BIRC3 and NOC2L synergistically promote P53 acetylation to accelerate necroptosis in sepsis-associated acute kidney injury.

Sepsis-associated acute kidney injury (SA-AKI), defined as AKI occurring within 7 days after the onset of sepsis, is more common in critically ill patients and is strongly associated with poor prognosis. To investigate the relationship between cell death and SA-AKI, we used mRNAseq assays in SA-AKI rat kidneys. Sequencing results showed significant up-regulation of baculovirus-containing IAP repeat sequence 3 (BIRC3) and multiple forms of programmed cell death, including necroptosis, which were also verified. Meanwhile, Birinapant, an inhibitor of BIRC3, attenuated necroptosis and inflammatory responses. Furthermore, using laser confocal microscopy and coupled immunoprecipitation coupled mass spectrometry (Co-IP/MS), we identified the intercalating protein of BIRC3, NOC2 like Nucleolar Associated Transcriptional Repressor (NOC2L), for the first time. Apoptosis was quantified by flow cytometry, Annexin V-FITC, and mitochondrial membrane potentials, and cellular damage was examined by projected electron microscopy. Because NOC2L can inhibit P53 acetylation, we further investigated how P53 acetylation regulates necroptosis in SA-AKI and preliminarily discovered that BIRC3 promotes acetylation at the P53-K382 site. Concurrently, BIRC3's promotion of p53 acetylation outweighs NOC2L's inhibition of this process, and both molecules jointly regulate p53-K382 acetylation to drive downstream necroptosis. This study confirms that BIRC3 induces necroptosis in renal cells and accelerates kidney disease progression. Preliminary evidence confirms that BIRC3 promotes p53 acetylation at the K382 site. Furthermore, BIRC3 and its interacting protein NOC2L synergistically regulate p53 acetylation, thereby promoting downstream necroptosis. BIRC3 and NOC2L may serve as potential therapeutic targets for SA-AKI, offering novel therapeutic strategies.