#1284 Proteinuria causes excessive proliferation and senescence in proximal tubular cells via receptor-mediated endocytosis
Authors: Kurosaki Yoshifumi , Imoto Akemi , Ouchi Motoshi , Morita Asuka , Kawakami Fumitaka , Iizuka Yoshiko , Weyer Kathrin , Mollet Geraldine , Ichikawa Takafumi , Takenaka Tsuneo , Nielsen Rikke , Ishii Naohito 
Published: May 2024

Abstract

Background and Aims
Proteinuria induces proximal tubule (PT) injury, oxidative stress, lysosomal dysfunction, and inflammation, which contribute to the progression of CKD. Cellular senescence and the associated secretory phenotype, where cells secrete proinflammatory and profibrotic mediators, have been linked to renal interstitial inflammation and fibrosis. Premature senescence is induced by excessive proliferation, oxidative stress, or DNA injury. In kidneys, hyperglycemia or hypertension have been reported to elicit this response. However, the direct association between proteinuria-induced PT protein overload and cellular senescence is unknown. We aimed to clarify the effect of protein overload on cellular proliferation and senescence in proteinuric mice with or without knockout (KO) of the receptors responsible for protein endocytosis, megalin and cubilin.

Method
Podocin-KO (proteinuric mouse model) and megalin-cubilin-podocin triple-KO mice were used in study. Kidneys from these mice were analyzed using immunohistochemical and immunofluorescent staining and the mice were injected with EdU to investigate renal proliferation. mRNA expression of different markers in renal cortex were evaluated with quantitative rt-PCR. To investigate albumin induced cellular proliferation and senescence, immortalized proximal tubular cells (RPTEC/TERT1, ATCC) were treated with human serum albumin (HSA; Sigma), fatty acid-free HSA (Sigma), and transferrin (Sigma). Western blotting (WB) and quantitative rt-PCR, of different markers were conducted and staining for senescence-associated beta-galactosidase (SA-β-gal) was performed.

Results
PCNA, a proliferation marker, was detected at a higher level in PTs of podocin-KO mice compared to wild-type (WT) mice, and triple-KO mice. Furthermore, we evaluated EdU DNA incorporation, in mosaic megalin and cubilin-expressing triple-KO mice. Coimmunostaining of megalin (Fig. 1-a) or cubilin (Fig. 1-b) with incorporated EdU revealed that most of the EdU-positive nuclei was observed in megalin or cubilin-positive tubules (white arrowheads). A few EdU positive nuclei was detected in megalin or cubilin-negative tubules or the interstitium (yellow arrowheads). The mRNA expression of PDGF- β, a growth factor, was more upregulated in the cortex of podocin-KO mice than in triple-KO mice. These data indicate that protein uptake via endocytic receptors induces secretion of PDGF-β from PT cells, acting in a paracrine manner potentially inducing proliferation. Additionally, immunofluorescent staining revealed that senescence markers, p21 and γ-H2AX, were detected in PTs of podocin-KO mice at a higher level than in triple-KO mice. The mRNA expression of TGF-β (profibrotic) and MCP-1 (proinflammatory) were higher in podocin-KO, than in triple-KO mice in accordance with more senescent cells in podocin KO mice. Upregulation of p21, p16, and γ-H2AX as well as positive staining for SA-β-gal in RPTEC/TERT1 cells, were only detected in HSA (containing free fatty acids)-treated cells in a dose dependent manner and not in cells treated with HSA depleted for free fatty acids or transferrin. Our results show that excessive protein reabsorption generates senescent cells in proximal tubules potentially through increased proliferation elicited by paracrine signaling. The increase in senescent cells was associated to profibrotic and proinflammatory signaling in line with a senescent secretory phenotype. Our studies in PRTEC/TERT1 confirmed our animal experiments and showed that senescence was induced only by fatty acid bound albumin.

Conclusion
The present study showed that proteinuria directly induced cellular senescence in PTECs via megalin/cubilin endocytosis of filtered protein. Fatty acid bound-albumin is suggested to cause the cellular senescence.