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Madhav Menon, MBBS, MD

Associate Professor; Director of Research in Kidney Transplantation, Nephrology

Research Summary

Many patients with CKD will progress and there is an urgent need for therapies, & we showed SHROOM3 was a promising candidate where antagonizing it reduced fibrosis in kidneys carrying a common mutation (ie A- allele). However this contrasted a protective role for SHROOM3 in glomeruli, implying Shroom3-antagonism may create glomerular injury, an effect needing to be circumvented. Our work showing that different functional parts of the protein are responsible for opposing effects protective (in glomeruli) and adverse (in tubular cells), will allow specific targeting of Shroom3 as therapy for CKD.

Extensive Research Description

1. Chronic kidney disease (CKD) is identified as decline in renal function estimated by glomerular filtration rate (eGFR) and/or signified by the presence of proteinuria. By histology in native and allograft kidneys, CKD is characterized by renal interstitial fibrosis, vascular intimal fibrosis and glomerulo- sclerosis, reflecting damage to different renal compartments. Genome-wide association studies (GWAS) have identified candidate susceptibility loci for CKD. The mechanistic basis of GWAS-variant associations with CKD are largely undescribed, hindering translation of GWAS information for the development of novel therapies for CKD. We previously showed that a CKD-associated SHROOM3 locus - Rs17319721, in the donor kidney increased SHROOM3 expression (by TCF7L2-dependent transcription) and promoted renal allograft fibrosis (IF/TA), through TGF-β1 signaling. These data contrast with evidence of a protective role for Shroom3 in glomerular development. Consistently, opposing associations were seen between glomerular- and non- glomerular SHROOM3, and renal function in CKD biopsies. In allografts, homozygosity at Rs173198721 ie A/A, which associated with lower GFR, was associated with reduced albuminuria by 2-years post-transplant. GWAS data also showed that Rs17319721 was associated with reduced albuminuria but reduced eGFR. To study mechanism of these dichotomous effects, we used inducible Shroom3 knockdown mice and observed reduced renal fibrosis with tubular Shroom3 knockdown. In tubular cells, Rho kinase (ROCK) inhibitors or ROCK-binding (ASD2-) domain deletion in Shroom3 reduced profibrotic signaling. Conversely, glomerular-, but not tubular-Shroom3 knockdown, induced albuminuria with diffuse podocyte foot process effacement without podocyte loss. This phenotype is similar to human minimal change disease (MCD). In podocytes, we identified & confirmed the novel interaction of SHROOM3 with FYN (a Src kinase) via a critical Src homology-3 binding domain, distinct from its ASD2-domain. In vitro and in vivo, Shroom3-Fyn interaction was required for activation of Fyn kinase and downstream Nephrin phosphorylation and actin cytoskeleton in podocytes. This novel mechanism explains the protective effect of Shroom3 (& Rs17319721) on proteinuria in adults. We hypothesize that SHROOM3 has dichotomous roles in renal tubular cells and podocytes, that are mediated by distinct protein motifs. We will test our hypothesis by three aims. In aim-1, we will overeprexpress ASD2- domain deficient Shroom3 in vitro/in vivo to confirm ASD2-domain dependent profibrotic signaling by Shroom3. In aim-2, Fyn-binding mutant Shroom3 will be overexpressed to confirm podocyte injury and phenotype in vivo. Since impaired Fyn activation is associated with MCD, and Shroom3 knockdown inhibited Fyn, in aim-3, we will investigate the relevance of Shroom3-Fyn interaction to human MCD by comparative glomerular morphometry and genomics utilizing human data from the Nephrotic syndrome NEPTUNE consortium. This work is essential to developing domain-specific Shroom3 inhibitors for fibrosis in CKD and IF/TA.

2. Non HLA-mismatches and renal allograft failure: Recent data has shown that focal or global non-HLA donor-recipient mismatches associate with renal allograft outcomes. Here we examined global non-HLA mismatches by quantifying these in every donor-recipient pair in a scale of 0-1 using proportion of identity-by-descent (piBD). We showed that such a score independently associates with allograft survival via the development of early allograft fibrosis especially vascular intimal lesions or Cv-score. Based on these data, (a) we are applying bioinformatic approaches to dissect loci and regions of interest (b) identify potential implicated mechanisms based on genetic architecture (c) validate using a murine allo-transplantation model of global non MHC mismatches. This work has significant implications for allocation, risk stratification and potential targeted therapeutics. We identify novel mechanisms by which donor-recipient "mismatches" impact transplant outcomes


Selected Publications