PS, Star RA. Methyl-2-acetamidoacrylate, an ethyl pyruvate analog, decreases sepsis-induced acute kidney injury in mice. Am J Physiol Renal Physiol 295: F1825-F1835, 2008. First published October 15, 2008 doi:10.1152/ajprenal.90442.2008.-We tested the anti-inflammatory agent methyl-2-acetamidoacrylate (M2AA), an ethyl pyruvate analog, in a cecal ligation-and-puncture (CLP) model of sepsis in CD-1 mice. M2AA administration at the time of CLP improved survival, renal function, kidney histology, liver injury, and splenocyte apoptosis, and lowered cytokine levels (TNF-␣, IL-6, IFN-␥, and IL-10). When M2AA treatment was delayed 6 h (but not 12 h), M2AA still significantly reduced kidney dysfunction, liver injury, splenocyte apoptosis, and cytokine levels. NF-B, a M2AA target, was transiently activated in spleen, peaking at 6 h; kidney and liver NF-B increased steadily with a plateau at 12-24 h. M2AA reduced NF-B activation in spleen at 6 h and in kidney and liver at 24 h. Splenectomy diminished the ability of M2AA to reduce cytokines, especially IL-6, but M2AA still decreased kidney and liver dysfunction, suggesting that splenic NF-B is not central to M2AA action. In contrast, beneficial effects of chloroquine on cytokines and organ damage were neutralized by splenectomy, demonstrating a spleen-specific chloroquine target. Because M2AA and chloroquine act differently, we tested this combination. Survival at 96 h was highest with combination therapy (57%) vs. chloroquine (38%), M2AA (47.6%), or vehicle (5%). The benefit of combination therapy over chloroquine or M2AA alone did not reach statistical significance, indicating potential mechanistic overlap. We conclude that the transient target(s) for M2AA responsible for the narrow 6-h therapeutic window is not splenic NF-B. Identifying this new target and downstream signaling pathways could lengthen the therapeutic window and improve combination therapy with chloroquine. cecal ligation-puncture; spleen; apoptosis; nuclear factor-B; chloroquine THE MORTALITY RATE OF SEPSIS and septic shock remain unacceptably high and have not changed in several decades (9). Approximately 50% of septic patients develop acute kidney injury (AKI) (28, 34). The mortality rate of septic patients with AKI remains as high as 70%, and the development of AKI in septic patients predicts a poor outcome (28). Ethyl pyruvate (EP) is a derivative of an endogenous antioxidant pyruvate (35). EP can scavenge reactive oxygen species and can downregulate proinflammatory cytokines both in vitro and in vivo. EP inhibits high-mobility group box 1 (HMGB1) and decreases the activation of p38 mitogen-activated protein kinase (MAPK) and nuclear factor-B (NF-B) (35,45,47,51). EP also preserves mucosal histology and permeability after mesenteric ischemia-reperfusion injury (40) and survival and intestinal damage after hemorrhagic shock (42), alcoholic hepatitis (52), and coronary ischemia and reperfusion (50). Previously, our group (2, 33) reported that EP can decrease sepsis-induced AKI and multiple organ failu...