Podocyte injury is a key feature of DKD and renal accumulation of lipid correlates with the development of glomerulosclerosis. Decreased expression of ATP-binding cassette transporter 1 (ABCA1) occurs in glomerular transcripts from patients DKD and is associated with the presence of podocyte lipid droplets in kidney biopsies. Fibroblasts from patients with Tangier disease carrying ABCA1 loss of function mutations are characterized by cardiolipin accumulation, a mitochondrial specific phospholipid. While increases in hepatic cholesterol and cardiolipin content are observed in association with mitochondrial dysfunction in patients with non-alcoholic steatohepatitis (NASH), h yperglycemia induced excess mitochondrial superoxide production has been considered the primary driver of mitochondrial dysfunction in DKD. These observations led us to hypothesize that ABCA1 deficiency renders podocytes susceptible to DKD-mediated injury via cardiolipin dependent mitochondrial dysfunction. Our preliminary data suggest that ABCA1 deficiency leads to changes in the mitochondrial membrane lipid composition and CL accumulation in association with mitochondrial dysfunction and oxidative stress in vitro rendering podocyte susceptible to injury. In vivo, we demonstrate that podocyte specific Abca1 deficiency (pABCA1) is associated with accumulation of esterified cholesterol in kidney cortex but is not sufficient to cause proteinuria. However, Abca1 deficient podocytes cultured in diabetic milieu are more susceptible to DKD-related injury and pABCA1 diabetic mice have worsened DKD progression and accumulation of docosahexaenoic acid (DHA)-rich cardiolipin, a cardiolipin species especially susceptible to reactive oxygen species (ROS). The phenotype of these mice can be partially rescued by inhibition of cardiolipin peroxidation with Elamipretide, an inhibitor of CL peroxidation. We propose three specific aims to test several hypotheses.
In specific aim 1, we will determine if ABCA1 deficiency and hyperglycemia contribute differently to mitochondrial (dys)function.
In specific aim 2, we will investigate the effect of ABCA1 deficiency on the lipid composition and fluidity of mitochondrial membranes and in specific aim 3, we will determine if inhibition of cardiolipin peroxidation can rescue ABCA1 dependent mitochondrial dysfunction. This innovative study is aimed at deciphering the role of ABCA1-mediated lipid compartmentalization and CL accumulation in mitochondrial dysfunction and podocyte injury. If successful, this study will have high impact as it elucidates a new pathway important in podocyte injury and may lead to the identification of new drug targets for the treatment of patients with DKD.

Public Health Relevance

Diabetic kidney disease (DKD) is the most common cause of end stage kidney disease in the USA, yet current treatment strategies slow but do not halt the progression of the disease. We previously demonstrated an important role of cholesterol accumulation inside kidney cells as a novel mechanism contributing to the progression of DKD; this competitive renewal application is built upon our previously obtained data and it proposes to investigate the mechanisms linking cholesterol accumulation in kidney cells to impaired cellular respiration and energy metabolism. The strength of this proposal lies in the idea that a new type of fat amenable to therapeutic intervention and relevant to human diseases may contribute to DKD. !

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Pathobiology of Kidney Disease Study Section (PBKD)
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Sadusky, Anna Burkart
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University of Miami School of Medicine
Internal Medicine/Medicine
Schools of Medicine
Coral Gables
United States
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Mitrofanova, Alla; Molina, Judith; Varona Santos, Javier et al. (2018) Hydroxypropyl-?-cyclodextrin protects from kidney disease in experimental Alport syndrome and focal segmental glomerulosclerosis. Kidney Int 94:1151-1159
Agrawal, Shipra; Zaritsky, Joshua J; Fornoni, Alessia et al. (2018) Dyslipidaemia in nephrotic syndrome: mechanisms and treatment. Nat Rev Nephrol 14:57-70
Wang, Qiang; Pronin, Alexey N; Levay, Konstantin et al. (2017) Regulator of G-protein signaling G?5-R7 is a crucial activator of muscarinic M3 receptor-stimulated insulin secretion. FASEB J 31:4734-4744
Manzoli, Vita; Colter, David C; Dhanaraj, Sridevi et al. (2017) Engineering human renal epithelial cells for transplantation in regenerative medicine. Med Eng Phys 48:3-13
Ahmad, Anis; Mitrofanova, Alla; Bielawski, Jacek et al. (2017) Sphingomyelinase-like phosphodiesterase 3b mediates radiation-induced damage of renal podocytes. FASEB J 31:771-780
Pedigo, Christopher E; Merscher, Sandra M; Fornoni, Alessia (2017) Direct Measurement of Free and Esterified Cholesterol Mass in Differentiated Human Podocytes: A TLC and Enzymatic Assay-Based Method. Methods Mol Biol 1609:51-56
Pedigo, Christopher E; Ducasa, Gloria Michelle; Leclercq, Farah et al. (2016) Local TNF causes NFATc1-dependent cholesterol-mediated podocyte injury. J Clin Invest 126:3336-50
Perkovic, Vlado; Agarwal, Rajiv; Fioretto, Paola et al. (2016) Management of patients with diabetes and CKD: conclusions from a ""Kidney Disease: Improving Global Outcomes"" (KDIGO) Controversies Conference. Kidney Int 90:1175-1183
Grahammer, Florian; Wigge, Christoph; Schell, Christoph et al. (2016) A flexible, multilayered protein scaffold maintains the slit in between glomerular podocytes. JCI Insight 1:
Bassi, Roberto; Fornoni, Alessia; Doria, Alessandro et al. (2016) CTLA4-Ig in B7-1-positive diabetic and non-diabetic kidney disease. Diabetologia 59:21-9

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