The balance between salt excretion and absorption in the kidney tubules is a major determinant of vascular volume homeostasis and systemic blood pressure. The kidney collecting duct plays a major role in the fine tuning of the final urine by regulating the transport of solutes, acid base molecules and fluid via distinct transporters in specialized cells. The absorption or secretion of chloride in the collecting duct constitutes a major component of systemic salt homeostasis. Chloride is absorbed in non A-intercalated cells, predominantly via pendrin (Slc26a4), however, very little is known about chloride secretion in the collecting duct and the molecule(s) mediating this process. We provide evidence demonstrating that Slc26a9 (PAT4), which can function as a chloride channel, is localized on the apical membrane of principal cells in the collecting duct. We further report that mice with genetic deletion of Slc26a9 display reduced ability to excrete chloride when subjected to water deprivation. These results strongly suggest that Slc26a9 plays an important role in chloride excretion by functioning as an apical chloride channel in the collecting duct. Further, we observe that Slc26a9 mice display elevated systemic blood pressure, which is aggravated with high salt intake, a phenotype likely related to their reduced ability to secret chloride. We provide evidence demonstrating that pendrin (Slc26a4) plays a major role in compensatory chloride absorption in the collecting duct in response to increased delivery of salt to the distal nephron caused by diuretics. Lastly and continuing with the proposed studies in our existing Merit Review award, we report the generation of collecting duct specific AE1 null mice. Both AE1 and Slc26a7 (PAT2) are Cl-/HCO3- exchangers expressed on the basolateral membrane of A-intercalated cells and play an important role in acid secretion and bicarbonate absorption in the outer medullary collecting duct. We hypothesize that Slc26a9 (PAT4) plays a major role in vascular volume homeostasis by regulating renal chloride secretion in the collecting duct. As such, we hypothesize that the downregulation or inhibition of Slc26a9 may play an important role in the pathogenesis of salt sensitive hypertension. We hypothesize that pendrin (Slc26a4) plays an important role in compensatory salt absorption in the collecting duct in response to diuretic therapy. As such, we hypothesize that pendrin can confer resistance to or blunt the effect of loop or DCT diuretics (furosemide or thiazide derivatives) by increasing the absorption of salt delivered to the distal nephron. Lastly, we hypothesize that the activation of Cl-/HCO3- exchangers PAT2 or AE1 by physiologic maneuvers can mitigate the severity of distal renal tubular acidosis in AE1 or PAT2 null mice, respectively. Ascertaining the role of collecting duct chloride transporters should shed new light on the pathophysiology of several disorders resulting from enhanced salt absorption or excretion, acid base disorders and blood pressure dysregulation originating from distal nephron. They will further provide novel therapeutic insights in patients with diuretic resistance, salt sensitive hypertension and altered acid base homeostasis.

Public Health Relevance

A large number of our veterans are admitted to the hospital each year with high blood pressure or abnormal acid base status. The distal nephron of the kidney plays a major role in vascular volume and blood pressure regulation and systemic acid base balance by regulating the transport of electrolytes and acid-base molecules in specialized cells and via specific transporters. We have identified two transport proteins in the kidney collecting duct that play important roles in the regulation of blood pressure and acid base homeostasis. We believe that the examination of the role of these transporters and their interaction with other transport proteins through the use of genetically engineered mouse models should provide novel insight into the pathogenesis of various diseases associated with increased blood pressure or abnormal acid base balance. Further, the information gathered can be eventually used to design therapeutic maneuvers aimed at correcting elevated blood pressure or excess loss of fluid or bicarbonate in the kidney.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Nephrology (NEPH)
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Cincinnati VA Medical Center Research
United States
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Barone, Sharon; Xu, Jie; Zahedi, Kamyar et al. (2018) Probenecid Pre-treatment Downregulates the Kidney Cl-/HCO3- Exchanger (Pendrin) and Potentiates Hydrochlorothiazide-Induced Diuresis. Front Physiol 9:849
Alshahrani, Saeed; Rapoport, Robert M; Zahedi, Kamyar et al. (2017) The non-diuretic hypotensive effects of thiazides are enhanced during volume depletion states. PLoS One 12:e0181376
Alshahrani, Saeed; Soleimani, Manoocher (2017) Ablation of the Cl-/HCO3- Exchanger Pendrin Enhances Hydrochlorothiazide-Induced Diuresis. Kidney Blood Press Res 42:444-455
Soleimani, M (2011) Dietary fructose, salt absorption and hypertension in metabolic syndrome: towards a new paradigm. Acta Physiol (Oxf) 201:55-62