology &amp;amp; Toxicology, 137(6): e70159.
[14] &amp;nbsp;&amp;nbsp;&amp;nbsp; Jiang Y, Zhou L, Shen Y, et al., 2024, Safety Assessment of Brexpiprazole: Real-World Adverse Event Analysis from the FAERS Database. Journal of Affective Disorders, 346: 223&amp;ndash;229.
[15] &amp;nbsp;&amp;nbsp;&amp;nbsp; Yu G, Wang L, Han Y, et al., 2012, clusterProfiler: An R Package for Comparing Biological Themes Among Gene Clusters. Omics, 16(5): 284&amp;ndash;287.
[16] &amp;nbsp;&amp;nbsp;&amp;nbsp; Trott O, Olson A, 2010, AutoDock Vina: Improving the Speed and Accuracy of Docking with a New Scoring Function, Efficient Optimization, and Multithreading. Journal of Computational Chemistry, 31(2): 455&amp;ndash;461.
[17] &amp;nbsp;&amp;nbsp;&amp;nbsp; Blank M, Parkin L, Paul C, et al., 2014, A Nationwide Nested Case-Control Study Indicates an Increased Risk of Acute Interstitial Nephritis with Proton Pump Inhibitor Use. Kidney International, 86(4): 837&amp;ndash;844.
[18] &amp;nbsp;&amp;nbsp;&amp;nbsp; Luo H, Yi G, Tang H, et al., 2024, Proton Pump Inhibitors May Increase the Risk of Cisplatin-Induced Acute Kidney Injury in Patients with Nasopharyngeal Carcinoma: A Prospective Cohort Study. Scientific Reports, 14(1): 18839.
[19] &amp;nbsp;&amp;nbsp;&amp;nbsp; Al-Aly Z, Maddukuri G, Xie Y, 2020, Proton Pump Inhibitors and the Kidney: Implications of Current Evidence for Clinical Practice and When and How to Deprescribe. American Journal of Kidney Diseases, 75(4): 497&amp;ndash;507.
[20] &amp;nbsp;&amp;nbsp;&amp;nbsp; Fontecha-Barriuso M, Mart&amp;iacute;n-Sanchez D, Martinez-Moreno J, et al., 2020, Molecular Pathways Driving Omeprazole Nephrotoxicity. Redox Biology, 32: 101464.
[21] &amp;nbsp;&amp;nbsp;&amp;nbsp; Koda R, Watanabe H, Tsuchida M, et al., 2018, Immune Checkpoint Inhibitor (Nivolumab)-Associated Kidney Injury and the Importance of Recognizing Concomitant Medications Known to Cause Acute Tubulointerstitial Nephritis: A Case Report. BMC Nephrology, 19(1): 48.
[22] &amp;nbsp;&amp;nbsp;&amp;nbsp; Raghavan R, Shawar S, 2017, Mechanisms of Drug-Induced Interstitial Nephritis. Advances in Chronic Kidney Disease, 24(2): 64&amp;ndash;71.
[23] &amp;nbsp;&amp;nbsp;&amp;nbsp; Parmar M, Kaleem S, Samuganathan P, et al., 2023, Impact of Proton Pump Inhibitors on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review. Cureus, 15(12): e49883.
[24]&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Targownik L, Fisher D, Saini S, 2022, AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology, 162(4): 1334&amp;ndash;1342.
[25] &amp;nbsp;&amp;nbsp;&amp;nbsp; Hu X, Gan L, Tang Z, et al., 2024, A Natural Small Molecule Mitigates Kidney Fibrosis by Targeting Cdc42-Mediated GSK-3&amp;beta;/&amp;beta;-Catenin Signaling. Advanced Science (Weinh), 11(13): e2307850.
[26] &amp;nbsp;&amp;nbsp;&amp;nbsp; Zhang Q, Qin Z, Wang Q, et al., 2024, Pharmacokinetic Profiling of ZCL-278, a Cdc42 Inhibitor, and Its Effectiveness Against Chronic Kidney Disease. Biomedicine &amp;amp; Pharmacotherapy, 179: 117329.
[27] &amp;nbsp;&amp;nbsp;&amp;nbsp; Toda N, Mori K, Kasahara M, et al., 2017, Crucial Role of Mesangial Cell-Derived Connective Tissue Growth Factor in a Mouse Model of Anti-Glomerular Basement Membrane Glomerulonephritis. Scientific Reports, 7: 42114.
[28] &amp;nbsp;&amp;nbsp;&amp;nbsp; Song K, Qing Y, Guo Q, et al., 2020, PDGFRA in Vascular Adventitial MSCs Promotes Neointima Formation in Arteriovenous Fistula in Chronic Kidney Disease. JCI Insight, 5(21): e137298.
[29] &amp;nbsp;&amp;nbsp;&amp;nbsp; Kanellis J, Ma F, Kandane-Rathnayake R, et al., 2010, JNK Signaling in Human and Experimental Renal Ischaemia/Reperfusion Injury. Nephrology Dialysis Transplantation, 25(9): 2898&amp;ndash;2908.
[30] &amp;nbsp;&amp;nbsp;&amp;nbsp; Bruno S, Tapparo M, Collino F, et al., 2017, Renal Regenerative Potential of Different Extracellular Vesicle Populations Derived from Bone Marrow Mesenchymal Stromal Cells. Tissue Engineering Part A, 23(21&amp;ndash;22): 1262&amp;ndash;1273.
[31]&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; Ma M, Luo Q, Fan L, et al., 2022, The Urinary Exosomes Derived from Premature Infants Attenuate Cisplatin-Induced Acute Kidney Injury in Mice via MicroRNA-30a-5p/Mitogen-Activated Protein Kinase 8 (MAPK8). Bioengineered, 13(1): 1650&amp;ndash;1665.
[32] &amp;nbsp;&amp;nbsp;&amp;nbsp; Borekci A, Kuru Bektasoglu P, Somay A, et al., 2025, Esomeprazole&amp;rsquo;s Antifibrotic Effects on Rats with Epidural Fibrosis. Global Spine Journal, 15(5): 2611&amp;ndash;2616.
[33] &amp;nbsp;&amp;nbsp;&amp;nbsp; Hollingsworth S, Dror R, 2018, Molecular Dynamics Simulation for All. Neuron, 99(6): 1129&amp;ndash;1143.</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
