Institute of Physiology, University of Zürich, Zürich, Switzerland; Division of Nephrology, University Hospital Zürich, Zürich, Switzerland.
Institute of Physiology, University of Zürich, Zürich, Switzerland.
Kidney Int. 2017 Apr;91(4):842-855. doi: 10.1016/j.kint.2016.11.016. Epub 2017 Jan 28.
Dent disease is a rare X-linked tubulopathy caused by mutations in the endosomal chloride-proton exchanger (ClC-5) resulting in defective receptor-mediated endocytosis and severe proximal tubule dysfunction. Bone marrow transplantation has recently been shown to preserve kidney function in cystinosis, a lysosomal storage disease causing proximal tubule dysfunction. Here we test the effects of bone marrow transplantation in Clcn5 mice, a faithful model for Dent disease. Transplantation of wild-type bone marrow in Clcn5 mice significantly improved proximal tubule dysfunction, with decreased low-molecular-weight proteinuria, glycosuria, calciuria, and polyuria four months after transplantation, compared to Clcn5 mice transplanted with ClC-5 knockout bone marrow. Bone marrow-derived cells engrafted in the interstitium, surrounding proximal tubule cells, which showed a rescue of the apical expression of ClC-5 and megalin receptors. The improvement of proximal tubule dysfunction correlated with Clcn5 gene expression in kidneys of mice transplanted with wild-type bone marrow cells. Coculture of Clcn5 proximal tubule cells with bone marrow-derived cells confirmed rescue of ClC-5 and megalin, resulting in improved endocytosis. Nanotubular extensions between the engrafted bone marrow-derived cells and proximal tubule cells were observed in vivo and in vitro. No rescue was found when the formation of the tunneling nanotubes was prevented by actin depolymerization or when cells were physically separated by transwell inserts. Thus, bone marrow transplantation may rescue the epithelial phenotype due to an inherited endosomal defect. Direct contacts between bone marrow-derived cells and diseased tubular cells play a key role in the rescue mechanism.
Dent 病是一种罕见的 X 连锁管状病,由内体氯-质子交换器(ClC-5)的突变引起,导致受体介导的内吞作用缺陷和严重的近端肾小管功能障碍。最近的研究表明,骨髓移植可在胱氨酸病(一种导致近端肾小管功能障碍的溶酶体贮积病)中保留肾功能。在这里,我们测试了骨髓移植在 Clcn5 小鼠中的效果,Clcn5 小鼠是 Dent 病的忠实模型。与接受 ClC-5 敲除骨髓移植的 Clcn5 小鼠相比,将野生型骨髓移植到 Clcn5 小鼠中,在移植后四个月时,可显著改善近端肾小管功能障碍,表现为低分子量蛋白尿、糖尿、尿钙和多尿减少。骨髓来源的细胞在间质中定植,包围近端肾小管细胞,使 ClC-5 和 megalin 受体的顶端表达得到挽救。与接受野生型骨髓细胞移植的小鼠的肾脏中 Clcn5 基因表达相关,近端肾小管功能障碍的改善。Clcn5 近端肾小管细胞与骨髓来源细胞的共培养证实了 ClC-5 和 megalin 的挽救,导致内吞作用改善。在体内和体外观察到植入的骨髓来源细胞和近端肾小管细胞之间存在纳米管状延伸。当通过肌动蛋白解聚阻止形成隧穿纳米管或通过 Transwell 插入物将细胞物理分离时,未发现挽救作用。因此,骨髓移植可能由于内体缺陷的遗传而挽救上皮表型。骨髓来源的细胞与患病管状细胞之间的直接接触在挽救机制中起着关键作用。