More than 500,000 Americans suffer from end-stage renal disease (ESRD). African Americans develop ESRD at rates 4-5 fold higher than European Americans. Recently we showed that coding sequence variants in the ApolipoproteinL1 (ApoL1) gene, present only in individuals with recent African ancestry, explain a very large proportion of this health disparity. This has now been confirmed by multiple additional studies. ApoL1 variants have a major impact on different types of kidney disease including hypertension-associated ESRD, focal segmental glomerulosclerosis, and HIV-associated nephropathy. Individuals with two variant ApoL1 alleles have a 7-30 fold increased risk for kidney disease. 3.5 million African Americans likely have the high risk ApoL1 genotype. African Americans without two variant alleles have minimal excess risk. At present, little is known about the biology of ApoL1 or its rol in the kidney. ApoL1 has a defined role in resistance to trypanosomes, and the G1 and G2 variants appear to have become common in Africa because they confer protection against the forms of trypanosomes that cause African Sleeping Sickness. Here, our goal is to elucidate the function of ApoL1 and its role in causing human kidney disease in order to understand the biological mechanisms underlying this large disparity in kidney disease risk. ApoL1 is a Bcl2 family member with a BH3-only domain, suggesting a possible role in apoptosis. Our initial experiments in oocytes lead us to believe that this pathway may be an important mechanism of glomerular injury in ApoL1-associated disease. We propose to: 1. Define the cell biology and cell physiology of ApoL1: We will define the basic cellular biology of ApoL1 including biosynthesis, trafficking, ion channel properties, endocytosis, and effects on organellar structure and function. We will compare wild type and renal risk variant ApoL1 biology to understand the mechanisms that lead to kidney disease. 2. Examine specific effects of ApoL1 on apoptosis in podocytes: We hypothesize that ApoL1 risk variants promote podocyte apoptosis via a BH3 domain in the N- terminus and that the renal risk variants enhance ApoL1's pro-apoptotic effects. We will test this hypothesis both in cultured podocytes of different ApoL1 genotypes and by transfecting podocytes with ApoL1 constructs designed to probe the underlying apoptotic mechanisms. 3. Use a zebrafish model to study ApoL1- mediated renal injury in vivo: We will use zebrafish to understand how ApoL1 variants promote glomerular injury. We have demonstrated that the G1 risk variant increases embryonic lethality and causes glomerular pathology, and that wild type ApoL1 can reverse the pathologic phenotype caused by G1. We will examine the effects of heterologous ApoL1 expression in a whole organism using ubiquitous and tissue-specific promoters. We will define the risk variant domains that cause disease and the wild type domains that prevent G1-mediated injury. We will also define the specific interactions between the wild-type, G1, and G2 forms of ApoL1 in vivo. Lastly, we will examine the role of ApoL1 variants in promoting or preventing apoptosis of glomerular cells.
We have recently found that specific genetic variants in a single gene, APOL1, account for the very high rate of kidney disease in African Americans, and also confer resistance to Sleeping Sickness in Africa. We now want to understand precisely how these genetic variants lead to this major disparity in kidney disease at a biological level. This i of major importance in understanding the molecular mechanism of an enormous minority health disparity. Understanding how these differences in the APOL1 gene cause kidney disease in African Americans will have direct implications for improving all aspects of care for the growing number people with this serious public health problem and ultimately removing a major racial health disparity.
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