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Renal plasticity revealed through reversal of polycystic kidney disease in mice

Abstract

Initiation of cyst formation in autosomal dominant polycystic kidney disease (ADPKD) occurs when kidney tubule cells are rendered null for either PKD1 or PKD2 by somatic ‘second hit’ mutations. Subsequent cyst progression remodels the organ through changes in tubule cell shape, proliferation and secretion. The kidney develops inflammation and fibrosis. We constructed a mouse model in which adult inactivation of either Pkd gene can be followed by reactivation of the gene at a later time. Using this model, we show that re-expression of Pkd genes in cystic kidneys results in rapid reversal of ADPKD. Cyst cell proliferation is reduced, autophagy is activated and cystic tubules with expanded lumina lined by squamoid cells revert to normal lumina lined by cuboidal cells. Increases in inflammation, extracellular matrix deposition and myofibroblast activation are reversed, and the kidneys become smaller. We conclude that phenotypic features of ADPKD are reversible and that the kidney has an unexpected capacity for plasticity controlled at least in part by ADPKD gene function.

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Fig. 1: Reactivation of Pkd2 reverses cyst formation.
Fig. 2: Serial imaging shows reduction in total kidney volume after PC2 re-expression.
Fig. 3: Changes of tubule cell shapes after re-expression of PC2.
Fig. 4: Decreased cyst cell proliferation after re-expression of PC2.
Fig. 5: Reversal of inflammatory changes in cystic kidneys after PC2-HA re-expression.
Fig. 6: Reversal of fibrotic changes in cystic kidneys after PC2-HA re-expression.
Fig. 7: Later-stage reactivation of Pkd2 reverses cyst formation but kidney repair is less complete.
Fig. 8: Reactivation of Pkd1 reverses cyst formation.

Data availability

There are no accession codes, unique identifiers or weblinks for publicly available datasets associated with this publication. The figures do not have associated raw data. There are no restrictions on data availability associated with any part of this work. Full-length western blots supporting all the figures are provided as Source Data.

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Acknowledgements

We thank the George M. O’Brien Kidney Center at Yale (P30 DK079310) for assistance with BAC recombineering and BUN measurements. This work was supported by NIH/National Institute of Diabetes and Digestive and Kidney Diseases grants (nos. R01 DK121948 and RC1 DK086738 to S.S.) and a PKD Foundation grant (no. 196F14 to M.M.). We thank the Amy P. Goldman Foundation for their generous and steadfast support.

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K.D., C.Z., X.T. and M.M. performed the experiments. D.C. and F.H. performed and analyzed the MRI studies. S.S. conceived the study. K.D. and S.S. designed the study and analyzed the data. K.D. and S.S. prepared the figures. S.S. wrote the manuscript with input from all the authors.

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Correspondence to Stefan Somlo.

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Dong, K., Zhang, C., Tian, X. et al. Renal plasticity revealed through reversal of polycystic kidney disease in mice. Nat Genet 53, 1649–1663 (2021). https://doi.org/10.1038/s41588-021-00946-4

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