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BASIC RESEARCH www.jasn.org Proximal Tubules Have the Capacity to Regulate Uptake of Albumin † Mark C. Wagner,* Silvia B. Campos-Bilderback,* Mahboob Chowdhury, Brittany Flores,* ‡ Xianyin Lai, Jered Myslinski,* Sweekar Pandit,* Ruben M. Sandoval,* Sarah E. Wean,* † | Yuan Wei,§ Lisa M. Satlin,§ Roger C. Wiggins, Frank A. Witzmann, and | Bruce A. Molitoris* *Indiana University School of Medicine, The Roudebush Veterans Affair Medical Center, Indiana Center for Biological Microscopy, Indianapolis, Indiana; §Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York; †Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; ‡Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana; and |Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana ABSTRACT Evidence from multiple studies supports the concept that both glomerular filtration and proximal tubule (PT) reclamation affect urinary albumin excretion rate. To better understand these roles of glomerular filtration and PT uptake, we investigated these processes in two distinct animal models. In a rat model of acute exogenous albumin overload, we quantified glomerular sieving coefficients (GSC) and PT uptake of Texas Red-labeled rat serum albumin using two-photon intravital microscopy. No change in GSC was observed, but a significant decrease in PT albumin uptake was quantified. In a second model, loss of endogenous albumin was induced in rats by podocyte-specific transgenic expression of diphtheria toxin receptor. In these albumin-deficient rats, exposure to diphtheria toxin induced an increase in albumin GSC and albumin filtration, resulting in increased exposure of the PTs to endogenous albumin. In this case, PT albumin reabsorption was markedly increased. Analysis of known albumin receptors and assessment of cortical protein expression in the albumin overload model, conducted to identify potential proteins and pathways affected by acute protein overload, revealed changes in the expression levels of calreticulin, disabled homolog 2, NRF2, angiopoietin-2, and proteins involved in ATP synthesis. Taken together, these results suggest that a regulated PT cell albumin uptake system can respond rapidly to different physiologic conditions to minimize alterations in serum albumin level. J Am Soc Nephrol 27: 482–494, 2016. doi: 10.1681/ASN.2014111107 While the clinical relevance of proteinuria, and disease conditions. This understanding is important especially albuminuria, has been well documented, because before appropriate therapies can be devel- the quantitative and mechanistic significance of oped to modulate albuminuria, the structural, func- different components to albumin excretion remains tional and mechanistic characterization need to be an area of considerable excitement and debate.1 Recent better understood and interrelated. data from several laboratories utilizing different ap- proaches have delineated a role of proximal tubules (PTs) in regulation of albumin reabsorption and rec- Received November 18, 2014. Accepted May 4, 2015. 2 lamation. Furthermore, albumin transcytosis has Published online ahead of print. Publication date available at 3 been visualized in PT cells and FcRn has been shown www.jasn.org. to mediate the transcytosis of albumin across PTCs,4 Correspondence: Dr. Bruce A. Molitoris, Nephrology Division, 2 as it is known to do for many other cell types. There- Department of Medicine, Indiana University School of Medicine, fore, the present studies were conducted to begin dif- 950 West Walnut Street, Building R2, Room 266, Indianapolis, IN ferentiating and quantifying glomerular and PT 46202. Email: [email protected] contributions to albuminuria under physiologic and Copyright © 2016 by the American Society of Nephrology 482 ISSN : 1046-6673/2702-482 J Am Soc Nephrol 27: 482–494, 2016 www.jasn.org BASIC RESEARCH PTs regulate glomerular filtrate uptake, sorting, degradation, albumin from baseline. An average of 75% of the amount of transcytosis, and secretion, thus serving as a key contributor in albumin injected was recovered in the urine on days 2–5. This determining urine composition. Further, PT cells have extremely increase in albuminuria is consistent with previous results, which active endocytosis mechanisms and are thus responsible also showed no change in hematocrit or total plasma protein.9 for retrieving most filtered proteins under normal conditions.5 Glomerular filtration rate (GFR, ml/min/100 g) measured using Given the recent data supporting increased filtration of proteins 24-hour creatinine clearances, showed no significant measurable (i.e., albumin), understanding their endocytic mechanisms be- change between day 0 and 3 or 4 day 1=0.7160.14, imaging comes even more important.2 A clear role of megalin/cubilin in day=0.6860.12. receptor-mediated clathrin-dependent endocytosis function ex- ists and in addition there is an active non-selective fluid-phase Acute Albumin Overload does not Correlate with endocytosis pathway.6 However, the only known transcytosis re- Glomerular Sieving Alterations ceptor for albumin is FcRn.7 While many questions remain con- This acute albumin overload model allowed us to determine cerning these processes it is clear that multiple diseases result whether elevated albumin excretion resulted from increased from protein trafficking defects in PT.2,8 Therefore, to begin ad- passageviatheglomerularfiltrationbarrier.Intravitaltwo-photon dressing how the PTs handle filtered proteins two different rat microscopy was used to quantify GSCs on days 3 or 4, enabling us models of proteinuria have been investigated. to evaluate GSC for rats with variable but elevated albuminuria First, the acute albumin overload model, which has been used levels. Each rat had an average of five surface glomeruli that were for over 20 years and induces a significant rapid and reversible measured at two time points following Texas Red rat serum increase in albuminuria, was evaluated.9,10 The second model albumin(TR-RSA)infusion.Imagecollectiondidnotstartuntilat was a transgenic rat line that specifically expresses the diphtheria least 10 minutes post TR-RSA infusion to allow equilibration to toxin (DT) receptor in podocytes under the control of the podocyte- occur. Figure 1D shows the GSC values on the y axis (overall specific podocin promoter. Under physiologic conditions urinary mean of 0.008060.0013) and the corresponding 24-hour urine albumin was unaltered, but the presence of DTresults in selective albumin values plotted on the x axis. Note, these values were also podocyte injury/death resulting in increased albumin leak across no different from GSCs for control MWF female rats (mean GSC the glomerular filtration barrier.11 of 0.007560.0029). If increased passage of albumin across the An implicit assumption has always been that in both models glomerular filtration barrier was the cause of albuminuria then albuminuria results from enhanced passage of albumin across the one would expect that rats with the highest albumin excretion glomerular filtration barrier. However, recent data from multiple levels would have the highest GSC values. However, there was no laboratories supports a role for both the glomerulus and PT cell in correlation between the measured GSC for albumin and the determining the level of albuminuria in disease processes.2 Pre- 24-hour urinary albumin excretion. This result raised the possi- viously it had not been possible to evaluate the role of the PTC in bility that a nonglomerular event was responsible for increased these models. However, intravital two-photon microscopy of the albumin excretion. The other well-studied mechanism that has kidney now permits a direct evaluation of changes occurring in been shown to contribute to elevated urinary albumin is an al- glomerular filtration and PTC uptake of fluorescent molecules teration in PTC uptake of filtered proteins.2 simultaneously in the same nephron.12,13 An increase in the glo- merular sieving coefficient (GSC) would be consistent with a PT Albumin Reabsorption Decreased During Albumin glomerular effect while changes in the level of PTC uptake would Loading support a role for the PTC in albuminuria. The ability to simul- Intravital microscopy was used to quantify tracer amounts of TR- taneously monitor both mechanisms is essential for understand- RSAuptake by PTCs. Less TR-RSAappeared in the early S1 segment ing the mechanism of albuminuria. of the PTs (visible opening to glomerulus) in protein overload rats compared with control rats. An example of this is shown in Figure 2A where the control PT S1 had increased TR-RSA fluorescence RESULTS than a PT S1 in the protein overloaded rat, images captured 20–30 min after TR-RSA infusion. To quantify TR-RSA uptake we used Albuminuria in the MWF Rats Following Albumin our established method that determines total PTC uptake without Overload distinguishing between different PT segments, Figure 2B.12 Abox Initial studies were undertaken to characterize the albumin plot of these data gave a mean value of 335761339 total integrated overload model in the female Munich Wistar Fromter (MWF) fluorescence (TIF)/mm2 for control and 12556976 TIF/mm2 for rats. Their superficial glomeruli have allowed our laboratory, and protein overload with a P value of 0.014. To further characterize others, to directly observe and quantify glomerular and tubular uptake changes we focused on the robust endocytic activity of the events
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