Familial juvenile hyperuricemic nephropathy: detection of mutations in the uromodulin gene in five Japanese families.

Familial juvenile hyperuricemic nephropathy (FJHN) is an autosomal-dominant disease characterized by hyperuricemia of underexcretion type, gout, and chronic renal failure. We previously reported linkage on chromosome 16p12 in a large Japanese family designated as family 1 in the present study. Recent reports on the discovery of mutations of the uromodulin (UMOD) gene in families with FJHN encouraged us to screen UMOD mutations in Japanese families with FJHN, including family 1.



Six unrelated Japanese families with FJHN were examined for mutations of the UMOD gene by direct sequencing. To confirm the results of the mutation screening, parametric linkage analyses were performed using markers in 16p12 region and around other candidate genes of FJHN.



Five separate heterozygous mutations (Cys52Trp, Cys135Ser, Cys195Phe, Trp202Ser, and Pro236Leu) were found in five families, including family 1. All mutations were co-segregated with the disease phenotype in all families, except for family 1, in which an individual in the youngest generation was found as a phenocopy by the genetic testing. Revised multipoint linkage analysis showed that the UMOD gene was located in the interval showing logarithm of odds (LOD) score above 6.0. One family carrying no mutation in the UMOD gene showed no linkage to the medullary cystic kidney disease type 1 (MCKD1) locus, the genes of hepatocyte nuclear factor-1beta (HNF-1beta), or urate transporters URAT1 and hUAT.



Our results gave an evidence for the mutation of the UMOD gene in the majority of Japanese families with FJHN. Genetic heterogeneity of FJHN was also confirmed. Genetic testing is necessary for definite diagnosis in some cases especially in the young generation.

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title: Familial Juvenile Gouty Nephropathy: Exclusion of 16p12 from the Candidate Locus
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title: Uromodulin: a unique 85-kilodalton immunosuppressive glycoprotein isolated from urine of pregnant women.
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title: Uromodulin (Tamm-Horsfall glycoprotein/uromucoid) is a phosphatidylinositol-linked membrane protein.
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title: Mechanism of release of urinary Tamm-Horsfall glycoprotein from the kidney GPI-anchored counterpart.
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title: Pathologic localization of Tamm-Horsfall protein in interstitial deposits in renal disease.
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title: Tamm-Horsfall protein. Abnormal localization in renal disease.
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title: Intracellular transport, cell-surface exposure and release of recombinant Tamm-Horsfall glycoprotein.
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title: Biosynthesis and oligosaccharide processing of human Tamm-Horsfall glycoprotein permanently expressed in HeLa cells.
abstract: Human Tamm-Horsfall glycoprotein (T-H) is produced by renal cells of ascending limb of loop of Henle and is largely excreted in urine. N-linked glycans account for close to 30% of the weight of T-H. We studied the biosynthesis of recombinant T-H permanently expressed in HeLa cells. The conversion from the precursor (84 kDa) to the mature form (97 kDa) mainly depends on the processing of glycans from the high-mannose to polyantennary type. The conversion from precursor to mature form is very slow and the glycan structure of precursor appears to be that of a glycoprotein not yet processed by Golgi alpha 1,2 mannosidase. Since T-H has a very high number of disulfide bridges (more than 50 cysteine residues/mol) one may infer that the rate limiting step for the precursor export out of ER is the formation of a correct set of disulfide bonds.  T-H isolated from HeLa cells retained one N-linked chain with the high-mannose structure similarly to urinary T-H. This result indicates that the occurrence of one unprocessed high-mannose chain in mature T-H is host-cell independent and very likely related to the T-H primary structure.

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title: Tamm Horsfall protein binds to a single class of carbohydrate specific receptors on human neutrophils.
abstract: Several studies have implicated urinary Tamm Horsfall protein (THP) in the aetiology of tubulointerstitial inflammation. Previous research has demonstrated that particulate THP will initiate inflammatory activation of human polymorphonuclear leukocytes (PMN) through a trypsin sensitive mechanism. The present study describes the binding of 125I-monomeric THP to human PMN at 4 degrees C and demonstrates that radiolabeled THP binds to PMN in a saturable, reversible and time dependent manner. The addition of 400 to 600 ng 125I-THP/2 x 10(6) PMN was sufficient to achieve saturable binding. Scatchard analysis of binding data yielded linear plots suggesting a single class of receptors with a mean density of 26218/cell and a dissociation constant (KD) of 4.2 x 10(-9) M. Binding reached steady state by 15 minutes and could be rapidly displaced by the addition of an excess of unlabeled THP. The KD calculated from experimentally derived kinetic rate constants (k1 and k2) was of a similar order of magnitude (0.9 x 10(-9) M) to that generated from Scatchard plots. In addition 125I-THP bound specifically to PMN plasma membrane immobilized on nitrocellulose filters, a process which could be inhibited by unlabeled monomeric THP. Chemical modification of unlabeled THP abolished its capacity to inhibit binding. Specific inhibition studies showed that N-acetylneuraminic (sialic) acid dose dependently displaced the binding of 125I-THP to immobilized PMN membranes at concentrations up to 100 mM. These results indicate that the reported activation of human PMN by THP is mediated through a single class of sialic acid-specific cell surface receptors.

title: Binding of human neutrophils to cell-surface anchored Tamm-Horsfall glycoprotein in tubulointerstitial nephritis.
abstract: Human Tamm-Horsfall glycoprotein (T-H) is a glycosylphosphatidylinositol-anchored protein exposed at the surface of distal nephron cells, and urinary T-H is the released soluble counterpart. The latter has been implicated in tubulointerstitial nephritis, and the proinflammatory potential has been related to its ability to bind in vitro human neutrophils (PMNs). We have examined the conditions required for the binding of neutrophils to cell-surface anchored T-H and the consequent effects.



A HeLa cell-line derivative permanently transformed with human T-H cDNA and expressing T-H at the cell surface was used throughout the study. The adhesion of PMNs to cells expressing T-H was analyzed by immunofluorescence microscopy before and after the opsonization of cells with anti-T-H antibodies. The oxidative burst induced by adhesion of PMNs to the cells was determined by the activation of myeloperoxidase. Quantitative and qualitative changes in the release of T-H under the adhesion of activated PMNs were determined by dot-blot and Western blot analysis.



No binding of neutrophils to cell-surface-anchored T-H was observed. On the contrary, the opsonization of cells with anti-T-H antibodies resulted in a dramatic adhesion of neutrophils. Such an adhesion induced the oxidative burst of PMNs and a large increment in the release of T-H, as well as the release of the slightly faster migrating T-H form, which is normally retained intracellularly.



These results support the notion that, after the autoimmune response, the adhesion of neutrophils to cell-surface T-H contributes to the pathogenesis of tubulointerstitial nephritis, favoring a further accumulation of T-H in the interstitium and inducing the loss of cell integrity via reactive oxygen metabolites generated by activated neutrophils.

title: Release of gelatinase and superoxide from human mononuclear phagocytes in response to particulate Tamm Horsfall protein.
abstract: This study describes the in vitro activation of human mononuclear phagocytes by particulate Tamm Horsfall protein (THP). Peripheral blood monocytes phagocytosed THP particles with the accompanying release of superoxide radicals, N-acetyl-beta-D-glucosaminidase, and neutral metalloproteinase. Immunoprecipitation and substrate gel analysis identified the neutral proteinase as a 95-kd gelatinase. A comparison with other particulate ligands highlighted the specificity of the response to THP and showed that the magnitude of the response was comparable with that obtained with lipopolysaccharide (100 micrograms/ml). Parallel studies using peritoneal macrophages resulted in a similar pattern of enzyme release and reactive oxygen species synthesis. THP has been implicated in the pathogenesis of tubulointerstitial nephritis associated with reflux nephropathy. The present study indicates that an inflammatory response initiated by a neutrophil-THP interaction may be extended into a chronic phase via the activation of mononuclear phagocytes. The subsequent release of reactive oxygen metabolites and proteinases may contribute to the tissue damage and fibrosis associated with chronic immune-mediated tubulointerstitial nephritis.

title: Uromodulin and Tamm-Horsfall protein induce human monocytes to secrete TNF and express tissue factor.
abstract: Effects of uromodulin (URO) and Tamm-Horsfall protein (THP), the most abundant proteins in the urine of pregnant and normal women, respectively, on the induction of TNF-alpha secretion and tissue factor (TF) expression of human monocytes were studied. THP, URO, and its fragments stimulated human mononuclear cells to proliferate and secrete TNF-alpha. The release of URO and THP-induced TNF-alpha in monocytes was dependent upon protein tyrosine kinase activation that results in tyrosine phosphorylation. URO and THP also induced TF expression of human monocytes and monocytic cell line U937 in a dose-dependent manner. TF expression was transient, reached its peak at 6 h and declined toward basal levels by 24 h. Reverse transcriptase-PCR and dot-blot analysis confirmed the induction of TF mRNA synthesis. URO and THP-induced TF expression were inhibited by actinomycin D and pentoxifylline further supporting the requirement of de novo TF mRNA synthesis. The possibility of LPS contamination of URO and THP was excluded because: 1) URO and THP-induced TF expression were inhibited by specific Ab; 2) URO was less capable of inducing TF in HUVEC as compared with LPS; 3) polymyxin B blocked the induction of Limulus clotting by LPS but not by URO and THP; 4) both LPS-sensitive (C3H/HeN) and -resistant (C3H/HeJ) mice produced little or no TNF-alpha after URO challenge. Therefore, our findings suggest that URO and THP play a significant role in the innate immunity of the urinary system and that the immunostimulatory activity of URO is potentially useful for immunotherapy.

title: Tubulointerstitial immune complex nephritis in rats immunized with Tamm-Horsfall protein.
abstract: Rats immunized with Tamm-Horsfall protein (TH) developed autoantibodies to TH and tubulointerstitial nephritis with granular deposits of IgG, C3, and TH at the base of tubular cells of the thick ascending limb of Henle's loop and selective infiltration of leukocytes around this distal nephron segment. Selective IgG deposition at the base of cells in the tubular segment containing TH and the direct relationships of the amount of immune deposits and the severity of histologic lesions to serum levels of anti-TH antibodies suggest a pathogenetic role for the autoantibodies to TH. The immune deposits in this model of tubulointerstitial nephritis appear to be the consequence of in situ formation of immune complexes. This mechanism involves the diffusion of circulating antibodies to TH across tubular basement membranes and their combination with TH molecules associated with tubular cell surface membranes.

title: Tubulointerstitial nephritis and immunologic responses to Tamm-Horsfall protein in rabbits challenged with homologous urine or Tamm-Horsfall protein.
abstract: Tubulointerstitial nephritis was produced in 19 of 23 New Zealand White rabbits challenged i.v. with adjuvant-free homologous urine for greater than or equal to 16 wk and 11 of 14 challenged with adjuvant-free rabbit Tamm-Horsfall protein for 2 to 24 wk. Lesions were identical in the two groups of rabbits and were characterized by focal mononuclear infiltrates and microscopic scarring localized to distal nephron segments identified as the thick ascending limb of the loop of Henle. Concomitant immunoglobulin deposition was not detected despite antecedent elevations in serum IgG antibody directed against Tamm-Horsfall protein in 17 of 19 and 10 of 11 affected rabbits, respectively. Peripheral lymphocytes from affected rabbits were found to be cytotoxic and underwent blast transformation in the presence of homologous urine or Tamm-Horsfall protein in vitro. These lymphocytes were shown to produce a soluble cytotoxic product upon exposure to Tamm-Horsfall protein. Neither tubulointerstitial nephritis nor this pattern of cellular and humoral immune response to Tamm-Horsfall protein was found in two age-matched control groups: one unchallenged, and the other challenged i.v. with urine that had been selectively depleted of Tamm-Horsfall protein by 95%. It is concluded that the tubulointerstitial nephritis produced in rabbits by injection of urine or Tamm-Horsfall protein is the result of a predominately cellular immune response directed against Tamm-Horsfall protein.

title: GP-2/THP gene family encodes self-binding glycosylphosphatidylinositol-anchored proteins in apical secretory compartments of pancreas and kidney.
abstract: A family of homologous genes is shown to encode GP-2, the major glycosylphosphatidylinositol (GPI)-linked glycoprotein of pancreatic zymogen granule membranes, and Tamm-Horsfall protein (THP), a GPI-linked glycoprotein associated with apical vesicles in kidney thick ascending limb of Henle (TALH) cells. The C-terminal regions of GP-2 (Asp54-Phe530) and THP (Asp175-His644) from rat show 53% identity, 86% similarity, and 26 conserved cysteine residues including one epidermal growth factor motif. The unique N-terminal domain of rat THP (unique-THP, Pro29-Gln174) shows four conserved epidermal growth factor motifs, three in tandem and one in reverse orientation. GP-2 homologues are observed in a wide variety of epithelial cells, several of which contain highly regulated secretory processes. GP-2 released from zymogen granule membranes with phosphatidylinositol phospholipase C reacts with anti-cross-reactive determinant antibody (anti-CRD), confirming the GPI nature of the pancreatic homologue. In contrast, GP-2 and THP, released endogenously from pancreas and kidney, respectively, do not react with anti-cross-reactive determinant antibody, suggesting alternative enzymatic mechanisms for their physiological release. Globular domains of GP-2 and THP, but not albumin, show pH- and ion-dependent self-association in vitro. The GP-2/THP family appears to represent a newly discovered class of GPI-anchored proteins, which may utilize pH- and ion-dependent self-association mechanisms for establishing membrane (micro)domains targeted to intracellular secretory compartments.

title: Cytochemical and immunocytochemical characterization of a fibrillar network (GP2) in pancreatic juice: possible role as a sieve in the pancreatic ductal system.
abstract: The secretory product of the exocrine pancreas contains sedimentable and non-sedimentable materials. Electron microscopy of the pellet obtained after ultracentrifugation reveals two major components: microvesicles (pancreasomes) and a fibrillar network of small mesh size. Negative staining of an unfixed pellet demonstrated that these structures are not fixation artifacts. Cytochemical analysis showed that pancreasomes are reactive to osmication and uranyl acetate staining, whereas the fibrillar network was unreactive thereby indicating that the latter does not contain lipids; however, lead citrate staining reveals the network. Alcian blue, known to bind sulfate groups of mucosubstances, reacted strongly with the fibrillar network. The pellet was also characterized by immunocytochemistry with specific antibodies to amylase and glycoprotein 2 (GP2). Both antibodies were located only on the fibrillar network. Washing of the pellet with 100 mM KCl-250 mM NaBr had little effect on GP2 content, but reduced considerably alpha-amylase associated with the reticular matrix. It appeared that GP2 was the major component of the scaffolding that gives rise to the fibrillar network and that other proteins such as alpha-amylase could reversibly bind to it. When double-labeling immunocytochemistry was carried out on the unwashed pellet, labeling of the first antigen reduced the labeling of the second. Removal of amylase by washing the pellet increased the GP2 signal. These results indicate that amylase is bound on the GP2 network. Although the function of the GP2 network is still not clearly defined several possibilities could be envisaged at the level of the pancreatic duct system: 1) The network could drain off any aggregates or precipitates forming in small ducts. 2) The small mesh of the network would present a physical barrier to infecting bacteria that could enter into the duct system from the intestine, especially in conditions of low flow rates. 3) The network may exert a mechanical pressure on the membranes bordering the acinar lumen and small ducts thereby preventing their collapse in basal conditions.

title: Localization by immunofluorescence and by light- and electron-microscopic immunoperoxidase techniques of Tamm-Horsfall glycoprotein in adult hamster kidney.
abstract: 1. Tamm-Horsfall glycoprotein was isolated from hamster urine and antiserum against it was produced in rabbits. Immunoglobulin G was isolated from the antiserum. 2. Indirect methods of immunofluorescence staining were applied to kidney sections previously fixed by both perfusion and immersion methods. Tamm-Horsfall glycoprotein was identified associated with only the cells of the ascending limb of the loop of Henle and the distal convoluted tubule. Maculae densae were free of the glycoprotein. 3. Indirect immunoperoxidase procedures with light microscopy were applied to kidney sections. The results extended those found by immunofluorescence by showing that the glycoprotein is largely associated with the plasma membrane of the cells. Macula densa cells were shown to be free of the glycoprotein, although the luminal surface of the remaining cells in the transverse section of the nephron at that region was shown to contain it. 4. A variety of immuno-electron-microscopic techniques were applied to sections previously fixed in a number of ways. Providing periodate/lysine/paraformaldehyde was used as the fixative, the glycoprotein was often seen to be present not only on the luminal surface of the cells of the thick ascending limb of the loop of Henle and of the distal convoluted tubule, but also on the basal plasma membrane, including the infoldings. 5. It is generally accepted that the hyperosmolarity in the medulla of the kidney results from passage of Cl(-) ions with their accompanying Na(+) ions across the single cell layer of the lumen of the thick ascending limb of the loop of Henle, a region of the nephron with relatively high impermeability to water. We suggest that Tamm-Horsfall glycoprotein operates as a barrier to decrease the passage of water molecules by trapping the latter at the membrane of the cells. Our hypothesis requires the glycoprotein on the basal plasma membrane also.

title: Tamm-Horsfall glycoprotein: ultrastructural immunoperoxidase localization in rat kidney.
abstract: Tamm-Horsfall urinary glycoprotein (TH) is the primary constituent of urinary casts. The intracellular distribution of TH in normal rat kidney was determined by immunoelectron microscopy using horseradish peroxidase-labeled antibodies and compared with morphologic localization of TH by immunofluorescence and light immunoperoxidase microscopy. Electron microscopy revealed an intracellular localization of TH restricted to the thick ascending limb of the loop of Henle (ALH). In this nephron segment, TH was distributed on and between adjacent intercellular membranes and infolding intracellular membranes at the base of these cells, within Golgi vacuoles, apical vesicles, and on the luminal membranes. Macula densa cells were negative, although typical ALH cells across the lumen of the same tubular segment were positive. Other renal segments were negative for intracellular TH. The unique distribution of TH is consistent with the known function of the ALH as the diluting segment of the nephron. We speculate that the aggregation and gel formation of TH on and between ALH surface membranes may restrict water movement across the ALH. This influence on permeability would be an important role for TH in the generation of concentration gradients for the countercurrent multiplier system of the kidney.

title: Mechanoelectrical transduction, ion movement and water stasis in uromodulin
abstract: Mechanical movement of a column of the urinary glycoprotein uromodulin modulates an applied voltage. This change is a property of the glycoprotein and its interaction with the walls of the container and is related to its capacitance. The voltage modulation is not accompanied by changes in rotationally restricted water as has been reported for hyaluronic acid. Diffusion experiments with tritiated water also support the hypothesis that uromodulin acts as a water barrier, but allows ion movement.

title: Goodman and Gilman's The Pharmacological Basis of Therapeutics
abstract: Being asked to review Goodman and Gilman is a lot like being asked to comment on motherhood. The stature of " G & G ," the "blue bible" of pharmacology, is intimidating. For a reviewer reared in its teachings, it is difficult to find fault. Luckily, in keeping with the textbook's tradition, this new edition is virtually without fault. The book covers an everincreasing body of knowledge in crisp, clear language and its time-honored, familiar format. The eighth edition marks the 50th anniversary of the textbook. As mentioned in the preface by the senior editor, Alfred Goodman Gilman, the primary objectives of the book have remained the same since his father and Dr Goodman wrote the first edition in 1940: the correlation of pharmacology with related medical sciences, the continual reinterpretation of the actions and uses of drugs in view of medical advances, and the emphasis on applying pharmacodynamics to therapeutics. Dr

title: Factors affecting urate excretion following diuretic administration in man.
abstract: In order to investigate the mechanism of diuretic-induced urate retention and hyperuricemia, renal clearance studies were performed in normal subjects, utilizing furosemide and ethacrynic acid. After the intravenous administration of either diuretic, uric acid excretion always increased, at least transiently. However, during the second hour following furosemide or ethacrynic acid, uric acid excretion decreased during diuretic-induced extracellular fluid volume contraction, but remained near or above control levels when urinary losses were simultaneously replaced with isotonic saline solution. The extremely low rates of uric acid excretion in the volume-depleted subjects suggested that tubular secretion was impaired. Since the diminution in uric acid excretion occurred only after volume depletion, a direct effect of these diuretics on tubular secretion is unlikely. Instead, it is postulated that stimulatory and suppressive effects of furosemide and ethacrynic acid on urate secretion could be mediated indirectly through altered renal blood flow and angiotensin release, respectively.