Kidney disease causes ApoAI/HDL to lose their vasculoprotective effects. A likely mechanism for the protective loss is modification of ApoAI/HDL reactive carbonyls which are increased. Kidney injury increases reactive carbonyls and permits more ApoAI to escape into the glomerular ultrafiltrate. We examined how apoAI was metabolized in the injured proteinuric kidney. Nphs1-hCD25 mice (NEP25) expressing human CD25 in podocytes were injured by immunotoxin, LMB2. Six weeks after LMB2, we assessed urinary excretion and intrarenal localization of ApoAI and examined the renal lymphatic network with podoplanin. In vitro, we studied proximal tubular cells (PTC) and lymphatic endothelial cells (LEC) exposed to ApoAI or modified ApoAI (IsoLG-ApoAI). NEP25 mice developed glomerulosclerosis, increased urinary excretion of albumin and ApoAI with high molecular weight forms of ApoAI appearing in urine of injured mice assessed by western blot. Proteinuric kidneys had more ApoAI and VEGFC staining that localized to tubular epithelial cells and showed a dramatically more dense and complex lymphatic network than wild type mice. ApoAI localized to lymphatic vessels. Cultured PTC and LEC responded differently to normal and isolevuglandin (IsoLG)-modified ApoAI. In PTC, IsoLG-ApoAI promoted more ApoAI uptake and VEGFC secretion, a powerful lymphaniogenic stimulus. In LEC, IsoLG-ApoAI led to greater cell viability, migration and ROS production than normal ApoAI. Notably, supernatant of PTC exposed to ApoAI secreted a high molecular weight form of ApoAI. In conclusion, injury that disrupts the glomerular filtration barrier causing proteinuria also leads to a dramatic increase in filtered ApoAI followed by greater uptake by the proximal tubules, interstitium and lymphatic vessels. Proximal tubules can modify ApoAI and activate tubular secretion of VEGFC, which in turn promotes renal lymphangiogenesis and encourages delivery of kidney-modified ApoAI into circulation.
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