Abstract

Nephrotic syndrome is one of the most common glomerular diseases in children and can be classified on the basis of steroid responsiveness. While multiple genetic causes have been discovered for steroid resistant nephrotic syndrome, the genetics of steroid sensitive nephrotic syndrome remains elusive. Mutations in Epithelial Membrane Protein 2 (EMP2), a member of the GAS3/PMP22 tetraspan family of proteins, were recently implicated as putative monogenic cause of steroid sensitive nephrotic syndrome. We investigated this hypothesis by developing Emp2 reporter and knockout mouse models. In lacZ reporter mice (engineered to drive expression of the enzyme β-galactosidase under the control of the endogenous murine Emp2 promoter), Emp2 promoter activity was not observed in podocytes but was particularly prominent in medium- and large-caliber arterial vessels in the kidney and other tissues where it localizes specifically in vascular smooth muscle cells (vSMCs) but not in the endothelium. Strong Emp2 expression was also found in non-vascular smooth muscle cells found in other organs like the stomach, bladder, and uterus. Global and podocyte-specific Emp2 knockout mice were viable and did not develop nephrotic syndrome showing no evidence of abnormal glomerular histology or ultrastructure. Altogether, our results do not support that loss of function of EMP2 represent a monogenic cause of proteinuric kidney disease. However, the expression pattern of Emp2 indicates that it may be relevant in smooth muscle function in various organs and tissues including the vasculature.

Highlights

  • Nephrotic syndrome (NS) encompasses a triad of clinical features including proteinuria (≥3 g/24 h), low serum albumin, and edema, and is often accompanied by complications such as secondary hyperlipidemia, thrombotic events, and infections caused by encapsulated organisms [1]

  • Using quantitative real-time PCR analysis, we surveyed the relative expression of Emp2 transcript across multiple organs and tissues in mice (Figure 1A)

  • A new Mendelian form of sensitive NS (SSNS) has been proposed with the discovery of biallelic mutations of Epithelial Membrane Protein 2 (EMP2) in four individuals from three families with SSNS and steroid-resistant NS (SRNS) [9]

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Summary

Introduction

Nephrotic syndrome (NS) encompasses a triad of clinical features including proteinuria (≥3 g/24 h), low serum albumin (hypoalbuminemia), and edema, and is often accompanied by complications such as secondary hyperlipidemia, thrombotic events, and infections caused by encapsulated organisms [1]. 90% of nephrotic patients respond to corticosteroid treatment and are classified as having idiopathic steroid-sensitive NS (SSNS). The remaining 10% of cases which are refractory to corticosteroids are categorized as steroid-resistant NS (SRNS). Mutations in genes highly expressed in the podocytes have been identified in about two thirds of SRNS patients [2]. Many of these SRNS-linked genes encode for proteins that are integral components of the slit diaphragms, regulators of actin cytoskeleton dynamics and cell-matrix interactions, essential for mitochondrial function, and podocyte integrity [3].

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