Abstract-The (pro)renin receptor ([P]RR) is a transmembrane protein that binds both renin and prorenin with high affinity, increasing the catalytic cleavage of angiotensinogen and signaling intracellularly through mitogen-activated protein kinase activation. Although initially reported as having no homology with any known membrane protein, other studies have suggested that the (P)RR is an accessory protein, named ATP6ap2, that associates with the vacuolar H ϩ -ATPase, a key mediator of final urinary acidification. Using in situ hybridization, immunohistochemistry, and electron microscopy, together with serial sections stained with nephron segment-specific markers, we found that (P)RR mRNA and protein were predominantly expressed in collecting ducts and in the distal nephron. Within collecting ducts, the (P)RR was most abundant in microvilli at the apical surface of A-type intercalated cells. Dual-staining immunofluorescence demonstrated colocalization of the (P)RR with the B1/2 subunit of the vacuolar H ϩ -ATPase, the ion exchanger that secretes H ϩ ions into the urinary space and that associates with an accessory subunit homologous to the (P)RR. In collecting duct/distal tubule lineage Madin-Darby canine kidney cells, extracellular signal-regulated kinase 1/2 phosphorylation, induced by either renin or prorenin, was attenuated by the selective vacuolar H ϩ -ATPase inhibitor bafilomycin. The predominant expression of the (P)RR at the apex of acid-secreting cells in the collecting duct, along with its colocalization and homology with an accessory protein of the vacuolar H ϩ -ATPase, suggests that the (P)RR may function primarily in distal nephron H ϩ transport, recently noted to be, at least in part, an angiotensin II-dependent phenomenon. Key Words: (pro)renin receptor Ⅲ intercalated cell Ⅲ vacuolar H ϩ -ATPase Ⅲ ATP6ap2 Ⅲ prorenin Ⅲ renin-angiotensin system Ⅲ bafilomycin A little more than a decade ago, the binding characteristics and activity of a specific renin receptor in cultured mesangial cells were reported. 1 This was followed in 2002 by the identification of an apparently novel, 350 amino acid, single-transmembrane protein that binds both renin and prorenin with high affinity. 2 Ligand binding to this (pro)renin receptor ([P]RR) induced a 4-fold increase in the catalytic cleavage of angiotensinogen, as well as stimulating intracellular signaling, with activation of mitogen-activated protein kinases extracellular signal-regulated kinase (ERK) 1/2 2 and induction of transforming growth factor-␤ expression. 3 The existence of a (P)RR not only expanded our understanding of the physiology of the renin-angiotensin system (RAS) but also provided insight into the potential pathogenetic role of prorenin, the enzymatically inactive zymogen that is elevated in disease states, eg, diabetes mellitus, where it predicts the subsequent development of nephropathy and retinopathy. 4 Given its localization to the mesangium, its actions in augmenting local angiotensin II production, and its ability to increase mesangial tr...

Experimental type I diabetes mellitus is characterized by an early increase in kidney weight and glomerular volume, but changes in gene expression accompanying diabetic renal growth have not been fully elucidated. In the current study, total RNA was extracted from renal cortex and isolated glomeruli of streptozotocin-induced diabetic rats 24 hours, 48 hours, 96 hours, one and two weeks after the onset of hyperglycemia (blood glucose > 15 mmol/liter), insulin-treated diabetic rats (blood glucose < 6.0 mmol/liter), and normal rats. RNA samples were reverse transcribed (RT) and subjected to polymerase chain reaction (PCR) amplication with specific 5' and 3' primers for rat transforming growth factor (TGF-beta 1) and beta-actin. RT-PCR analysis revealed that glomerular TGF-beta 1 mRNA levels increased relative to beta-actin as early as 24 hours after the onset of hyperglycemia, reaching a plateau after 96 hours that was sustained at one and two weeks. In cortical samples, TGF-beta 1 mRNA levels increased less abruptly, reaching a peak one week after the onset of hyperglycemia. Intensive insulin treatment to normalize blood glucose levels attenuated the rise in glomerular and renal cortical TGF-beta 1 mRNA. Cryostat sections of rat kidneys were immunostained for TGF-beta 1 utilizing a polyclonal anti-porcine TGF-beta 1 antibody and semiquantitative scoring of TGF-beta 1 immunostaining revealed a twofold increase in diabetic glomeruli after two weeks compared to normal glomeruli. Increased segmental immunostaining for TGF-beta 1 was also evident in cortical tubules of diabetic rats. These studies establish that TGF-beta 1 expression in the kidney increases during the phase of rapid renal hypertrophy in diabetic rats. Normalization of blood glucose levels with insulin treatment attenuates the increase in TGF-beta 1 expression.

Endothelial nitric oxide synthase (eNOS) deficiency may contribute to the pathogenesis of diabetic nephropathy in both experimental models and humans, but the underlying mechanism is not fully understood. Here, we studied two common sequelae of endothelial dysfunction in diabetes: glomerular capillary growth and effects on neighboring podocytes. Streptozotocin-induced diabetes increased glomerular capillary volume in both C57BL/6 and eNOS 2/2 mice. Inhibiting the vascular endothelial growth factor receptor attenuated albuminuria in diabetic C57BL/6 mice but not in diabetic eNOS 2/2 mice, even though it inhibited glomerular capillary enlargement in both. In eNOS 2/2 mice, an acute podocytopathy and heavy albuminuria occurred as early as 2 weeks after inducing diabetes, but treatment with either captopril or losartan prevented these effects. In vitro, serum derived from diabetic eNOS 2/2 mice augmented actin filament rearrangement in cultured podocytes. Furthermore, conditioned medium derived from eNOS 2/2 glomerular endothelial cells exposed to both high glucose and angiotensin II activated podocyte RhoA. Taken together, these results suggest that the combined effects of eNOS deficiency and hyperglycemia contribute to podocyte injury, highlighting the importance of communication between endothelial cells and podocytes in diabetes. Identifying mediators of this communication may lead to the future development of therapies targeting endothelial dysfunction in albuminuric individuals with diabetes.