Lecture #8 Flashcards
what is ADKTD?
autosomal dominant tubulointerstitial kidney disease
what symptoms are associated with a loss of kidney function?
- progressive loss of kidney function
- bland urine sediment
- no proteinuria
- small kidney
- urinary concentrating defect
what are the main functional defects seen in patients with ADKTD?
urinary concentrating defects - polyuria and polydipsia
what physical attributes are seen in the kidney of patients with ADKTD?
- interstitial fibrosis
- tubular atrophy
- thickening / lamellation of the tubular base membrane
- tubular dilations
- progressice fibrotic phenotype
as of now, it is known that ADKTD is caused by mutations in how many different genes?
5
what are the two most frequently mutated genes?
UMOD (uromodulin) and MUC1 (mucin 1)
what is unique about HNFβ?
it is a transcription factor so it is associated with many diseases besides ADKTD
what are the most rare versions of ADKTD?
ADKTD-REN and ADKTD-SEC61A1
what are the three main diagnostic methods?
urinalysis, imaging, inheritance
what is the other name for uromodulin?
Tamm-Horsfall protein
describe the normal occurrence of uromodulin:
the most abundant protein in human urine in physiological conditions
where is uromodulin expressed in the kidney?
only expressed in the thick ascending limb (TAL) of Henle’s loop where there are specific cells of the nephron
describe the structural features of uromodulin:
there are a huge amount of cysteines which are involved in the formation of S-S bonds and there is the zona pellucida domain which is found in a lot of extracellular proteins that are all involved in the formation extracellular polymers
what protein cleaves uromodulin once it reaches the membrane, cleaving the ends of the ZP and separating the interactions of the two domains?
hepsin
what does cleavage by hepsin allow for?
interactions with other uromodulin forming filaments
what is the function of uromodilin in the TAL segment?
regulates ion transport
what is the function of the loop of Henle?
the portion where important molecules are reabsorbed from the urine → in general urine comes in the loop super concentrated and then gets progressively diluted implementing the mechanism in which we have the counter current gradient in kidneys where most of the water gets reabsorbed thanks to the osmotic gradient
what is the function of uromodulin once it is secreted?
acts as a defense factor against infectious and calcium oxalate crystal formation
describe the immunoregulatory function of uromodulin:
this protein acts as a DAMP → when the tubule is damaged the protein extravasates into the interstitium and activates inflammatory cells acting as a guardian of the integrity of the tubules once its secreted in the nephron
what generally causes disease in uromodulin mutations?
not a loss of function but instead a gain of function
describe the general cause of mutations in uromodulin:
majority of mutations affect cysteine → gof is most likely due to a misfolding of uromodulin causing the loss of a S-S bond
where does uromodulin accumulate in these mutations?
in the ER → mutations are likely interfering with protein folding
when uromodulin is mutated what does it colocalize with?
calnexin - fully or partially retained in the ER
what is the function of EndoH?
digests glycosylated enzymes only when they are in high mannose conformation
under what condition is EndoH able to be used?
can be used to detach glycans from a protein only when they are in the ER - if they get modified in the golgi it is no longer possible
what was demonstrated to be the primary effect of mutated UMOD?
ER retention - different mutations show a different extent and therefore a more or less functional protein
how many classes are UMOD mutations divided into?
4
what does a class 1 UMOD mutation represent?
a milder mutation associated with a better kidney survival than other classes
what is the UPR?
an adaptive pathway triggered when the cell tries to counteract the accumulation of misfolded proteins inside the cell itself
what does the UPR activate?
the expression of chaperones, decreases protein translation, and increases protein degradation associated with the ER
if the UPR is mutant and is unable to be switched off, what occurs?
it can be associated with cell damage eventually leading to transdifferentiation and activation of inflammatory pathways and apoptosis
what three pathways does the UPR activate?
ATF6, PERK, IRE1
when there is an increase in unfolded proteins in the ER what protein is sequestered?
BiP - the main chaperone in the ER