Alport syndrome (AS) is one of the most common types of inherited nephritis caused by mutation in one of the glomerular basement membrane components. AS is characterized by proteinuria at early stage of the disease and glomerular hyperplastic phenotype and renal fibrosis at late stage. Here, we show that global deficiency of tumor suppressor p53 significantly accelerated AS progression in X-linked AS mice and decreased the lifespan of these mice. p53 protein expression was detected in 21-week-old wild-type mice but not in age-matched AS mice. Expression of proinflammatory cytokines and profibrotic genes was higher in p53 +/2 AS mice than in p53 +/+ AS mice. In vitro experiments revealed that p53 modulates podocyte migration and positively regulates the expression of podocyte-specific genes. We established podocyte-specific p53 (pod-p53)-deficient AS mice, and determined that pod-p53 deficiency enhanced the AS-induced renal dysfunction, foot process effacement, and alteration of gene-expression pattern in glomeruli. These results reveal a protective role of p53 in the progression of AS and in maintaining glomerular homeostasis by modulating the hyperplastic phenotype of podocytes in AS.J Am Soc Nephrol 27: 144-157, 2016144-157, . doi: 10.1681 Alport syndrome (AS) is a hereditary glomerulonephritis that progressively declines the renal function. The most common mutation in AS is found in the COL4A5 gene located on the X-chromosome. 1,2 AS starts with glomerular basement membrane (GBM) dysplasia associated with type IV collagen loss. 3 Alteration of GBM matrix components caused by type IV collagen loss, mesangial cell invasion to the glomerular capillary tuft and podocyte foot process effacement lead to albuminuria and renal inflammation. 4 Renal fibrosis and glomerular crescent formation caused by proliferation of glomerular epithelial cells (GECs) such as podocytes and parietal epithelial cells (PECs) are detected in late-stage AS. 5,6 The phenotypic characteristics of AS involving dysplasia, mesangial expansion, and alteration in cytoskeletal organization suggest a dysregulation of factors involved in cellular homeostasis. p53 protein is critical in maintaining cellular homeostasis. p53 inactivation or deletion leads to abnormal cell growth and metastasis while persistent p53 activation results in cell apoptosis or senescence. 7 p53 is activated in the kidney of diabetic nephropathy and in drug-induced acute kidney injury, and this activation induces podocyte and proximal tubular cell apoptosis resulting in the progression of renal dysfunction. [8][9][10] Conversely, the expression of p53 target gene, p21 is suppressed in the podocyte of renal diseases with hyperplastic phenotype of glomerular and tubule cells such as minimal change disease, focal segmental glomerulosclerosis, and AS. 11 It was shown that p53 stabilization by treatment with nutlin-3a, an inhibitor of Received November 19, 2014. Accepted March 26, 2015 Published online ahead of print. Publication date available at www.jasn.org.Correspond...