Cardiovascular complications such as hypertension are a continuous concern in patients with autosomal dominant polycystic kidney disease (ADPKD). The PKD2 encoding for polycystin-2 is mutated in ≈15% of ADPKD patients. Here, we show that polycystin-2 is localized to the cilia of mouse and human vascular endothelial cells. We demonstrate that the normal expression level and localization of polycystin-2 to cilia is required for the endothelial cilia to sense fluid shear stress through a complex biochemical cascade, involving calcium, calmodulin, Akt/PKB, and protein kinase C. In response to fluid shear stress, mouse endothelial cells with knockdown or knockout of Pkd2 lose the ability to generate nitric oxide (NO). Consistent with mouse data, endothelial cells generated from ADPKD patients do not show polycystin-2 in the cilia and are unable to sense fluid flow. In the isolated artery, we further show that ciliary polycystin-2 responds specifically to shear stress and not to mechanical stretch, a pressurized biomechanical force that involves purinergic receptor activation. We propose a new role for polycystin-2 in transmitting extracellular shear stress to intracellular NO biosynthesis. Thus, aberrant expression or localization of polycystin-2 to cilia could promote high blood pressure because of inability to synthesize NO in response to an increase in shear stress (blood flow).
A "two-hit" hypothesis predicts a second somatic hit, in addition to the germline mutation, as a prerequisite to cystogenesis and has been proposed to explain the focal nature for renal cyst formation in autosomal dominant polycystic kidney disease (ADPKD) A gene mutation can result in disease through direct or indirect mechanisms. For instance, in the gain-offunction mutation, a germline mutant allele confers new or enhanced protein activity with a pathologic function, whereas a dominant-negative mutation produces an aberrant protein that interferes with the function of the normal protein..In haploinsufficiency, a loss of 50% of normal protein as a result of a mutation in one of its alleles is sufficient to cause disease. In the two-hit mechanism, the disease results from a germline mutation in one allele, followed by the subsequent acquisition of a somatic mutation in the second normal allele with no remaining functional protein.Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. PKD1 and PKD2 are the genes that encode for the polycystin-1 (PC1) and polycystin-2 (PC2) proteins, respectively. Although patients with ADPKD carry heterozygous mutations in either PKD1 or PKD2 and present 100% penetrance of cystic kidney phenotypes, fewer than 5% of nephrons form cysts. These fluid-filled cysts are lined by a single layer of epithelial cells and can occur at any site along the nephron. The presence of renal cysts in ADPKD, despite the low number, results in a gradual decline in renal function. To explain the focal nature of renal cyst formation in ADPKD, Reeders (1) proposed a "two-hit" hypothesis suggesting that a second somatic alteration to the gene, in addition to a germline mutation, is a prerequisite to the disease phenotype. Although a mechanism based on haploinsufficiency has not been excluded, somatic mutations in either PKD1 or PKD2 indeed have been found in several ADPKD cyst-lining epithelia (2-8), even though a somatic loss of other chromosomes or mutations in other loci also are found (2). These data provided hints that ADPKD is a recessive disease at the cellular level. The lack of a cellular assay for PC1 function has prevented an experimental demonstration of loss of function in cyst-lining epithelia in ADPKD.We and others have shown previously that PC1 and PC2 are localized to the primary cilia (9). The mechanosensation function of polycystins can be assayed in cultured mouse kidney epithelial cells by monitoring changes in the intracellular calcium concentration in response to fluid-flow shear stress (10). To test the loss-of-function hypothesis in ADPKD with regard to mechanosensory ability, we used the flow assay to examine shear stress-induced calcium responses in cells that were derived from a heterozygous Pkd1 mouse model. Furthermore, we
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