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Chronic kidney disease is a major public health burden associated with a drastically reduced quality of living and life span that lacks suitable, individualized therapeutic strategies. Here we present a human induced pluripotent stem cell line (iPSC, UMGACBi001-A) reprogrammed from urine cells of an acute septic dialysis patient suffering from chronic kidney disease using non-integrating administration of RNAs. The generated iPSCs were positively characterized for typical morphology, pluripotency marker expression, directed differentiation potential, non-contamination, chromosomal consistency and donor identity. This iPSC-line can be a useful source for in vitro disease modelling and individualized therapeutic approaches.
Chronic kidney disease (CKD) is a major public health burden affecting more than 500 million people worldwide. Podocytopathies are the main cause for the majority of CKD cases due to pathogenic morphological as well as molecular biological alterations of postmitotic podocytes. Podocyte de-differentiation is associated with foot process effacement subsequently leading to proteinuria. Since currently no curative drugs are available, high throughput screening methods using a small number of animals are a promising and essential tool to identify potential drugs against CKD in the near future. Our study presents the implementation of the already established mouse GlomAssay as a semi-automated high-throughput screening method—shGlomAssay—allowing the analysis of several hundreds of FDA-verified compounds in combination with downstream pathway analysis like transcriptomic and proteomic analyses from the same samples, using a small number of animals. In an initial prescreening we have identified vitamin D3 and its analog calcipotriol to be protective on podocytes. Furthermore, by using RT-qPCR, Western blot, and RNA sequencing, we found that mRNA and protein expression of nephrin, the vitamin D receptor and specific podocyte markers were significantly up-regulated due to vitamin D3- and calcipotriol-treatment. In contrast, kidney injury markers were significantly down-regulated. Additionally, we found that vitamin D3 and calcipotriol have had neither influence on the expression of the miR-21 and miR-30a nor on miR-125a/b, a miRNA described to regulate the vitamin D receptor. In summary, we advanced the established mouse GlomAssay to a semi-automated high-throughput assay and combined it with downstream analysis techniques by using only a minimum number of animals. Hereby, we identified the vitamin D signaling pathway as podocyte protective and to be counteracting their de-differentiation.
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.