Alport syndrome is a rare hereditary renal disease that is characterized by blood and protein in the urine, hypertension, progressive kidney failure, hearing loss, and eye abnormalities. While it is possible to diagnose the disease early, current therapies are unable to prevent end-stage kidney failure. In this episode, Lina Shehadeh and colleagues determined that osteopontin is highly upregulated in the renal tubules of a mouse model of Alport syndrome and promotes excessive cholesterol influx to the kidney. Deletion of the osteopontin-encoding gene ameliorated Alport-associated disease manifestations and improved lifespan. Together, these results identify osteopontin as a driver of renal dysfunction in Alprot syndrome and provides potential therapeutic targets to be further explored.
Alport syndrome is a rare hereditary renal disorder with no etiologic therapy. We found that osteopontin (OPN) is highly expressed in the renal tubules of the Alport mouse and plays a causative pathological role. OPN genetic deletion ameliorated albuminuria, hypertension, tubulointerstitial proliferation, renal apoptosis, and hearing and visual deficits in the Alport mouse. In Alport renal tubules we found extensive cholesterol accumulation and increased protein expression of dynamin-3 (DNM3) and LDL receptor (LDLR) in addition to dysmorphic mitochondria with defective bioenergetics. Increased pathological cholesterol influx was confirmed by a remarkably increased uptake of injected DiI-LDL cholesterol by Alport renal tubules, and by the improved lifespan of the Alport mice when crossed with the Ldlr–/– mice with defective cholesterol influx. Moreover, OPN-deficient Alport mice demonstrated significant reduction of DNM3 and LDLR expression. In human renal epithelial cells, overexpressing DNM3 resulted in elevated LDLR protein expression and defective mitochondrial respiration. Our results suggest a potentially new pathway in Alport pathology where tubular OPN causes DNM3- and LDLR-mediated enhanced cholesterol influx and impaired mitochondrial respiration.
Wen Ding, Keyvan Yousefi, Stefania Goncalves, Bradley J. Goldstein, Alfonso L. Sabater, Amy Kloosterboer, Portia Ritter, Guerline Lambert, Armando J. Mendez, Lina A. Shehadeh