Epithelial Na(+) Channel Research Articles

Paracrine stimulation of perinatal lung functional and structural maturation by mesenchymal stem cells

BackgroundMesenchymal stem cells (MSCs) were shown to harbor therapeutic potential in models of respiratory diseases, such as bronchopulmonary dysplasia (BPD), the most common sequel of preterm birth. In these studies, cells or animals were challenged with hyperoxia or other injury-inducing agents. However, little is known about the effect of MSCs on immature fetal lungs and whether MSCs are able to improve lung maturity, which may alleviate lung developmental arrest in BPD.MethodsWe aimed to determine if the conditioned medium (CM) of MSCs stimulates functional and structural lung maturation. As a measure of functional maturation, Na+ transport in primary fetal distal lung epithelial cells (FDLE) was studied in Ussing chambers. Na+ transporter and surfactant protein mRNA expression was determined by qRT-PCR. Structural maturation was assessed by microscopy in fetal rat lung explants.ResultsMSC-CM strongly increased the activity of the epithelial Na+ channel (ENaC) and the Na,K-ATPase as well as their mRNA expression. Branching and growth of fetal lung explants and surfactant protein mRNA expression were enhanced by MSC-CM. Epithelial integrity and metabolic activity of FDLE cells were not influenced by MSC-CM. Since MSC’s actions are mainly attributed to paracrine signaling, prominent lung growth factors were blocked. None of the tested growth factors (VEGF, BMP, PDGF, EGF, TGF-β, FGF, HGF) contributed to the MSC-induced increase of Na+ transport. In contrast, inhibition of PI3-K/AKT and Rac1 signaling reduced MSC-CM efficacy, suggesting an involvement of these pathways in the MSC-CM-induced Na+ transport.ConclusionThe results demonstrate that MSC-CM strongly stimulated functional and structural maturation of the fetal lungs. These effects were at least partially mediated by the PI3-K/AKT and Rac1 signaling pathway. Thus, MSCs not only repair a deleterious tissue environment, but also target lung cellular immaturity itself.

Acid-sensing (proton-gated) ion channels (ASICs) (version 2020.5) in the IUPHAR/BPS Guide to Pharmacology Database

Acid-sensing ion channels (ASICs, nomenclature as agreed by NC-IUPHAR [43, 2, 3]) are members of a Na+ channel superfamily that includes the epithelial Na+ channel (ENaC), the FMRF-amide activated channel (FaNaC) of invertebrates, the degenerins (DEG) of Caenorhabitis elegans, channels in Drosophila melanogaster and 'orphan' channels that include BLINaC [62] and INaC [64] that have also been named BASICs, for bile acid-activated ion channels [81]. ASIC subunits contain two TM domains and assemble as homo- or hetero-trimers [41, 38, 7] to form proton-gated, voltage-insensitive, Na+ permeable, channels that are activated by levels of acidosis occurring in both physiological and pathophysiological conditions with ASIC3 also playing a role in mechanosensation (reviewed in [40, 80, 43, 61, 21]) . Splice variants of ASIC1 [termed ASIC1a (ASIC, ASICα, BNaC2α) [75], ASIC1b (ASICβ, BNaC2β) [17] and ASIC1b2 (ASICβ2) [70]; note that ASIC1a is also permeable to Ca2+] and ASIC2 [termed ASIC2a (MDEG1, BNaC1α, BNC1α) [59, 76, 37] and ASIC2b (MDEG2, BNaC1β) [51]] have been cloned and differ in the first third of the protein. Unlike ASIC2a (listed in table), heterologous expression of ASIC2b alone does not support H+-gated currents. A third member, ASIC3 (DRASIC, TNaC1) [74] is one of the most pH-sensitive isoforms (along with ASIC1a) and has the fastest activation and desensitisation kinetics, however can also carry small sustained currents. ASIC4 (SPASIC) evolved as a proton-sensitive channel but seems to have lost this function in mammals [52]. Mammalian ASIC4 does not support a proton-gated channel in heterologous expression systems but is reported to downregulate the expression of ASIC1a and ASIC3 [1, 39, 31, 49]. ASIC channels are primarily expressed in central (ASIC1a, -2a, 2b and -4) and peripheral neurons including nociceptors (ASIC1-3) where they participate in neuronal sensitivity to acidosis. They have also been detected in taste receptor cells (ASIC1-3)), photoreceptors and retinal cells (ASIC1-3), cochlear hair cells (ASIC1b), testis (hASIC3), pituitary gland (ASIC4), lung epithelial cells (ASIC1a and -3), urothelial cells, adipose cells (ASIC3), vascular smooth muscle cells (ASIC1-3), immune cells (ASIC1,-3 and -4) and bone (ASIC1-3) (ASIC distribution is well reviewed in [50, 25]). A neurotransmitter-like function of protons has been suggested, involving postsynaptically located ASICs of the CNS in functions such as learning and fear perception [32, 45, 87], responses to focal ischemia [82] and to axonal degeneration in autoimmune inflammation in a mouse model of multiple sclerosis [36], as well as seizures [88] and pain [80, 26, 27, 13, 29]. Heterologously expressed heteromultimers form ion channels with differences in kinetics, ion selectivity, pH- sensitivity and sensitivity to blockers that resemble some of the native proton activated currents recorded from neurones [51, 5, 35, 11]. In general, the known small molecule inhibitors of ASICs are non-selective or partially selective, whereas the venom peptide inhibitors have substantially higher selectivity and potency. Several clinically used drugs are known to inhibit ASICs, however they are generally more potent at other targets (e.g. amiloride at ENaCs, ibuprofen at COX enzymes) [60, 56]. The information in the tables below are for the effects of inhibitors on homomeric channels, for information of known effect on heteromeric channels see the comments below.

Carfilzomib-Induced Hypertension Is Mediated By Ion Channel Dysregulation in the Kidneys; The Potent Role of AMP-Activated Kinase α

Introduction: Carfilzomib (Cfz), an irreversible proteasome inhibitor (PI), is an approved agent against relapsed/refractory multiple myeloma (R/R MM). Cfz is associated with high incidence of cardiovascular adverse effects. Hypertension stands as the most frequent cardiovascular complication of Cfz. Even though thrombotic microangiopathy (TMA) is inculpated of Cfz's hypertensive phenotype, its exact pathophysiology is still elusive. In our previous work, we showed that Cfz establishes cardiotoxicity in vivo in a Protein Phosphatase 2A (PP2A)-AMP-activated kinase α (AMPKα)-dependent manner (Efentakis P et al. Blood. 2019;133(7):710-723) but does not lead to a permanent vascular deficit, indicating that hypertension is not vascular derived [Efentakis P et al. IJMS 2020;21(15):E5185]. Taking under consideration that renal homeostasis plays an important role in blood pressure regulation we sought to (i) characterize the dose-dependent manifestation of Cfz-induced hypertension; (ii) investigate the molecular signaling of Cfz in the kidneys by proteomic and immunoblotting analyses and (iii) study the renal ion channels regulation. Methods: Forty C57Bl/6 mice (12-14 weeks of age) were randomly assigned to: (i) Acute Protocol: a. Control [Normal Saline (N/S) 0.9%] and b. Cfz (8mg/kg) for two days and (ii) Sub-acute Protocol: a) Control (N/S 0.9%,) and b) Cfz (8mg/kg) for seven days. Intraperitoneal administration of N/S 0.9% and Cfz was performed at two consecutive and on alternate days for the acute and sub-acute protocols respectively. At baseline and endpoint of the experiments, systolic (SBP) and diastolic blood pressure (DBP) were measured, and subsequently mice were sacrificed for the collection of blood and renal samples. Blood samples were collected in citrate buffer for hematological/coagulation profiling [prothrombin time (PT) and INR estimation] and for cleaved Von Willebrand Factor (cl. VWF) immunoblotting assessment as well as for blood testing of white blood cells (WBCs) and platelets. Renal samples underwent histological proteomic and molecular analyses. Results: SBP and DBP were found to be elevated in Cfz group only in the sub-acute protocol compared to control (SBP: 78.5±2.0 vs 68.2±0.7, p<0.01 and DBP: 104.1±2.3 vs 97.4±2.4, p<0.05, respectively). Neutrophil count in the whole blood was elevated both in the acute and sub-acute protocols, while platelet count was decreased in the acute protocol and restored after sub-acute Cfz administration. Mice presented a thrombotic phenotype characterized by increased PT and INR and decreased cl. VWF after acute Cfz treatment, and a hemorrhagic phenotype with restored cl. VWF after sub-acute Cfz administration. However, the presence of TMA was not confirmed by histological evaluation of the kidneys in any of the protocols. Nonetheless histological evaluation of the kidneys revealed inflammation of the perirenal adipose tissue only in the sub-acute protocol. Proteomic analysis presented that proteasome regulation, metabolism and transport of organic anion processes are affected by Cfz administration. Molecular analysis of the renal tissue showed that Cfz induced an increase in the inducible nitric oxide synthase (iNOS) and microtubule-associated proteins 1A/1B light chain 3B (LC3-B) expression and a decreased AMPKα phosphorylation. Moreover, RT-PCR analysis of the renal samples revealed that collecting duct ion channels epithelial Na+ channel (ENaC), Na+/K+/ATPase and urea transporter 1 (UTA-1) mRNA levels were increased in Cfz group. Conclusion: Sub-acute Cfz treatment establishes a renal-derived hypertensive phenotype and a circulating inflammatory phenotype as indicated by the increased neutrophil and WBCs count in the blood. TMA does not seem to be implicated with the observed phenotype in vivo as investigated molecularly and histologically. Cfz-induced dephosphorylation of AMPKα and the subsequent dysregulation of the collecting duct renal ion channel homeostasis is found to be responsible for the observed effect. Therefore, Cfz seems to induce hypertension by a dysregulation of water-ion re-absorbance leading to increased cardiac preload. The latter comes in agreement with clinical data showing that some Cfz-treated patients present with fluid retention, which can be attributed to the aforementioned renal effects of the drug. Disclosures Efentakis: Amgen: Research Funding. Kastritis:Amgen: Consultancy, Honoraria, Research Funding; Genesis Pharma: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria. Dimopoulos:BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau. Andreadou:Amgen: Research Funding. Terpos:Amgen: Honoraria, Research Funding; Genesis pharma SA: Honoraria, Other: travel expenses , Research Funding; Janssen: Honoraria, Research Funding; Takeda: Honoraria, Other: travel expenses , Research Funding; Celgene: Honoraria; Sanofi: Honoraria; BMS: Honoraria.

Osmotic Adaptation by Na+-Dependent Transporters and ACE2: Correlation with Hemostatic Crisis in COVID-19.

COVID-19 symptoms, including hypokalemia, hypoalbuminemia, ageusia, neurological dysfunctions, D-dimer production, and multi-organ microthrombosis reach beyond effects attributed to impaired angiotensin-converting enzyme 2 (ACE2) signaling and elevated concentrations of angiotensin II (Ang II). Although both SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and SARS-CoV-2 utilize ACE2 for host entry, distinct COVID-19 pathogenesis coincides with the acquisition of a new sequence, which is homologous to the furin cleavage site of the human epithelial Na+ channel (ENaC). This review provides a comprehensive summary of the role of ACE2 in the assembly of Na+-dependent transporters of glucose, imino and neutral amino acids, as well as the functions of ENaC. Data support an osmotic adaptation mechanism in which osmotic and hemostatic instability induced by Ang II-activated ENaC is counterbalanced by an influx of organic osmolytes and Na+ through the ACE2 complex. We propose a paradigm for the two-site attack of SARS-CoV-2 leading to ENaC hyperactivation and inactivation of the ACE2 complex, which collapses cell osmolality and leads to rupture and/or necrotic death of swollen pulmonary, endothelial, and cardiac cells, thrombosis in infected and non-infected tissues, and aberrant sensory and neurological perception in COVID-19 patients. This dual mechanism employed by SARS-CoV-2 calls for combinatorial treatment strategies to address and prevent severe complications of COVID-19.

Retromer is involved in epithelial Na+ channel trafficking.

The epithelial Na+ channel (ENaC) located at the apical membrane in many epithelia is the rate-limiting step for Na+ reabsorption. Tight regulation of the plasma membrane population of ENaC is required, as hypertension or hypotension may result if too many or too few ENaCs are present. Endocytosed ENaC travels to the early endosome and is then either trafficked to the lysosome for degradation or recycled back to the plasma membrane. Recently, the retromer recycling complex, located at the early endosome, has been implicated in plasma membrane protein recycling pathways. We hypothesized that the retromer is required for recycling of ENaC. Stabilization of retromer function with the retromer stabilizing chaperone R55 increased ENaC current, whereas knockdown or overexpression of individual retromer and associated proteins altered ENaC current and cell surface population of ENaC. KIBRA was identified as an ENaC-binding protein allowing ENaC to link to sorting nexin 4 to alter ENaC trafficking. Knockdown of the retromer-associated cargo-binding sorting nexin 27 protein did not alter ENaC current, whereas CCDC22, a CCC-complex protein, coimmunoprecipitated with ENaC, and CCDC22 knockdown decreased ENaC current and population at the cell surface. Together, our results confirm that retromer and the CCC complex play a role in recycling of ENaC to the plasma membrane.

Abstract MP44: Proteolytic Activation Of ENaC Mediates Fructose-Induced Salt-Sensitive Hypertension

In nephrotic syndrome, glomerular injury leads to filtration of plasma proteases. Once in the urine, these enzymes cleave and activate the epithelial Na channel (ENaC) causing inappropriate Na retention and hypertension. Dietary fructose causes inappropriate Na retention and salt-sensitive hypertension but whether proteolytic activation of ENaC is involved, and the source of the proteases, is unknown. We hypothesized that dietary fructose increases expression and release of proteases from the proximal nephron, and that these enzymes activate ENaC thereby causing Na retention and salt-sensitive hypertension. To test this hypothesis we first measured proximal nephron protease expression and urinary protease excretion in rats on either a high-salt diet without fructose (high salt) or one containing 4% NaCl plus 20% fructose in the drinking water (high salt/fructose) for 7 days. High salt/fructose treatment increased proximal nephron expression of trypsin I, an enzyme known to cleave and activate ENaC, by 68±7% (p < 0.01). Urinary excretion of trypsin I was 8.4±1.3 arbitrary units/μg protein in rats fed high salt while it was 20.3±4.6 arbitrary units/μg protein in those on the high salt/fructose diet, 142% greater (p < 0.02). There was no difference in total urinary protein excretion between groups. Finally, we examined the effect of high salt/fructose and high salt plus 20% glucose) high salt/glucose) on blood pressure before and after oral amiloride. After 7 days the systolic blood pressure of rats on high salt/fructose was 148±6 mm Hg while it was only 124±5 in those on high salt/glucose (p < 0.02). Amiloride reduced systolic blood pressure in rats on the high salt/fructose diet from 148±6 to 134±5 mm Hg but had no significant effect on the high salt/glucose group. We conclude that proteolytic cleavage of ENaC contributes to fructose-induced salt-sensitive hypertension and that the source of the protease(s) is likely the proximal tubule rather than glomerular filtration.

Abstract P229: Site-1 Protease-derived Soluble (pro) Renin Receptor Mediates Aldosterone-induced Enac Activation In The Collecting Duct

We have previously shown that activation of (pro)renin receptor (PRR) induces epithelial Na + channel (ENaC) activity in cultured collecting duct cells. Here, we examined the role of soluble PRR (sPRR), generated by site-1 protease (S1P), a newly identified PRR cleavage protease, in ENaC regulation, and further tested its relevance to Aldo signaling. In cultured mpkCCD cells, administration of recombinant histidine-tagged sPRR (sPRR-His) at 10 nM for 24 h induced a significant increase in the amiloride-sensitive short-circuit current as assessed using the Ussing chamber technique ( I eq : 7.5 ± 0.7 μA/cm 2 in sPRR group vs. 3.5 ± 0.5 μA/cm 2 in vehicle group, n = 6, p < 0.01) . In primary cultured rat IMCD cells, the same sPRR-His treatment induced a 1.7 fold increase in protein expression of the α-subunit but not β- or γ-subunit of ENaC, in parallel with upregulation of mRNA expression as well as promoter activity of the α-subunit. The upregulation of α-ENaC transcription depended on β-catenin signaling. Consistent results obtained by epithelial volt ohmmeter measurement of equivalent current and Using chamber determination of short-circuit current showed that Aldo-induced ENaC activity was almost completely abolished by PF-429242 (PF), a S1P inhibitor, and the response was restored by supplement of sPRR-His ( I eq : 7.2 ± 0.7 μA/cm 2 in Aldo group vs. 5.0 ± 0.3 μA/cm 2 in Aldo/PF group vs. 6.8 ± 0.3 μA/cm 2 in Aldo/PF/sPRR-His group, n = 5, p < 0.05). Medium sPRR was elevated by Aldo and inhibited by PF. Male C57BL/6 mice were pretreated with PF (30 mg/kg/day) or vehicle via minipump, followed by 3 days of aldosterone (0.2 mg/kg/day via a second minipump). Amiloride-sensitive Na+ current in freshly isolated CCD as measured by using patch clamp lower in Aldo + PF group than in Aldo group. Together, these results support an essential role of S1P-derived sPRR in mediating Aldo-induced ENaC activation.

Abstract MP38: High Salt Activates The NLRP3 Inflammasome In Antigen Presenting Cells Via ENaC To Promote Salt-Sensitive Hypertension

Salt-sensitivity is a major risk factor for hypertension and cardiovascular disease (CVD). Reducing dietary Na + decreases blood pressure and CVD risk. However, the precise mechanisms of how Na + leads to hypertension are still not well defined. Recently, we found that dendritic cells (DCs) in response to increases in extracellular [Na + ] exhibit an amiloride-sensitive epithelial Na + channel (ENaC)-dependent activation of NADPH-oxidase, superoxide production, reactive isolevuglandin (IsoLG)-protein adduct formation, and cytokine secretion which promote hypertension. We hypothesized that the NLRP3 inflammasome in antigen-presenting cells (APCs) mediates salt-sensitive hypertension through an ENaC-dependent mechanism. To test this hypothesis, we cultured mouse splenocytes in normal-salt or high-salt (HS) media with or without co-treatment with the ENaC inhibitor, amiloride (20 μM). Using flow cytometry, we found that HS increased monocyte and DC IL-1β production, which was confirmed through an ELISA assay detecting IL-1β release (2.131 ± 0.733 vs 12.75 ± 1.108 pg/mL, p<0.01) into the culture media, and amiloride treatment prevented IL-1β production (12.75 ± 1.108 vs 1.905 ± 0.3495 pg/mL, p<0.01) in these cells. To confirm our in vitro data, we treated salt-sensitive mice on a 129-SvJ background with a HS diet (4% NaCl) for 28 days with or without amiloride (1mg/kg/day in drinking water) or NLRP3 inflammasome inhibitor MCC950 (10mg/kg i.p.). Amiloride or MCC950 treated mice developed blunted hypertension in response to HS (120.4 ± 2.99; 101.0 ± 3.74) compared to vehicle controls (140.5 ± 3.98). Amiloride treated mice also exhibited less expression of NLRP3, pro-IL1β, and IsoLGs in DCs and monocytes compared to controls. Interestingly, MCC950 treated mice exhibited decreased pro-IL1β but not NLRP3 expression or IsoLG production. Using the DOCA-salt model, we found similar increases in NLRP3, pro-IL1β, and IsoLGs expression in DCs and monocytes, which was abolished after treatment with IsoLG scavenger 2-HOBA (1g/L). Our findings suggest a role for ENaC-dependent NLRP3 inflammasome activation in APCs in response to a HS diet, which may represent a promising treatment approach to salt-induced hypertension.

Abstract P234: Pre- And Post-treatment Analysis Of Pendrin In The Urinary Exosome In Primary Aldosteronism

Background and Aim: Pendrin is a Cl/HCO3 exchanger that is selectively present at the apical membrane in non-α intercalated cells of the renal tubules in the kidney. Besides its role in acid/base homeostasis, accumulating studies provided evidence that pendrin regulates extracellular fluid volume and electrolyte balance. Experimental studies using animal models also indicate that pendrin is upregulated in a high aldosterone state, along with the induction of NaCl cotransporter and epithelial Na channel. However, the regulation of pendrin in human is unclear. The present study was conducted to examine the levels of pendrin in subjects with primary aldosteronism. Methods: Sixteen patients who were diagnosed as primary aldosteronism at Teikyo University Hospital and Yokohama Rosai Hospital were enrolled in this study. We isolated exosomes from pre- and post-treatment urine samples by the ultracentrifugation method, and the levels of pendrin was evaluated by Western blotting. The loading amount was adjusted by creatinine concentration. Purification of exosomal fraction was confirmed by electron microscopy and also by the presence of alix, a marker of exosome. Results and Discussion: Among 16 patients, six received unilateral adrenalectomy and 10 received MR antagonist as the treatment. Mean aldosterone-to renin ratio was 1085. We excluded two subjects because alix was not detected in the pre-treatment samples, and the analysis was done in 14 subjects. In human urine, pendrin was detected at ~110kDa and ~220kDa, the latter likely representing a dimer. We found that pendrin abundance was significantly reduced by 49.8% (P<0.01) in post-treatment samples compared with pre-treatment samples. Therefore, pendrin is altered in primary aldosteronism, likely contributing to the pathophysiology of aldosterone excess in humans.

NOX4-dependent regulation of ENaC in hypertension and diabetic kidney disease.

NADPH oxidase 4 (NOX4) is the most abundant NOX isoform in the kidney; however, its importance for renal function has only recently emerged. The NOX4-dependent pathway regulates many factors essential for proper sodium handling in the distal nephron. However, the functional significance of this pathway in the control of sodium reabsorption during the initiation of chronic kidney disease is not established. The goal of this study was to test Nox4-dependent ENaC regulation in two models: SS hypertension and STZ-induced type 1 diabetes. First, we showed that genetic ablation of Nox4 in Dahl salt-sensitive (SS) rat attenuated a high-salt (HS)-induced increase in epithelial Na+ channel (ENaC) activity in the cortical collecting duct. We also found that H2 O2 upregulated ENaC activity, and H2 O2 production was reduced in both the renal cortex and medulla in SSNox4-/- rats fed an HS diet. Second, in the streptozotocin model of hyperglycemia-induced renal injury ENaC activity in hyperglycemic animals was elevated in SS but not SSNox4-/- rats. NaCl cotransporter (NCC) expression was increased compared to healthy controls, while expression values between SS and SSNox4-/- groups were similar. These data emphasize a critical contribution of the NOX4-mediated pathway in maladaptive upregulation of ENaC-mediated sodium reabsorption in the distal nephron in the conditions of HS- and hyperglycemia-induced kidney injury.

Sex differences in solute transport along the nephrons: effects of Na+ transport inhibition.

Each day, ~1.7 kg of NaCl and 180 liters of water are reabsorbed by nephron segments in humans, with urinary excretion fine tuned to meet homeostatic requirements. These tasks are coordinated by a spectrum of renal Na+ transporters and channels. The goal of the present study was to investigate the extent to which inhibitors of transepithelial Na+ transport (TNa) along the nephron alter urinary solute excretion and how those effects may vary between male and female subjects. To accomplish that goal, we developed sex-specific multinephron models that represent detailed transcellular and paracellular transport processes along the nephrons of male and female rat kidneys. We simulated inhibition of Na+/H+ exchanger 3 (NHE3), bumetanide-sensitive Na+-K+-2Cl- cotransporter (NKCC2), Na+-Cl- cotransporter (NCC), and amiloride-sensitive epithelial Na+ channel (ENaC). NHE3 inhibition simulations predicted a substantially reduced proximal tubule TNa, and NKCC2 inhibition substantially reduced thick ascending limb TNa. Both gave rise to diuresis, natriuresis, and kaliuresis, with those effects stronger in female rats. While NCC inhibition was predicted to have only minor impact on renal TNa, it nonetheless had a notable effect of enhancing excretion of Na+, K+, and Cl-, particularly in female rats. Inhibition of ENaC was predicted to have opposite effects on the excretion of Na+ (increased) and K+ (decreased) and to have only a minor impact on whole kidney TNa. Unlike inhibition of other transporters, ENaC inhibition induced stronger natriuresis and diuresis in male rats than female rats. Overall, model predictions agreed well with measured changes in Na+ and K+ excretion in response to diuretics and Na+ transporter mutations.

Cisplatin Decreases ENaC Activity Contributing to Renal Salt Wasting Syndrome.

Cisplatin (CDDP) is an important anticancer drug. A common side effect of CDDP is renal salt and water-wasting syndrome (RSWS). The origin of RSWS is obscure. Emerging evidence, though, suggests that broad inhibition of sodium transport proteins by CDDP may result in decreases in tubular reabsorption, causing increases in sodium and water excretion. In this sense, CDDP would be acting like a diuretic. The effect of CDDP on the epithelial Na+ channel (ENaC), which is the final arbiter fine-tuning renal Na+ excretion, is unknown. We test here whether CDDP affects ENaC to promote renal salt and water excretion. The effects of CDDP and benzamil (BZM), a blocker of ENaC, on excretion of a sodium load were quantified. Similar to BZM, CDDP facilitated renal Na+ excretion. To directly quantify the effects on ENaC, principal cells in split-open tubules were patch clamped. CDDP, at doses comparable to those used for chemotherapy (1.5 µM), significantly decreased ENaC activity in native tubules. To further elaborate on this mechanism, the dose-dependent effects of CDDP on mouse ENaC (mENaC) heterologously expressed in Chinese Hamster Ovary (CHO) cells were tested using patch clamping. As in native tubules, CDDP significantly decreased the activity of mENaC expressed in CHO cells. Dose–response curves and competition with amiloride identified CDDP as a weak inhibitor of ENaC (apparent IC50 = 1 µM) that competes with amiloride for inhibition of the channel, weakening the inhibitory actions of the latter. Such observations are consistent with CDDP being a partial modulator of ENaC, which possibly has a binding site that overlaps with that of amiloride. These findings are consistent with inhibition of ENaC by CDDP contributing to the RSWS caused by this important chemotherapy drug.

ENaC inhibition in cystic fibrosis: potential role in the new era of CFTR modulator therapies.

ENaC inhibition with BI 1265162 is a promising strategy to optimise outcomes in patients with CF either eligible, or ineligible, for CFTR modulator therapy. Phase II clinical trials of BI 1265162 must now show this translates into clinical benefit. https://bit.ly/2OQ1IUI

Aldosterone-dependent and -independent regulation of Na+ and K+ excretion and ENaC in mouse kidneys.

We investigated the regulation of Na+ and K+ excretion and the epithelial Na+ channel (ENaC) in mice lacking the gene for aldosterone synthase (AS) using clearance methods to assess excretion and electrophysiology and Western blot analysis to test for ENaC activity and processing. After 1 day of dietary Na+ restriction, AS-/- mice lost more Na+ in the urine than AS+/+ mice did. After 1 wk on this diet, both genotypes strongly reduced urinary Na+ excretion, but creatinine clearance decreased only in AS-/- mice. Only AS+/+ animals exhibited increased ENaC function, assessed as amiloride-sensitive whole cell currents in collecting ducts or cleavage of αENaC and γENaC in Western blots. To assess the role of aldosterone in the excretion of a K+ load, animals were fasted overnight and refed with high-K+ or low-K+ diets for 5 h. Both AS+/+ and AS-/- mice excreted a large amount of K+ during this period. In both phenotypes the excretion was benzamil sensitive, indicating increased K+ secretion coupled to ENaC-dependent Na+ reabsorption. However, the increase in plasma K+ under these conditions was much larger in AS-/- animals than in AS+/+ animals. In both groups, cleavage of αENaC and γENaC increased. However, Na+ current measured ex vivo in connecting tubules was enhanced only in AS+/+ mice. We conclude that in the absence of aldosterone, mice can conserve Na+ without ENaC activation but at the expense of diminished glomerular filtration rate. Excretion of a K+ load can be accomplished through aldosterone-independent upregulation of ENaC, but aldosterone is required to excrete the excess K+ without hyperkalemia.

The role of hypoxia-induced modulation of alveolar epithelial Na+- transport in hypoxemia at high altitude.

Reabsorption of excess alveolar fluid is driven by vectorial Na+-transport across alveolar epithelium, which protects from alveolar flooding and facilitates gas exchange. Hypoxia inhibits Na+-reabsorption in cultured cells and in-vivo by decreasing activity of epithelial Na+-channels (ENaC), which impairs alveolar fluid clearance. Inhibition also occurs during in-vivo hypoxia in humans and laboratory animals. Signaling mechanisms that inhibit alveolar reabsorption are poorly understood. Because cellular adaptation to hypoxia is regulated by hypoxia-inducible transcription factors (HIF), we tested whether HIFs are involved in decreasing Na+-transport in hypoxic alveolar epithelium. Expression of HIFs was suppressed in cultured rat primary alveolar epithelial cells (AEC) with shRNAs. Hypoxia (1.5% O2, 24 h) decreased amiloride-sensitive transepithelial Na+-transport, decreased the mRNA expression of α-, β-, and γ-ENaC subunits, and reduced the amount of αβγ-ENaC subunits in the apical plasma membrane. Silencing HIF-2α partially prevented impaired fluid reabsorption in hypoxic rats and prevented the hypoxia-induced decrease in α- but not the βγ-subunits of ENaC protein expression resulting in a less active form of ENaC in hypoxic AEC. Inhibition of alveolar reabsorption also caused pulmonary vasoconstriction in ventilated rats. These results indicate that a HIF-2α-dependent decrease in Na+-transport in hypoxic alveolar epithelium decreases alveolar reabsorption. Because susceptibles to high-altitude pulmonary edema (HAPE) have decreased Na+-transport even in normoxia, inhibition of alveolar reabsorption by hypoxia at high altitude might further impair alveolar gas exchange. Thus, aggravated hypoxemia might further enhance hypoxic pulmonary vasoconstriction and might subsequently cause HAPE.

Reactive species generated by heme impair alveolar epithelial sodium channel function in acute respiratory distress syndrome

We previously reported that the highly reactive cell-free heme (CFH) is increased in the plasma of patients with chronic lung injury and causes pulmonary edema in animal model of acute respiratory distress syndrome (ARDS) post inhalation of halogen gas. However, the mechanisms by which CFH causes pulmonary edema are unclear. Herein we report for the first time that CFH and chlorinated lipids (formed by the interaction of halogen gas, Cl2, with plasmalogens) are increased in the plasma of patients exposed to Cl2 gas. Ex vivo incubation of red blood cells (RBC) with halogenated lipids caused oxidative damage to RBC cytoskeletal protein spectrin, resulting in hemolysis and release of CFH. Patch clamp and short circuit current measurements revealed that CFH inhibited the activity of amiloride-sensitive epithelial Na+ channel (ENaC) and cation sodium (Na+) channels in mouse alveolar cells and trans-epithelial Na+ transport across human airway cells with EC50 of 125 nM and 500 nM, respectively. Molecular modeling identified 22 putative heme-docking sites on ENaC (energy of binding range: 86–1563 kJ/mol) with at least 2 sites within its narrow transmembrane pore, potentially capable of blocking Na+ transport across the channel. A single intramuscular injection of the heme-scavenging protein, hemopexin (4 μg/kg body weight), one hour post halogen gas exposure, decreased plasma CFH and improved lung ENaC activity in mice. In conclusion, results suggested that CFH mediated inhibition of ENaC activity may be responsible for pulmonary edema post inhalation injury.

Interactive Actions of Aldosterone and Insulin on Epithelial Na+ Channel Trafficking.

Epithelial Na+ channel (ENaC) participates in renal epithelial Na+ reabsorption, controlling blood pressure. Aldosterone and insulin elevate blood pressure by increasing the ENaC-mediated Na+ reabsorption. However, little information is available on the interactive action of aldosterone and insulin on the ENaC-mediated Na+ reabsorption. In the present study, we tried to clarify if insulin would modify the aldosterone action on the ENaC-mediated Na+ reabsorption from a viewpoint of intracellular ENaC trafficking. We measured the ENaC-mediated Na+ transport as short-circuit currents using a four-state mathematical ENaC trafficking model in renal A6 epithelial cells with or without aldosterone treatment under the insulin-stimulated and -unstimulated conditions. We found that: (A) under the insulin-stimulated condition, aldosterone treatment (1 µM for 20 h) significantly elevated the ENaC insertion rate to the apical membrane () 3.3-fold and the ENaC recycling rate () 2.0-fold, but diminished the ENaC degradation rate () 0.7-fold without any significant effect on the ENaC endocytotic rate (); (B) under the insulin-unstimulated condition, aldosterone treatment decreased 0.5-fold and increased 1.4-fold, without any significant effect on or . Thus, the present study indicates that: (1) insulin masks the well-known inhibitory action of aldosterone on the ENaC endocytotic rate; (2) insulin induces a stimulatory action of aldosterone on ENaC apical insertion and an inhibitory action of aldosterone on ENaC degradation; (3) insulin enhances the aldosterone action on ENaC recycling; (4) insulin has a more effective action on diminution of ENaC endocytosis than aldosterone.

AJP-Regulatory, Integrative and Comparative Physiology: Looking Toward the Future

<i>AJP-Regulatory, Integrative and Comparative Physiology</i>: Looking Toward the Future

MTOR Modulates Sodium and Potassium Conduction in Heterologous Expression System

The role of mammalian target of rapamycin (mTOR) complexes mTORC1 and mTORC2 in ion transport in kidney tubule has been an area of increasing interest in epithelial research. We and others have shown both in cultured cells and in vivo that mTORC2 is the hydrophobic motif kinase for serum and glucocorticoid kinase 1 (SGK1) and that its activity is required for epithelial Na+ channel (ENaC)‐dependent sodium reabsorption in the aldosterone‐sensitive distal nephron (ASDN). However, recent evidence has shown that mTORC2 can also modulate the renal outer medullary K+ channel (ROMK) activity directly. Electrogenic sodium reabsorption through ENaC generates the main driving force in ASDN for potassium secretion through ROMK, and is a key locus of acute regulation of K+ secretion. We suspected that differences observed in various studies may be due to acute vs. chronic regulation. We therefore compared the effects on ENaC and ROMK activity of chronic (through gene‐knockout) and acute (through a pharmacological approach) mTOR inhibition. We used CRISPR‐Cas9 to generate Sin1 (an essential component of mTORC2)‐deficient HEK‐293T cells, which were compared with wild type cells. The cells were transiently transfected with ENaC (alpha, beta gamma subunits) and ROMK1 channels. After recovery, the cells were treated with either vehicle or the mTOR inhibitor AZD8055 for 30 min and subjected to whole cell patch clamp to assess ENaC and ROMK currents. We found that in Sin1 KO cells (chronic loss of mTORC2) ENaC current was unaffected, while ROMK was markedly reduced. In contrast, acute mTOR inhibition with AZD8055 inhibited ENaC but not ROMK whole cell currents. These data provide initial support for the idea that acute pharmacologic inhibition of mTORC2 and chronic selective inhibition of mTORC2 have opposite effects on ENaC and ROMK activities. However, the results are also consistent with the possibility that global inhibition of mTOR (blocking mTORC1 and mTORC2) has distinct effects from selective inhibition of mTORC2. These observations may provide further insight into such diverse processes as aldosterone escape and the distinct plasma K+ concentrations seen in various types of hypertension.Support or Funding InformationThis work was supported by Relypsa Nephrolgy and Cardiology fellowship 2019–2020 to WS and NIH RO1‐DK 56695 to DP

The Terrestrial Migration of Vertebrates Drove the Evolution of ENaC Activation by Cleavage α

The epithelial Na+ channel (ENaC) is critical to regulating extracellular fluids through its activity in several epithelia, including the aldosterone‐sensitive distal nephron and colon, and the airway and alveoli. Human ENaC subunits are subject to activating proteolysis. The ENaC α and γ subunits may each be cleaved twice at polybasic tracts in their respective extracellular GRIP domains. This liberates imbedded inhibitory tracts, which activate the channel. Activation through either subunit requires double cleavage. To examine the evolution of ENaC cleavage sites, we generated a phylogenetic tree of ENaC and ENaC‐related subunits to identify key branch points in the evolution of ENaC subunits. The four ENaC subunits arose from three gene duplication events. First, a single gene diverged to an α/δ precursor and a β/γ precursor. Second, the β/γ precursor diverged to β and γ subunits. These two events occurred before the emergence of jawless fishes, as lampreys have α, β, and γ subunits. After the emergence of jawed fishes, α and δ diverged from the α/δ precursor; the lobe‐finned coelacanth is earliest rooted species to have all four subunits. We observed that the activating cleavage sites in the α and γ subunits appeared around the transition to terrestrial life. Among the fishes, only the Australian lungfish γ subunit had two cleavage sites, and all tetrapod α and γ subunits had two apparent cleavage sites. We ran nested likelihood models in BayesTraits and found a significant relationship between terrestrial status and having two cleavage sites in the α and γ subunits. Both sites showed a statistically significant coevolutionary pattern with the terrestrial state (proximal site, p = 0.004; distal site, p = 0.006). The sites also showed a coevolutionary pattern with each other (p = 0.0003). In contrast, the C‐terminal PY motif, which is important for aldosterone regulation through Sgk1/Nedd4‐2, did not show a dependence on terrestrial status (p = 0.58). We also performed ancestral reconstructions to determine whether these protein sequences arose through divergent or convergent evolution. Competing evolutionary models, where common ancestors were constrained to states reflecting each model, were compared using marginal likelihoods from Markov chain Monte Carlo simulations of each model. Our analysis strongly supports a convergent evolutionary model for the cleavage sites, and a divergent evolutionary model for the PY motifs. Our data suggest that aldosterone signaling adopted both long existing and newly evolved mechanisms to regulate ENaC function.