Characterization of polycystin-1 in ADPKD pathogenetic mechanism :
biogenesis and functional implications by genetic approaches in mouse

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic diseases. ADPKD is manifested by the presence of renal cysts detected most often in the adult stage, and frequently liver cysts, with highly variable progression. ADPKD leads to kidney failure with the only recourse of dialysis and eventual kidney transplantation. Mutations dispersed throughout the PKD1 gene (major player, the polycystin-1 protein, PC1) and the PKD2 gene (polycystin-2 protein, PC2) are responsible for ADPKD. The loss of function (LOF) pathogenetic mechanism, and therefore a cellular recessive effect, has been suggested as causative of ADPKD. LOF is indeed supported by the PKD1/PKD2 gene inactivation mouse models, which develop cysts, although in utero with impressive speed in the kidney but not in the liver. Despite many in vitro studies, the membrane/ciliary role of PC1/PC2 remains rather hypothetical and context-dependent. These studies have associated PC1/PC2 to a variety of signaling pathways and underlined exceptional structural and functional complexity, whose involvement has been tested especially in LOF models. However, pathocellular observations in humans with sustained and even increased expression of PKD1/PC1, and the absence of particular human extrarenal phenotypes questions the exclusivity of the LOF mechanism. It was therefore essential 1) to clarify the pathogenetic mechanism, 2) to generate in vivo tools authentic of ADPKD in terms of initiation and progression of the disease and 3) to better understand the essential functions of PC1/PC2 for an adequate clinical translation. This thesis addresses all of these issues. First, we demonstrated that an increase in endogenous PKD1, just like in humans, is pathogenetic by generating and characterizing in detail a transgenic mouse model of Pkd1 (Pkd1TAG). This model not only reproduces the renal human characteristics associated with defects of the primary cilium, but also the extrarenal, namely, liver cysts. The severity of the phenotype correlates with the expression level of Pkd1, which strongly supports a dosage model. Secondly, we have demonstrated with genetic complementation studies that these two organs rely on a balance of Pc1 GPS cleavage, a typical post-translational modification of aGPCR, whose activity and abundance seem strictly controlled. Furthermore, we have extensively characterized Pc1 biogenesis and its derivatives in vivo generated upon GPS cleavage. We have identified a new form, predominantly on the membrane, the Pc1deN form, in addition to confirming the two N- and C-terminal Pc1 fragments (NTF and CTF, respectively), which associate non-covalently. Importantly, we have demonstrated that traffic of Pc1deN i.e., the NTF form detached from the CTF, is still dependant on the integrity of the CTF fragment. Next, we generated a first model humanizing a PKD1 nonsense truncated mutation at the level of the NTF(E3043X) domain by reproducing it in a transgenic mouse (Pkd1extra). Structurally, this mutation, which mimics Pc1deN, has also been shown to be causative of PKD. The Pkd1extra model allowed the proposition of the existence of a cross-interaction between different forms of Pc1. In addition, our two mouse models are both associated with altered levels of c-Myc and Pc2, which is supportive of their involvement in ADPKD and a functional interaction between the polycystins. Finally, we have shown a significant overlap between ADPKD and acute renal injury (ischemia/AKI) namely increased expression of Pc1 and Pc2 but also stimulation of several cystogenic factors such as tuberin, β-catenin and the oncogene c-Myc. Our studies have therefore given crucial evidence to the contribution of PKD1 gene dosage mechanism in ADPKD. We have developed two mouse models, which can serve as a tool for the analysis of human pathology as well as for preclinical validation of ADPKD. The identification of a new form of Pc1 adds an additional level of complexity in part explaining the regulation capacity of Pc1 on several signaling pathways. Our findings lead us to propose new therapeutic approaches: firstly, targeting the CTF i.e., chaperone style, and also targeting intracellular modulators (c-Myc, Pc2, Hif1α). Together, our work is of paramount importance in an informative point of view and practical perspective for progress towards a therapy for treating ADPKD. The sharing of common pathways between AKI and ADPKD paves the way for parallel therapeutic approaches for assured much faster treatment.

Keyphrases: ADPKD, C-Myc, Pc2, ADPKD, Polycystin-1, GPS cleavage, AKI, Mouse models, Kidney, Liver, C-Myc, Pc2