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Morphological changes of the complex 3-D architecture of podocytes as well as the loss of these post-mitotic cells often result in severe kidney disease. Since currently, there are no curative drugs, we focused on the identification of non-invasive biomarkers, allowing an early detection of the onset of such diseases. Therefore, we analyzed the cellular- and the cell-free fractions of urine samples from patients suffering from chronic kidney disease (CKD), especially for injury markers as well as for exosome-derived miRNAs.
We identified the mRNA of the neuronal protein brain-derived neurotrophic factor (BDNF) in the cellular fraction of 120 CKD patients and found that the expression was highly correlated with the mRNA expression of the kidney injury marker molecule 1 (KIM-1). Furthermore, we found that both were correlated with the mRNA expression of the podocyte-specific gene Nephrin (NPHS1), suggesting that podocytes are very likely the cellular source.
Beside this, we observed that BDNF is upregulated in biopsies of diabetic patients and seems to be involved in the differentiation of podocytes. Immunofluorescence staining clearly showed that BDNF is localized in the cell body and major processes of podocytes within the glomerulus. Knockdown experiments in zebrafish larvae, a well-established animal model to study kidney function, showed the importance of BDNF on kidney function, morphology and filtration in vivo.
Additionally, we analyzed circulating exosomal microRNAs (miRs) isolated from the cell-free urine fraction. After the optimization of a column-based isolation protocol for exosomes, we identified miR-16 from a pre-selected set of candidates as a suitable endogenous reference gene for data normalization. Subsequently, we analyzed the exosomal levels of miR-21, miR-30a-5p and miR-92a in urine samples of 41 CKD patients and 5 healthy controls. We found significantly enhanced levels of miR-21 in CKD patients that were also negatively correlated with the eGFR, suggesting a negative influence on kidney function. MiR-21 was also highly upregulated in de-differentiated glomeruli and in kidneys of nephrotoxic serum- (NTS-) treated mice as an in vivo kidney injury model.
To summarize, we identified two promising new and non-invasive biomarkers for CKD in the urine of patients which may also have a functional relevance on kidney function.