Alport syndrome is a genetic disease that affects kidneys, ears, and eyes as a result of mutations in basement membrane collagen genes COL4A3, COL4A4, and COL4A5, encoding the ␣3, ␣4, and ␣5 chains of type IV collagen chains. 1 Deletion of COL4A3 gene in mice (␣3KO mice) leads to a phenotype that resembles human Alport renal disease. In these mice, deletion of ␣3 chain results in defective assembly of ␣3/␣4/␣5 type IV collagen triple helical protomers in the glomerular basement membrane (GBM). The GBM type IV collagen composition in the ␣3KO mouse is composed mostly of ␣1/␣2/␣1 protomers, an embryonic GBM composition, and, as mice develop into adulthood, the GBM presumably cannot withstand increasing glomerular filtration pressure and undergoes rapid endoproteolysis/turnover to generate the characteristic GBM breaks as observed by electron microscopy. As a result, ␣3KO mice develop progressive glomerulonephritis similar to those observed in patients with Alport syndrome and eventually die of renal failure.Interestingly, the strain background of mice confers significant differences in the rate of disease progression, with much longer survival observed in ␣3KO mice on a C57Bl/6 genetic background, which live up to 25 to 30 wk, in comparison with the 129sv genetic background, which live only 12 to 13 wk. Recent studies suggested a strain-dependent GBM deposition of ␣5/␣6/␣5 type IV collagen triple helical protomers in the ␣3KO on a C57Bl/6 background yet with almost undetectable levels in the ␣3KO on a 129sv background. 2 Such difference in GBM composition may offer better survival advantage, likely as a result of slower rate of GBM damage because of the presence of type IV collagen molecules (␣5 and ␣6) with better cross-linking capacity. 3 These findings not only highlight the role of type IV collagen specificity in maintaining GBM structure and function but also substantiate the notion that a potential improvement in GBM architecture and renal function can be achieved in Alport renal disease by altering the type IV collagen GBM composition to more stable molecules such as the ␣3 through ␣6 chains. 2,3 Indeed, Sugimoto et al. 4 along with Prodromidi et al. 5 provided evidence for the therapeutic benefit of bone marrow transplantation (BMT) in irradiated ␣3KO mice on the C57Bl/6 background. In contrast to irradiated ␣3KO mice that received ␣3KO bone marrow, the irradiated ␣3KO mice that received wild-type bone marrow revealed significant improvement in GBM architecture associated with de novo expression of ␣3 chain mRNA and protein. Furthermore, GBM protein analyses demonstrated the newly deposited ␣3 chains likely assemble into viable triple helical protomers. These mice also revealed statically significant improvement in renal function. In the study by Prodromidi et al., 5 irradiated ␣3KO mice that received ␣3KO bone marrow did not show improved renal functions after BMT and died from renal failure, similar to the study by Sugimoto et al. 4 Katayama et al. 6 in this issue of JASN, however, challenge these findin...