Pkd2 Deficiency in Embryonic Aqp2+ Progenitor Cells Is Sufficient to Cause Severe Polycystic Kidney Disease
Authors: Tsilosani Akaki , Gao Chao , Chen Enuo , Lightle Andrea R. , Shehzad Sana , Sharma Madhulika , Tran Pamela V. , Bates Carlton M. , Wallace Darren P. , Zhang Wenzheng 
Published: January 2024

Significance Statement
Autosomal dominant polycystic kidney disease (ADPKD) is a devastating disorder caused by mutations in polycystin 1 (PKD1) and polycystin 2 (PKD2). Currently, the mechanism for renal cyst formation remains unclear. Here, we provide convincing and conclusive data in mice demonstrating that Pkd2 deletion in embryonic Aqp2+ progenitor cells (AP), but not in neonate or adult Aqp2+ cells, is sufficient to cause severe polycystic kidney disease (PKD) with progressive loss of intercalated cells and complete elimination of α-intercalated cells, accurately recapitulating a newly identified cellular phenotype of patients with ADPKD. Hence, Pkd2 is a new potential regulator critical for balanced AP differentiation into, proliferation, and/or maintenance of various cell types, particularly α-intercalated cells. The Pkd2 conditional knockout mice developed in this study are valuable tools for further studies on collecting duct development and early steps in cyst formation. The finding that Pkd2 loss triggers the loss of intercalated cells is a suitable topic for further mechanistic studies.

Background
Most cases of autosomal dominant polycystic kidney disease (ADPKD) are caused by mutations in PKD1 or PKD2. Currently, the mechanism for renal cyst formation remains unclear. Aqp2+ progenitor cells (AP) (re)generate ≥5 cell types, including principal cells and intercalated cells in the late distal convoluted tubules (DCT2), connecting tubules, and collecting ducts.

Methods
Here, we tested whether Pkd2 deletion in AP and their derivatives at different developmental stages is sufficient to induce PKD. Aqp2Cre Pkd2

f/f
(Pkd2

AC
) mice were generated to disrupt Pkd2 in embryonic AP. Aqp2

ECE/+

Pkd2

f/f
(Pkd2

ECE
) mice were tamoxifen-inducted at P1 or P60 to inactivate Pkd2 in neonate or adult AP and their derivatives, respectively. All induced mice were sacrificed at P300. Immunofluorescence staining was performed to categorize and quantify cyst-lining cell types. Four other PKD mouse models and patients with ADPKD were similarly analyzed.

Results

Pkd2 was highly expressed in all connecting tubules/collecting duct cell types and weakly in all other tubular segments. Pkd2

AC
mice had obvious cysts by P6 and developed severe PKD and died by P17. The kidneys had reduced intercalated cells and increased transitional cells. Transitional cells were negative for principal cell and intercalated cell markers examined. A complete loss of α-intercalated cells occurred by P12. Cysts extended from the distal renal segments to DCT1 and possibly to the loop of Henle, but not to the proximal tubules. The induced Pkd2

ECE
mice developed mild PKD. Cystic α-intercalated cells were found in the other PKD models. AQP2+ cells were found in cysts of only 13/27 ADPKD samples, which had the same cellular phenotype as Pkd2

AC
mice.

Conclusions
Hence, Pkd2 deletion in embryonic AP, but unlikely in neonate or adult Aqp2+ cells (principal cells and AP), was sufficient to cause severe PKD with progressive elimination of α-intercalated cells, recapitulating a newly identified cellular phenotype of patients with ADPKD. We proposed that Pkd2 is critical for balanced AP differentiation into, proliferation, and/or maintenance of cystic intercalated cells, particularly α-intercalated cells.