Protective Effects of Nebivolol Against Cisplatin-Induced Nephrotoxicity: An Experimental Study

Authors

DOI:

https://doi.org/10.59222/ustjms.5.2

Keywords:

Cisplatin-induced nephrotoxicity, Nebivolol, Nephroprotection, Oxidative stress, Wistar rats

Abstract

Background: Cisplatin is an effective and commonly used anticancer drug, but its therapeutic application is constrained by its potential to cause kidney injury. This experimental study investigated nebivolol protective effects, which is a third-generation selective β1-adrenoceptor blocker with additional β3-adrenoceptor agonistic activity, against cisplatin-induced nephrotoxicity (CIN) in rats.

Methods: Twenty-one male Wistar rats were randomly allocated to three groups (n = 7 per group): control, cisplatin, and cisplatin plus nebivolol. Nebivolol (10 mg/kg/day, orally) was administered for 28 days, and cisplatin (6 mg/kg, intraperitoneally) was administered once on day 24. Renal function was assessed using serum and urine creatinine, blood urea nitrogen (BUN), serum urea, serum total protein, and creatinine clearance. Serum potassium and sodium concentrations were also measured. Renal oxidative stress was assessed using reduced glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA). Serum tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured as inflammatory markers. Hematoxylin and eosin (H&E) and periodic acid–Schiff (PAS) staining of kidney tissue sections were used to assess the histopathological changes.

Results: Body and relative kidney weights showed no significant between-group differences. Cisplatin induced marked renal dysfunction, inflammation, oxidative stress, electrolyte disturbances, and histopathological injury. Compared with cisplatin alone, nebivolol significantly reduced serum creatinine, urea, BUN, IL-6, and TNF-α concentrations and renal MDA levels, while increasing urine creatinine, serum total protein, renal GSH, and SOD activity. Creatinine clearance was higher after nebivolol coadministration than after cisplatin alone, but the difference was not statistically significant (P = 0.077). Nebivolol also attenuated tubular necrosis and inflammatory-cell infiltration and improved tubular, glomerular, and brush-border morphology. However, its effects on electrolytes were incomplete: serum potassium increased without reaching statistical significance compared with the cisplatin group, whereas sodium decreased further.
Conclusion: Nebivolol can ameliorate CIN in rats, as demonstrated by improvements in several renal functional, oxidative-stress, inflammatory, and histopathological outcomes. These findings support the nephroprotective potential of nebivolol but warrant confirmation in further preclinical studies.

Author Biographies

  • Jamal J. Omer, University of Science and Technology, Sana’a

    Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology (USTY), Sana'a, Yemen

  • Doa'a Ibrahim, University of Science and Technology, Sana’a

    Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology (USTY), Sana'a, Yemen

  • Mogahed A. Al-Shawia, Sana'a University

    Department of Biological Sciences, Faculty of Science, Sana'a University, Sana'a, Yemen

  • Mohammed M. Alabbasi, University of Science and Technology, Sana’a

    Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology (USTY), Sana'a, Yemen

References

1. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(4S):S1–115.

2. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–33.

3. Choudhury D. Z. Ahmed, Drug-associated renal dysfunction and injury. Nat Clin Pract Nephrol. 2006;2(2):80-91.

4. Pabla N, Dong Z. Cisplatin nephrotoxicity: mechanisms and renoprotective strategies. Kidney Int. 2008;73(9):994–1007.

5. Morsy MA, Heeba GH. Nebivolol ameliorates cisplatin-induced nephrotoxicity in rats. Basic Clin Pharmacol Toxicol. 2016;118(6):449–55.

6. Münzel T, Gori T. Nebivolol: the somewhat-different β-adrenergic receptor blocker. J Am Coll Cardiol. 2009;54(16):1491–9.

7. Maffei A, Lembo G. Nitric oxide mechanisms of nebivolol. Ther Adv Cardiovasc Dis. 2009;3(4):317–27.

8. Wolf SC, Sauter G, Jobst J, Kempf VA, Risler T, Brehm BR. Major differences in gene expression in human coronary smooth muscle cells after nebivolol or metoprolol treatment. Int J Cardiol. 2008;125(1):4–10.

9. Mercanoglu G, Safran N, Gungor M, Pamukcu B, Uzun H, Sezgin C, et al. The effects of nebivolol on apoptosis in a rat infarct model. Circ J. 2008;72(4):660–70.

10. Hussain S, Ashafaq M, Alshahrani S, Qadri M, Khardali A, Mawkili W, et al. Synergistic effect of piperine on curcumin in cisplatin-induced nephrotoxicity through DNA fragmentation and cytokines gene expressions. Drug Chem Toxicol. 2026;49(3):503–12.

11. Mohan IK, Khan M, Shobha JC, Naidu MU, Prayag A, Kuppusamy P, et al. Protection against cisplatin-induced nephrotoxicity by Spirulina in rats. Cancer Chemother Pharmacol. 2006;58(6):802–8.

12. Moningka NC, Tsarova T, Sasser JM, Baylis C. Protective actions of nebivolol on chronic nitric oxide synthase inhibition-induced hypertension and chronic kidney disease in the rat: a comparison with angiotensin II receptor blockade. Nephrol Dial Transplant. 2012;27(3):913–20.

13. Garud MS, Kulkarni YA. Attenuation of renal damage in type I diabetic rats by umbelliferone – a coumarin derivative. Pharmacol Rep. 2017;69(6):1263–9.

14. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10302):786–802.

15. Barri YM. Hypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008;10(1):39–45.

16. Hong S, Han K, Park KY, Lee CB, Kim DS, Park JH, et al. Association of systolic and diastolic blood pressure with the risk of end-stage renal disease in older type 2 diabetes mellitus patients without cardiovascular disease: a nationwide population-based study. Diabetes Metab J. 2025;49(6):1308–17.

17. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: core curriculum 2019. Am J Kidney Dis. 2019;74(1):120–31.

18. Güner G, Erbaş O. Candesartan protects from cisplatin-induced kidney damage via the GDF-15 pathway. Eur Rev Med Pharmacol Sci. 2024;28(3):1103–10.

19. Liu J, Wang Y, Qiao P, Ying Y, Lin S, Lu F, et al. Mechanisms of cisplatin-induced acute kidney injury: the role of NRF2 in mitochondrial dysfunction and metabolic reprogramming. Antioxidants (Basel). 2025;14(7):775.

20. Ighofose E. Cisplatin-induced nephrotoxicity and adaptive responses in renal progenitor cells: molecular insights from transcriptomic and proteomic analyses [dissertation]. Grand Forks (ND): University of North Dakota; 2025.

21. Abdelbar IGA, El-Wakeel LM, Sherif DM, Elkhouly AA. The impact of genetic polymorphisms on cisplatin-induced acute kidney injury: a systematic review. Arch Pharm Sci ASU. 2025;9(1):120–51.

22. Ali A, Muhammad RZ, Liaqat N, Hamza M, Zubair M, Faizan M. Prevalence, predictors, and outcomes of electrolyte imbalances and metabolic acidosis in internal medicine patients with acute kidney injury. Vasc Endovascular Rev. 2025;8(2 Suppl):219–24.

23. Alshahrani S, Muzafar HMA, Tripathi P, Alam MF, Rehman ZU, Tripathi R, et al. Ameliorating effect of Triticum aestivum (WG) against cisplatin-induced nephrotoxicity: role of cytokines, free radicals and apoptotic cascade. Nat Prod Commun. 2025;20(2):1934578X251316720.

24. Qi J, Gao L. Linarin protects against cisplatin-induced nephrotoxicity via subsiding proinflammatory and oxidative stress biomarkers in male Wistar rats. Pharmacogn Mag. 2025;21(3):939–47.

25. Kim H, Park KT, Jo H, Shin Y, Chung G, Ko SG, et al. The effect of ginger extract on cisplatin-induced acute anorexia in rats. Front Pharmacol. 2023;14:1267254.

26. Katolkar UN, Surana SJ. Exploring the potential role of phytopharmaceuticals in alleviating toxicities of chemotherapeutic agents. Curr Protein Pept Sci. 2024;25(10):753–79.

27. Dasari S, Njiki S, Mbemi A, Yedjou CG, Tchounwou PB. Pharmacological effects of cisplatin combination with natural products in cancer chemotherapy. Int J Mol Sci. 2022;23(3):1532.

28. Eslamifar Z, Ghaffaripour R, Sabbagh S. Modulating effect of Achillea millefolium extract on cisplatin-induced nephrotoxicity. Iran J Toxicol. 2025;19(2):83–91.

29. Şah H, Gülmez N, Sayıner S, Şehirli AÖ, Kükner A. Mitigating cisplatin-induced nephrotoxicity in rats: a comparative study of ambroxol and coenzyme Q10 effects. Cyprus J Med Sci. 2025;10(4):236–42.

30. El-Sheikh AAK, Morsy MA, Abdel-Latif RG. Modulation of eNOS/iNOS by nebivolol protects against cyclosporine A-mediated nephrotoxicity through targeting inflammatory and apoptotic pathways. Environ Toxicol Pharmacol. 2019;69:26–35.

31. Araújo Encinas JF, Foncesca Peiró CH, Perez MM, Santos Raimundo JR, de Gois KC, Peres MC, et al. Does nebivolol have renoprotective action in patients with chronic kidney disease conditions? An integrative review. Eur J Pharmacol. 2021;905:174180.

32. Gil da Costa RM, Levesque C, Bianchi-Frias D, Chatterjee P, Lam HM, Santos C, et al. Pharmacological NF-κB inhibition decreases cisplatin chemoresistance in muscle-invasive bladder cancer and reduces cisplatin-induced toxicities. Mol Oncol. 2023;17(12):2709–27.

33. Pinard L, Adam JP, Chagnon M, Bollée G, Soulières D. Hypokalemia, hypomagnesemia, and hyponatremia are associated with acute kidney injury in patients treated with cisplatin. J Oncol Pharm Pract. 2025;31(5):754–60.

Published

2026-08-27

Issue

Section

Articles

Similar Articles

You may also start an advanced similarity search for this article.