Dominant Polycystic Kidney Disease Research Articles

Role of CFTR in Polycystic Kidney Disease

Introduction: Polycystic kidney disease (PKD) causes numerous cysts to grow in the kidneys, liver and pancreas. These cysts are filled with fluid. In the United States about 600,000 people have PKD, which is the fourth leading cause of kidney failure. The two main types of PKD are autosomal dominant PKD (ADPKD), which is usually diagnosed in adulthood and autosomal recessive PKD (ARPKD), which can be diagnosed in the womb or shortly after a baby is born. ADPKD is associated with the slow but relentless formation of multiple renal cysts. CFTR is known to be involved in secreting fluid in ADPKD through its localization in the apical membrane. Thus, the plasma membrane is the expected site where CFTR functions. Here, we show that CFTR unexpectedly is located in primary cilia and plays a role in cilia length. ARPKD is associated with systemic and portal hypertension, fibrosis of the liver and kidney and enlarged kidneys, with fusiform dilation of the collecting ducts. Although it has been postulated that CFTR plays a role in fluid secretion in ADPKD, the opposite is true in ARPKD. For example, a double mutant of CFTR and polycystin/polyductin mice develop massively enlarged kidneys and die from renal failure at ~24 days after birth (Nakanishi et. al (2001). J. Am. Soc. Nephrol. 12, 719-725). Thus, knocking down CFTR makes the disease worse. Methods: We used for ADPKD a mouse model bearing the R3277C mutation in PC1 and ARPKD mouse model bearing pkhd1Pkhd1del3-4/del3-4 deletion. We injected male and female mice with 30 mg/kg of VX-809 every other day. Also, we injected ADPKD and ARPKD mice once with AAV1 del27-264CFTR at 30 days old and sacrificed at 90 days. Results: Cyst areas are significantly reduced in kidney and liver after treatment with VX809 or with AAV1 del27-264CFTR. Conclusion: These data indicate that VX-809 reduces proliferation and the presence of CFTR at the apical membrane while increasing CFTR at the basolateral membrane in kidney in ADPKD model and liver in ARPKD model. Demonstration of kidney and liver cyst reduction increases the therapeutic potential of VX-809 as a treatment of ADPKD and ARPKD. Also we are reporting direct evidence of involvement of CFTR in cyst reduction in liver and in kidney by using gene therapy method treating ADPKD and ARPKD mice with AAV1 del27-264CFTR which would bind to WTCFTR and correct the traffcking of CFTR in ADPKD and ARPKD mice. NIH and PKD Foundation. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Deletion of Aurora kinase A prevents the development of polycystic kidney disease in mice

Aurora Kinase A (AURKA) promotes cell proliferation and is overexpressed in different types of polycystic kidney disease (PKD). To understand AURKA’s role in regulating renal cyst development we conditionally deleted the gene in mouse models of Autosomal Dominant PKD (ADPKD) and Joubert Syndrome, caused by Polycystin 1 (Pkd1) and Inositol polyphosphate-5-phosphatase E (Inpp5e) mutations respectively. We show that while Aurka is dispensable for collecting duct development and homeostasis, its deletion prevents cyst formation in both disease models. Cross-comparison of transcriptional changes implicated AKT signaling in cyst prevention and we show that (i) AURKA and AKT physically interact, (ii) AURKA regulates AKT activity in a kinase-independent manner and (iii) inhibition of AKT can reduce disease severity. AKT activation also regulates Aurka expression, creating a feed-forward loop driving renal cystogenesis. We find that the AURKA kinase inhibitor Alisertib stabilises the AURKA protein, agonizing its cystogenic functions. These studies identify AURKA as a master regulator of renal cyst development in different types of PKD, functioning in-part via AKT.

State of the Science and Ethical Considerations for Preimplantation Genetic Testing for Monogenic Cystic Kidney Diseases and Ciliopathies.

There is a broad phenotypic spectrum of monogenic polycystic kidney diseases (PKDs). These disorders often involve cilia-related genes and lead to the development of fluid-filled cysts and eventual kidney function decline and failure. Preimplantation genetic testing for monogenic (PGT-M) disorders has moved into the clinical realm. It allows prospective parents to avoid passing on heritable diseases to their children, including monogenic PKD. The PGT-M process involves embryo generation through in vitro fertilization, with subsequent testing of embryos and selective transfer of those that do not harbor the specific disease-causing variant(s). There is a growing body of literature supporting the success of PGT-M for autosomal-dominant and autosomal-recessive PKD, although with important technical limitations in some cases. This technology can be applied to many other types of monogenic PKD and ciliopathies despite the lack of existing reports in the literature. PGT-M for monogenic PKD, like other forms of assisted reproductive technology, raises important ethical questions. When considering PGT-M for kidney diseases, as well as the potential to avoid disease in future generations, there are regulatory and ethical considerations. These include limited government regulation and unstandardized consent processes, potential technical errors, high cost and equity concerns, risks associated with pregnancy for mothers with kidney disease, and the impact on all involved in the process, including the children who were made possible with this technology.

PKD1 Nonsense Variant in a Lagotto Romagnolo Family with Polycystic Kidney Disease.

A female Lagotto Romagnolo dog with polycystic kidney disease (PKD) and her progeny, including PKD-affected offspring, were studied. All affected dogs appeared clinically inconspicuous, while sonography revealed the presence of renal cysts. The PKD-affected index female was used for breeding and produced two litters with six affected offspring of both sexes and seven unaffected offspring. The pedigrees suggested an autosomal dominant mode of inheritance of the trait. A trio whole genome sequencing analysis of the index female and her unaffected parents identified a de novo heterozygous nonsense variant in the coding region of the PKD1 gene. This variant, NM_001006650.1:c.7195G>T, is predicted to truncate 44% of the open reading frame of the wild-type PKD1 protein, NP_001006651.1:p.(Glu2399*). The finding of a de novo variant in an excellent functional candidate gene strongly suggests that the PKD1 nonsense variant caused the observed phenotype in the affected dogs. Perfect co-segregation of the mutant allele with the PKD phenotype in two litters supports the hypothesized causality. To the best of our knowledge, this is the second description of a PKD1-related canine form of autosomal dominant PKD that may serve as an animal model for similar hepatorenal fibrocystic disorders in humans.

Genetic analysis links the diagnosis of carriers of the PKD1 mutation gene that causes polycystic kidney disease

Polycystic kidney disease (PKD) is an inherited disorder characterised by the formation and growth of multiple cysts in the kidney, accompanied by a gradual increase in the size of both kidneys leading to impaired kidney function and renal failure. Autosomal dominant PKD is the most common genetic disorder with an estimated prevalence of 1/500-1/1000 in Western countries [1], caused by mutations in the PKD1 (MIM#601313) and PKD2 (MIM#173910), of which 85% of cases are caused by mutations in the PKD1 gene [2]. Because of the PKD1gene’s enormous size, numerous mutations, and up to 6 structural pseudogenes, which share a high degree of similarity sequences (97.7%) from the 5’UTR to exon 32 [3, 4], the methods for identifying PKD1 mutations are currently restricted and challenging from amplifying the mutant gene area. Therefore, it is essential to create a novel diagnostic technique with high accuracy and broad applicability for various mutation types that may circumvent the shortcomings of the conventional method. Objective: To develop a genetic linkage analysis technique for detecting the person with PKD1 mutation causing PKD. Materials and methods: 11 members were from a family with PKD1 gene mutations causing PKD. Designed PKD1 gene-linked STRs primers and conducted genetic linkage analysis with the family members. After comparing the outcomes of the technique with those of the Touchdown-PCR and ARMS-PCR methods, the complete technique is subsequently given. Results: Successfully developed the genetic linkage analysis technique for detecting the person with PKD1mutation causing PKD.

Severity of polycystic kidney disease revealed by multiparametric MRI.

We aimed to compare multiple MRI parameters, including relaxation rates ( , , and ), ADC from diffusion weighted imaging, pool size ratio (PSR) from quantitative magnetization transfer, and measures of exchange from spin-lock imaging ( ), for assessing and predicting the severity of polycystic kidney disease (PKD) over time. Pcy/Pcy mice with CD1 strain, a mouse model of autosomal dominant PKD, were imaged at 5, 9, and 26 wk of age using a 7T MRI system. Twelve-week normal CD1 mice were used as controls. Post-mortem paraffin tissue sections were stained using hematoxylin and eosin and picrosirius red to identify histological changes. Histology detected segmental cyst formation in the early stage (week 5) and progression of PKD over time in Pcy kidneys. In -weighted images, small cysts appeared locally in cystic kidneys in week 5 and gradually extended to the whole cortex and outer stripe of outer medulla region from week 5 to week 26. Regional PSR, , , and decreased consistently over time compared to normal kidneys, with significant changes detected in week 5. Among all the MRI measures, and allow highest detectability to PKD, while PSR and have highest correlation with pathological indices of PKD. Using optimum MRI parameters as regressors, multiple linear regression provides reliable prediction of PKD progression. , , and PSR are sensitive indicators of the presence of PKD. Multiparametric MRI allows a comprehensive analysis of renal changes caused by cyst formation and expansion.

Left Ventricular Non-compaction Cardiomyopathy and Polycystic Kidney Disease Revealed by Inappropriate Polycythemia: A Fortuitous Association? Case Report

Abstract We present the case of a patient with heart failure with reduced left ventricular (LV) ejection fraction, diagnosed in the first instance by echocardiography and further on by more accurate cardiac magnetic resonance imaging with LV non-compaction (LVNC). Blood tests showed high erythrocyte and hematocrit levels, inappropriate in this setting, whilst Janus Kinase 2V617F mutation was absent, erythropoietin level was slightly increased, and arterial O2 pressure level was normal. At the time of diagnosis, the patient had mild renal impairment, and abdominal echography revealed bilateral polycystic kidney disease (PKD). The patient had one son who fulfilled the echocardiographic criteria for LVNC and had bilateral renal cysts revealed by abdominal ultrasound. The genes responsible for autosomal dominant PKD (ADPKD) development are PKD1, on chromosome 16, coding for polycystin 1 and PKD2, on chromosome 4, coding for polycystin 2. There are some experimental data which suggest that polycystins might play an important role in cardiac development and hence PKD1 and PKD2 mutations may be involved in primary cardiomyopathies. These data could explain this particular association between LVNC and ADPKD. To date, there are only a few isolated cases reported, and only one shows this association in more than one member of the same family. Further genetic testing in the few reported cases would presumably elucidate whether this finding is the result of complex genetic synergy or just a simple coincidence.

RESET-PKD: a pilot trial on short-term ketogenic interventions in autosomal dominant polycystic kidney disease.

Ketogenic dietary interventions (KDI) have been shown to be effective in animal models of polycystic kidney disease (PKD), but data from clinical trials are lacking. Ten autosomal dominant PKD (ADPKD) patients with rapid disease progression were enrolled at visit V1 and initially maintained a carbohydrate-rich diet. At V2, patients entered one of the two KDI arms: a 3-day water fast (WF) or a 14-day ketogenic diet (KD). At V3, they resumed their normal diet for 3-6 weeks until V4. At each visit, magnetic resonance imaging kidney and liver volumetry was performed. Ketone bodies were evaluated to assess metabolic efficacy and questionnaires were used to determine feasibility. All participants [KD n=5, WF n=5; age 39.8±11.6 years; estimated glomerular filtration rate 82±23.5mL/min/1.73 m2; total kidney volume (TKV) 2224 ± 1156mL] were classified as Mayo Class 1C-1E. Acetone levels in breath and beta-hydroxybutyrate (BHB) blood levels increased in both study arms (V1 to V2 average acetone: 2.7±1.2p.p.m., V2 to V3: 22.8±11.9p.p.m., P=.0006; V1 to V2 average BHB: 0.22±0.08mmol/L, V2 to V3: 1.88±0.93mmol/L, P=.0008). Nine of 10 patients reached a ketogenic state and 9/10 evaluated KDIs as feasible. TKV did not change during this trial. However, we found a significant impact on total liver volume (ΔTLV V2 to V3: -7.7%, P=.01), mediated by changes in its non-cystic fraction. RESET-PKD demonstrates that short-term KDIs potently induce ketogenesis and are feasible for ADPKD patients in daily life. While TLV quickly changed upon the onset of ketogenesis, changes in TKV may require longer-term interventions.

Identification of an Electrogenic 2Cl−/H+ Exchanger, ClC5, as a Chloride-Secreting Transporter Candidate in Kidney Cyst Epithelium in Tuberous Sclerosis

Kidney cyst expansion in tuberous sclerosis complex (TSC) or polycystic kidney disease (PKD) requires active secretion of chloride (Cl-) into the cyst lumen. In PKD, Cl- secretion is primarily mediated via the cystic fibrosis transmembrane conductance regulator in principal cells. Kidney cystogenesis in TSC is predominantly composed of type A intercalated cells, which do not exhibit noticeable expression of cystic fibrosis transmembrane conductance regulator. The identity of the Cl--secreting molecule(s) in TSC cyst epithelia remains speculative. Based on RNA-sequencing analysis studies, we examined the expression of FOXi1, the chief regulator of acid base transporters in intercalated cells, along with localization of Cl- channel 5 (ClC-5), in kidneys of various models of TSC. Our results in Tsc2+/- mice show that the expansion of kidney cysts corresponds to the induction of Foxi1 and correlates with the strong appearance of ClC-5 and H+-ATPase on the apical membrane of cyst epithelia. In various mouse models of TSC, Foxi1 is robustly induced in the kidney, and ClC-5 appears along with H+-ATPase on the apical membrane of cyst epithelia. Expression of ClC-5 was also detected on the apical membrane of cyst epithelia in humans with TSC but was absent in humans with autosomal dominant PKD or in a mouse model of PKD. These results indicate that ClC-5 is expressed on the apical membrane of cyst epithelia and is a likely candidate mediating Cl- secretion into the kidney cyst lumen in TSC.

Enhancer and super-enhancer landscape in polycystic kidney disease

Widespread aberrant gene expression is a pathological hallmark of polycystic kidney disease (PKD). Numerous pathogenic signaling cascades, including c-Myc, Fos, and Jun, are transactivated. However, the underlying epigenetic regulators are poorly defined. Here we show that H3K27ac, an acetylated modification of DNA packing protein histone H3 that marks active enhancers, is elevated in mouse and human samples of autosomal dominant PKD. Using comparative H3K27ac ChIP-Seq analysis, we mapped over 16000 active intronic and intergenic enhancer elements in Pkd1-mutant mouse kidneys. We found that the cystic kidney epigenetic landscape resembles that of a developing kidney, and over 90% of upregulated genes in Pkd1-mutant kidneys are co-housed with activated enhancers in the same topologically associated domains. Furthermore, we identified an evolutionarily conserved enhancer cluster downstream of the c-Myc gene and super-enhancers flanking both Jun and Fos loci in mouse and human models of autosomal dominant PKD. Deleting these regulatory elements reduced c-Myc, Jun, or Fos abundance and suppressed proliferation and 3D cyst growth of Pkd1-mutant cells. Finally, inhibiting glycolysis and glutaminolysis or activating Ppara in Pkd1-mutant cells lowerd global H3K27ac levels and its abundance on c-Myc enhancers. Thus, our work suggests that epigenetic rewiring mediates the transcriptomic dysregulation in PKD, and the regulatory elements can be targeted to slow cyst growth.

Netrin-1 Overexpression Induces Polycystic Kidney Disease: A Novel Mechanism Contributing to Cystogenesis in Autosomal Dominant Polycystic Kidney Disease

Despite recent advances in understanding the pathogenesis of polycystic kidney disease (PKD), the underlying molecular mechanisms involved in cystogenesis are not fully understood. This study describes a novel pathway involved in cyst formation. Transgenic mice overexpressing netrin-1 in proximal tubular cells showed increased production and urinary excretion of netrin-1. Although no cysts were detectable immediately after birth, numerous small cysts were evident by the age of 4 weeks, and disease was accelerated along with age. Surprisingly, cyst formation in the kidney was restricted to male mice, with 80% penetrance. However, ovariectomy induced kidney cyst growth in netrin-1-overexpressing female mice. Cyst development in males was associated with albuminuria and polyuria and increased cAMP excretion in netrin-1 transgenic mice. Netrin-1 overexpression significantly increased extracellular signal-regulated kinase and focal adhesion kinase phosphorylation and vimentin expression. Interestingly, p53 expression was increased but in an inactive form. Furthermore, netrin-1 expression was increased in cystic epithelia and urine of various rodent models of PKD. siRNA-mediated suppression of netrin-1 significantly reduced cyst growth and improved kidney function in netrin-1 transgenic mice and in two genetic animal models of PKD. Together, these data demonstrate that netrin-1 up-regulation induced cyst formation in autosomal dominant PKD.

IRIS-Intelligent Rapid Interactive Segmentation for Measuring Liver Cyst Volumes in Autosomal Dominant Polycystic Kidney Disease.

Purpose: To develop and integrate interactive features with automatic methods for accurate liver cyst segmentation in patients with autosomal dominant polycystic kidney and liver disease (ADPKD). Methods: SmartClick and antiSmartClick were developed using iterative region growth guided by spatial and intensity connections and were integrated with automated level set (LS) segmentation and graphical user interface, forming an intelligent rapid interactive segmentation (IRIS) tool. IRIS and LS segmentations of liver cysts on weighted images of patients with ADPKD (n = 17) were compared with manual segmentation as ground truth (GT). Results: Compared to manual GT, IRIS reduced the segmentation time by more than 10-fold. Compared to automated LS, IRIS reduced the mean liver cyst volume error from 42.22% to 13.44% (p < 0.001). IRIS segmentation agreed well with manual GT (79% dice score and 99% intraclass correlation coefficient). Conclusion: IRIS is feasible for fast, accurate liver cyst segmentation in patients with ADPKD.

Establishment of the induced pluripotent stem cell line PLAFMCi006-A from peripheral blood mononuclear cells of polycystic kidney disease patients with PKD2 gene mutation

Polycystic kidney disease (PKD) caused by PKD2 mutation is an important type of autosomal dominant PKD. In this study, peripheral blood mononuclear cells from a patient with PKD2 polycystic kidney disease were reprogrammed to obtain induced pluripotent stem cells (iPSCs). After stable amplification, the pluripotency of the iPSCs was determined by identifying their cell-surface markers, their expression of pluripotency-related genes, and their ability to form teratomas with three germ layers in vivo. The establishment of the iPSC line could provide a basis for a kidney-like organ model of human PKD caused by PKD2 mutation for use in studying the pathogenesis of PKD along with relevant screening and testing intervention drugs.

Genetic testing, ultrasonography and preimplantation genetic testing of men with autosomal dominant polycystic kidney disease in Hunan, China.

The present study identified novel mutations in polycystic kidney disease (PKD) genes in China, determined the prevalence of cysts in the genital tract and accessory gonad in autosomal dominant PKD (ADPKD) patients, correlated these genes with ADPKD and male infertility and investigated whether male infertility associated with ADPKD affected the clinical outcomes in a preimplantation genetic testing (PGT) cycle cohort. This study was a cross-sectional study. Twenty-four unrelated men with ADPKD recruited from the Reproductive and Genetic Hospital of CITIC-Xiangya in China were investigated between January 2019 and December 2020. A total of 24 variations were identified in 22 patients, including 23, 1 and 0 variations in PKD1, PKD2 and GANAB, respectively. Genital tract and accessory gonadal cysts were significant dependent variables for male infertility. A diagnosis was made in 87.04% (94/108) and 51.85% (56/108) of the embryos for ADPKD and PGT-A respectively. Clinical pregnancy reached 72.73% per embryo transfer and 84.21% per patient. We identified a group of novel mutations in PKD genes, which enriches the PKD mutation spectrum. Although genital tract and accessory gonadal cysts greatly influence the fertility of men with ADPKD, they have minimal clinical consequences on pregnancy by intracytoplasmic sperm injection (ICSI) and PGT.

Ketogenic dietary interventions in autosomal dominant polycystic kidney disease-a retrospective case series study: first insights into feasibility, safety and effects.

Background Our laboratory published the first evidence that nutritional ketosis, induced by a ketogenic diet (KD) or time-restricted diet (TRD), ameliorates disease progression in polycystic kidney disease (PKD) animal models. We reasoned that, due to their frequent use for numerous health benefits, some autosomal dominant PKD (ADPKD) patients may already have had experience with ketogenic dietary interventions (KDIs). This retrospective case series study is designed to collect the first real-life observations of ADPKD patients about safety, feasibility and possible benefits of KDIs in ADPKD as part of a translational project pipeline.MethodsPatients with ADPKD who had already used KDIs were recruited to retrospectively collect observational and medical data about beneficial or adverse effects and the feasibility and safety of KDIs in questionnaire-based interviews.ResultsA total of 131 ADPKD patients took part in this study. About 74 executed a KD and 52 a TRD for 6 months on average. A total of 86% of participants reported that KDIs had improved their overall health, 67% described improvements in ADPKD-associated health issues, 90% observed significant weight loss, 64% of participants with hypertension reported improvements in blood pressure, 66% noticed adverse effects that are frequently observed with KDIs, 22 participants reported safety concerns like hyperlipidemia, 45 participants reported slight improvements in estimated glomerular filtration rate and 92% experienced KDIs as feasible while 53% reported breaks during their diet.Conclusions Our preliminary data indicate that KDIs may be safe, feasible and potentially beneficial for ADPKD patients, highlighting that prospective clinical trials are warranted to confirm these results in a controlled setting and elucidate the impact of KDIs specifically on kidney function and cyst progression.

Blood pressure in children with renal cysts and diabetes syndrome.

Cystic kidney diseases such as autosomal recessive or dominant polycystic kidney disease (ARPKD and ADPKD) are associated with high prevalence of arterial hypertension. On the contrary, studies on hypertension in children with renal cysts and diabetes (RCAD) syndrome caused by abnormalities in the HNF1B gene are rare. Therefore, the primary aim of our study was to investigate the prevalence of high blood pressure in children with RCAD syndrome due to HNF1B gene abnormalities and secondary to search for possible risk factors for development of high blood pressure. Data on all children with genetically proven RCAD syndrome from three pediatric nephrology tertiary centers were retrospectively reviewed (office blood pressure (BP), ambulatory blood pressure monitoring (ABPM), creatinine clearance, renal ultrasound, echocardiography, albuminuria/proteinuria). High blood pressure was defined as BP ≥ 95th percentile of the current ESH 2016 guidelines and/or by the use of antihypertensive drugs. Thirty-two children with RCAD syndrome were investigated. Three children received ACE inhibitors for hypertension and/or proteinuria. High blood pressure was diagnosed using office BP in 22% of the children (n = 7). In the 7 performed ABPM, 1 child (14%) was diagnosed with hypertension and one child with white-coat hypertension. Creatinine clearance, proteinuria, albuminuria, body mass index, enlargement, or hypodysplasia of the kidneys and prevalence of HNF1B-gene deletion or mutation were not significantly different between hypertensive and normotensive children.Conclusion:High blood pressure is present in 22% of children with RCAD syndrome. What is Known: • Arterial hypertension is a common complication in children with polycystic kidney diseases. What is New: • High office blood pressure is present in 22% and ambulatory hypertension in 14% of children with renal cyst and diabetes (RCAD) syndrome.

Simultaneous right-sided nephrectomy with orthotopic liver and kidney transplantation\u2014An alternative method for patients with autosomal dominant polycystic liver and kidney disease

PurposeIn patients suffering from autosomal dominant polycystic liver and kidney disease (ADPLKD), combined organ transplantation often poses a technical challenge due to the large volume of both organs. To simplify the transplantation procedure by improving the exposure of anatomical structures, we introduce a novel surgical technique of orthotopic liver and kidney transplantation.MethodsThe modified simultaneous liver and kidney transplantation technique via a right-sided L-incision included three steps: (1) right-sided nephrectomy in the recipient followed by (2) orthotopic liver transplantation in cava replacement technique and (3) the orthotopic kidney transplantation with arterial reconstruction to the right common iliac artery.ResultsIn total, seven patients with ADPLKD were transplanted by using the modified transplantation technique. The mean operation time was 342.43 min (±68.77). Postoperative patients were treated for 6.28 days (±2.50) in the intensive care unit and were discharged from the surgical ward approximately 28 days (±5.66) after the operation with normal graft function. Complications associated with the use of the modified technique, such as bleeding, anastomotic stenosis, biloma, or urinoma, did not occur.ConclusionModified simultaneous liver and kidney transplantation is a safe alternative for patients with ADPLKD. By combining right-sided nephrectomy and orthotopic graft transplantation, the approach optimizes the exposure of anatomical structures and simplifies the transplantation procedure. Additionally, the modified transplantation technique does not require a particular organ explantation procedure and can be applied for all liver and kidney grafts.

Comprehensive strategy improves the genetic diagnosis of different polycystic kidney diseases.

Polycystic kidney disease (PKD) is known to occur in three main forms, namely autosomal dominant PKD (ADPKD), autosomal recessive PKD (ARPKD) and syndromic PKD (SPKD), based on the clinical manifestations and genetic causes, which are diagnosable from the embryo stage to the later stages of life. Selection of the genetic test for the individuals with diagnostic imaging reports of cystic kidneys without a family history of the disease continues to be a challenge in clinical practice. With the objective of maintaining a limit on the time and medical cost of the procedure, a practical strategy for genotyping and targeted validation to resolve cystogene variations was developed in our clinical laboratory, which combined the techniques of whole‐exome sequencing (WES), Long‐range PCR (LR‐PCR), Sanger sequencing and multiplex ligation–dependent probe amplification (MLPA) to work in a stepwise approach. In this context, twenty‐six families with renal polycystic disorders were enrolled in the present study. Thirty‐two variants involving four ciliary genes (PKD1, PKHD1, TMEM67 and TMEM107) were identified and verified in 23 families (88.5%, 23/26), which expanded the variant spectrum by 16 novel variants. Pathogenic variations in five foetuses of six families diagnosed with PKD were identified using prenatal ultrasound imaging. Constitutional biallelic and digenic variations constituted the pathogenic patterns in these foetuses. The preliminary clinical data highlighted that the WES + LR PCR‐based workflow followed in the present study is efficient in detecting divergent variations in PKD. The biallelic and digenic mutations were revealed as the main pathogenic patterns in the foetuses with PKD.

POS-431 ALTERED REGULATION OF TRYPTOPHAN METABOLISM AND ARYL HYDROCARBON RECEPTOR DISTRIBUTION IN RODENT POLYCYSTIC KIDNEYS

Polycystic kidney disease (PKD) is an inherited disorder characterized by stimulated cell proliferation, increased fluid secretion into cysts, and interstitial inflammation in renal tissue. Many mechanisms of disease progression have been determined in both autosomal dominant and autosomal recessive PKD, but the exact signaling pathways responsible for cystogenesis remain unclear. To explore novel mechanisms of PKD progression, we evaluated altered metabolic activity and associated receptor expression and distribution in the kidneys of 4- and 20-week-old PCK rats, an orthologous model of human autosomal recessive PKD, by mass spectrometry, quantitative analysis, real-time RT-PCR and immunofluorescence. Based on mass spectrometry and quantitative analysis results, the abundances of kynurenine and kynurenic acid were significantly higher in both 4- and 20-week-old PCK kidneys compared with age-matched wild-type kidneys. Since kynurenine and kynurenic acid are endogenous agonists of aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor for activating metabolic enzymes such as those in the cytochrome P450 (CYP) superfamily, the expression of AhR was detected by real-time RT-PCR in the kidneys of wild-type and PCK rats. At 4-weeks of age with early stage PKD, the expression levels of AhR were significantly lower in PKD compared with wild-type kidneys. Intriguingly, its expression level in 20-week-old PCK kidneys with progressive stage PKD was higher compared with wild-type kidneys. Since cysts are derived from medulla in PCK kidneys, the distribution of AhR was observed by immunofluorescence mainly in renal medullary specimens. AhR is known to translocate into the nucleus upon ligand binding, and in normal kidneys at 4 weeks of age, AhR was localized to the nucleus in tubular epithelia, but not at 20 weeks of age in normal kidneys. However, in PCK kidneys at 20 weeks of age, AhR was localized in the nucleus in normal tubular epithelia and in developed cysts, while in dilated renal tubules (which develop into cysts), AhR translocated to the nucleus in PCK kidneys both at 4 and 20 weeks of age. Indolamine-2,3-dioxygenase 2 (IDO2) is an enzyme which catalyzes the conversion from tryptophan to kynurenine/kynurenic acid. In epithelial cells of dilated tubules in PCK kidneys, IDO2 was localized in the cytoplasm, suggesting that IDO2 may have a role in activating the AhR signaling pathway in cystogenesis. The current findings suggest that the progression of PKD may relate to the increased activation of tryptophan metabolism in combination with altered expression and distribution of AhR. Regulation of the kynurenine/kynurenic acid and AhR signaling pathway may have therapeutic potential against disease progression in PKD.

Ciclopirox olamine induces ferritinophagy and reduces cyst burden in polycystic kidney disease.

Despite the recent launch of tolvaptan, the search for safer polycystic kidney disease (PKD) drugs continues. Ciclopirox (CPX) or its olamine salt (CPX-O) is contained in a number of commercially available antifungal agents. CPX is also reported to possess anticancer activity. Several mechanisms of action have been proposed, including chelation of iron and inhibition of iron-dependent enzymes. Here, we show that CPX-O inhibited in vitro cystogenesis of primary human PKD cyst-lining epithelial cells cultured in a 3D collagen matrix. To assess the in vivo role of CPX-O, we treated PKD mice with CPX-O. CPX-O reduced the kidney-to-body weight ratios of PKD mice. The CPX-O treatment was also associated with decreased cell proliferation, decreased cystic area, and improved renal function. Ferritin levels were markedly elevated in cystic kidneys of PKD mice, and CPX-O treatment reduced renal ferritin levels. The reduction in ferritin was associated with increased ferritinophagy marker nuclear receptor coactivator 4, which reversed upon CPX-O treatment in PKD mice. Interestingly, these effects on ferritin appeared independent of iron. These data suggest that CPX-O can induce ferritin degradation via ferritinophagy, which is associated with decreased cyst growth progression in PKD mice. Most importantly these data indicate that CPX-O has the potential to treat autosomal dominant PKD.