Prompted by reports that MT-I interferes with renal uptake of the megalin ligand 2-microglobulin in conscious rats, we tested the hypothesis that megalin binds MT and mediates its uptake. Three lines of evidence suggest that binding of MT to megalin is critical in renal proximal tubular uptake of MT-bound heavy metals. First, MT binds megalin, but not cubilin, in direct surface plasmon resonance studies. Binding of MT occurs at a single site with a Kd ϳ10 Ϫ4 and, as with other megalin ligands, depends on divalent cations. Second, antisera and various known megalin ligands inhibit the uptake of fluorescently labeled MT in model cell systems. Anti-megalin antisera, but not control sera, displace Ͼ90% bound MT from rat renal brush-border membranes. Megalin ligands including 2-microglobulin and also recombinant MT fragments compete for uptake by megalin-expressing rat yolk sac BN-16 cells. Third, megalin and fluorescently labeled MT colocalize in BN-16 cells, as shown by fluorescent microscopic techniques. Follow-up surface plasmon resonance and flow cytometry studies using overlapping MT peptides and recombinant MT fragments identify the hinge SCKKSCC region of MT as a critical site for megalin binding. These findings suggest that disruption of the SCKKSCC motif can inhibit proximal tubular MT uptake and thereby eliminate much of the renal accumulation and toxicity of heavy metals such as cadmium, gold, copper, and cisplatinum. cadmium; cisplatin; cubilin; proximal tubules HEAVY METALS COMPLEXED TO metallothionein (MT) class I disturb many functions within the proximal tubules, but the entry route of these complexes into epithelial cells remains unknown (10,14,16,23,24,27,31,44). The best-studied heavy metal at present is cadmium. Environmental and occupational exposure to cadmium are widespread but mostly chronic and low level (1). Whether ingested or inhaled, the majority of absorbed cadmium eventually complexes with MT (9, 32), which is produced by several tissues and is largely intracellular but readily detectable at low levels in the circulation. The resulting heavy metal complex Cd-MT, containing seven cadmium ions (Fig. 1), is small enough (ϳ7 kDa) to be freely filtered through the renal glomerulus into the proximal tubular fluid, before reuptake into proximal tubular cells (15).Although neither the apoprotein nor the zinc complex appears toxic, Cd-MT is a renal tubular toxin whose damage is marked by proteinuria, glucosuria, and aminoaciduria, or in more severe cases, acute tubular necrosis or chronic renal failure (37). Conflicting reports implicate different transporters or, more likely, receptor-mediated pathways in the cellular uptake of Cd-MT (4,5,15,22,28,47). At least some of the uncertainty concerning uptake pathways arises from the use of in vivo and in vitro models that differ significantly in their behavior. For example, while CdCl 2 is more toxic than Cd-MT to cultured rat kidney proximal tubules and LLC-PK 1 cells, Cd-MT shows greater in vivo nephrotoxic effects (26,27,35). Furthermore, in vi...