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In sepsis-induced AKI, the accumulation of lactic acid in renal tubules activates the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) axis, leading to lymphocyte apoptosis and contributing to immunosuppression ( In addition, lipid-derived mediators produced from the autoxidation of intracellular polyunsaturated FAs, such as -linolenic acid and docosahexaenoic acid (DHA), exhibit anti-inflammatory effects ( 4.3 Facilitation of renal fibrosis Renal fibrosis represents the final common pathological outcome in most CKD cases, with epithelial injury and aberrant repair processes serving as central events in its progression

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Specifically, mycotoxins have been shown to: Suppress cytokine production, altering immune signaling Induce apoptosis (programmed cell death) in immune cells Disrupt the intestinal epithelial barrier, contributing to leaky gut Impair macrophage and dendritic cell function Alter the balance between inflammatory and regulatory immune pathways (Th1/Th2/Th17/Treg axis) Aspergillus fumigatus produces gliotoxin, which actively suppresses the immune systems ability to fight off fungal infection by inhibiting phagocytosis

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