The mammary gland consists of an organized network of epithelial ducts and lobules. This histoarchitecture can be recapitulated in vitro by culturing mammary epithelial cells as 3D spheroids embedded in a reconstituted basement membrane. I first used this assay to characterize the role of cell-cell and cell-ECM adhesion in the formation and polarization of the apical junction complexes in normal mammary epithelial cells. Cell-cell adhesion alone was sufficient to initiate polarized junction assembly. However, the addition of exogenous ECM generated a spatial polarity signal dependent on laminin-1 and α6 and β1 integrins. This caused clusters of mammary epithelial cells to re-localize the junctional complexes to the center of the spheroid prior to lumen formation. In ductal breast carcinoma, a critical hallmark is the loss of normal polarized tissue architecture without the induction of an epithelial-to-mesenchymal transformation (EMT). Thus, misregulation of molecules that function as polarity determinants may contribute to ductal tumor progression. Podocalyxin is an anti-adhesive glycoprotein that may be involved, as it is important in epithelial morphogenesis, and its overexpression in clinical breast tumors is associated with poor outcome. Despite this, overexpression of podocalyxin in normal mammary epithelial cells did not disrupt 3D morphogenesis or apicobasal polarity. However, its overexpression in non-metastatic breast tumor cells did perturb the architecture and growth of tumor spheroids in vitro and it facilitated subcutaneous tumor growth in vivo without causing an EMT. Mechanistically, podocalyxin localized to and expanded non-adhesive membrane domains and induced microvillus formation that was dependent on its extracellular domain and Rho GTPase-regulated actin polymerization. Podocalyxin also recruited its intracellular binding partners NHERF-1 and ezrin via its cytoplasmic tail. Strikingly, the formation of this protein complex was not required for microvillus formation. Additionally, podocalyxin delayed cell-cell aggregation and decreased the initial adhesion, spreading and strength of attachment of tumor cells to fibronectin where it restricted β1 integrin localization to the basal/attached domain. These alterations in adhesion possibly contributed to podocalyxin's ability to increase growth factor-dependent tumor cell migration. Altogether, these data indicate that podocalyxin overexpression may facilitate a ductal tumor-like progression that involves EMT-independent alterations in tissue architecture.

The mammary gland consists of an organized network of epithelial ducts and lobules. This histoarchitecture can be recapitulated in vitro by culturing mammary epithelial cells as 3D spheroids embedded in a reconstituted basement membrane. I first used this assay to characterize the role of cell-cell and cell-ECM adhesion in the formation and polarization of the apical junction complexes in normal mammary epithelial cells. Cell-cell adhesion alone was sufficient to initiate polarized junction assembly. However, the addition of exogenous ECM generated a spatial polarity signal dependent on laminin-1 and α6 and β1 integrins. This caused clusters of mammary epithelial cells to re-localize the junctional complexes to the center of the spheroid prior to lumen formation. In ductal breast carcinoma, a critical hallmark is the loss of normal polarized tissue architecture without the induction of an epithelial-to-mesenchymal transformation (EMT). Thus, misregulation of molecules that function as polarity determinants may contribute to ductal tumor progression. Podocalyxin is an anti-adhesive glycoprotein that may be involved, as it is important in epithelial morphogenesis, and its overexpression in clinical breast tumors is associated with poor outcome. Despite this, overexpression of podocalyxin in normal mammary epithelial cells did not disrupt 3D morphogenesis or apicobasal polarity. However, its overexpression in non-metastatic breast tumor cells did perturb the architecture and growth of tumor spheroids in vitro and it facilitated subcutaneous tumor growth in vivo without causing an EMT. Mechanistically, podocalyxin localized to and expanded non-adhesive membrane domains and induced microvillus formation that was dependent on its extracellular domain and Rho GTPase-regulated actin polymerization. Podocalyxin also recruited its intracellular binding partners NHERF-1 and ezrin via its cytoplasmic tail. Strikingly, the formation of this protein complex was not required for microvillus formation. Additionally, podocalyxin delayed cell-cell aggregation and decreased the initial adhesion, spreading and strength of attachment of tumor cells to fibronectin where it restricted β1 integrin localization to the basal/attached domain. These alterations in adhesion possibly contributed to podocalyxin's ability to increase growth factor-dependent tumor cell migration. Altogether, these data indicate that podocalyxin overexpression may facilitate a ductal tumor-like progression that involves EMT-independent alterations in tissue architecture.

The mammary gland consists of an organized network of epithelial ducts and lobules. This histoarchitecture can be recapitulated in vitro by culturing mammary epithelial cells as 3D spheroids embedded in a reconstituted basement membrane. I first used this assay to characterize the role of cell-cell and cell-ECM adhesion in the formation and polarization of the apical junction complexes in normal mammary epithelial cells. Cell-cell adhesion alone was sufficient to initiate polarized junction assembly. However, the addition of exogenous ECM generated a spatial polarity signal dependent on laminin-1 and α6 and β1 integrins. This caused clusters of mammary epithelial cells to re-localize the junctional complexes to the center of the spheroid prior to lumen formation. In ductal breast carcinoma, a critical hallmark is the loss of normal polarized tissue architecture without the induction of an epithelial-to-mesenchymal transformation (EMT). Thus, misregulation of molecules that function as polarity determinants may contribute to ductal tumor progression. Podocalyxin is an anti-adhesive glycoprotein that may be involved, as it is important in epithelial morphogenesis, and its overexpression in clinical breast tumors is associated with poor outcome. Despite this, overexpression of podocalyxin in normal mammary epithelial cells did not disrupt 3D morphogenesis or apicobasal polarity. However, its overexpression in non-metastatic breast tumor cells did perturb the architecture and growth of tumor spheroids in vitro and it facilitated subcutaneous tumor growth in vivo without causing an EMT. Mechanistically, podocalyxin localized to and expanded non-adhesive membrane domains and induced microvillus formation that was dependent on its extracellular domain and Rho GTPase-regulated actin polymerization. Podocalyxin also recruited its intracellular binding partners NHERF-1 and ezrin via its cytoplasmic tail. Strikingly, the formation of this protein complex was not required for microvillus formation. Additionally, podocalyxin delayed cell-cell aggregation and decreased the initial adhesion, spreading and strength of attachment of tumor cells to fibronectin where it restricted β1 integrin localization to the basal/attached domain. These alterations in adhesion possibly contributed to podocalyxin's ability to increase growth factor-dependent tumor cell migration. Altogether, these data indicate that podocalyxin overexpression may facilitate a ductal tumor-like progression that involves EMT-independent alterations in tissue architecture. / Medicine, Faculty of / Graduate

L'établissement de la polarité apico-basale dans les tissus épithéliaux est étroitement lié à la division cellulaire, mais les mécanismes moléculaires sous-jacents n'ont pas encore été établis. A l'aide d'un modèle de culture en 3 dimensions de cellules rénales (MDCK), j'ai montré que lors du développement d'un cyst, la GTPase Rab35 joue un rôle majeur dans l'établissement de la polarité et le positionnement du lumen pendant la première division cellulaire. Au niveau moléculaire, Rab35 permet de coupler l'initiation de la polarité apico-basale avec la cytocinèse via l'attachement au sillon de clivage de vésicules intracellulaires contenant des déterminants clé de l'établissement de la polarité. Ces vésicules transportent notamment les protéines aPKC, Cdc42, Crumbs3 ainsi que le facteur d'ouverture de la lumière Podocalyxin. De plus, l'attachement de ces vésicules au sillon de clivage dépend de l'interaction directe entre Rab35 et la queue cytoplasmique de Podocalyxin. Par conséquence, l'inactivation de Rab35 entraine une inversion complète de la polarité apico-basale des kystes 3D. J'ai mis en évidence un nouveau mécanisme de ciblage des vésicules intracellulaire au site de clivage dépendant de la protéine Rab35 impliqué à la fois dans l'initiation de la polarité apico-basale et dans l'ouverture de la lumière au centre du cyst. / Establishment and maintenance of apico-basal polarity in epithelial organs must be tightly coupled with cell division, but the underlying molecular mechanisms are largely unknown. Using 3D cultures of renal MDCK cells (cysts), I found that the Rab35 GTPase plays a crucial role in polarity initiation and apical lumen positioning during the first cell division of cyst development. At the molecular level, Rab35 physically couples cytokinesis with the initiation of apico-basal polarity by tethering intracellular vesicles containing key apical determinants at the cleavage site. These vesicles transport aPKC, Cdc42, Crumbs3 and the lumen promoting factor Podocalyxin, and are tethered through a direct interaction between Rab35 and the cytoplasmic tail of Podocalyxin. Consequently, Rab35 inactivation leads to complete inversion of apico-basal polarity in 3D cysts. This novel and unconventional mode of Rab-dependent vesicle targeting provides a simple mechanism for triggering both initiation of apico-basal polarity and lumen opening at the centre of cysts.

CD34 and its relatives, Podocalyxin and Endoglycan, comprise of a family of surface sialomucins expressed by hematopoietic stem/progenitor cells, and vascular endothelia. Recent data suggest that they serve as either pro- or anti-adhesion molecules depending on their cellular context and their post-translational modifications. We were interested in identifying Podocalyxin ligands and their cellular distribution and understanding the role of these factors in signaling, adhesion and migration. Using both a lambda phage screen assay and mass spectrometry, we identified the Na⁺/H⁺ exchanger regulatory factor-i (NHERF-l) as a selective ligand for Podocalyxin and Endoglycan but not for the closely related CD34. Furthermore, we showed that NHERF-1 is expressed by all, lineage⁻, Sca-1⁺ and c-kit⁺ (LSK) cells, which are known to express Podocalyxin and have long-term repopulating characteristics of hematopoietic stem cells. In addition, upon IL-3 stimulation of a factor dependent cell line (FDC-P 1) these proteins re-localize and co-localize in an asymmetrical pattern. By using a lentiviral based shRNA system to silence Podocalyxin and NHERF- i proteins, we observed that migration across stromal monolayer towards a CXCL12 and SCF gradient is significantly impeded in cells that lack Podocalyxin but not NHERF-1. Following in vitro stimulation with a combination of CXCL12 and SCF we observed that Podocalyxin co-associates with CXCR4. Furthermore, cells lacking Podocalyxin have decreased phospho-AKT, a key signaling molecule downstream of c-kit and CXCR4 receptors. Taken together, our data supports the conclusion that Podocalyxin co-association with CXCR4 modulates downstream signaling to efficiently regulate HSC homing.

CD34 and its relatives, Podocalyxin and Endoglycan, comprise of a family of surface sialomucins expressed by hematopoietic stem/progenitor cells, and vascular endothelia. Recent data suggest that they serve as either pro- or anti-adhesion molecules depending on their cellular context and their post-translational modifications. We were interested in identifying Podocalyxin ligands and their cellular distribution and understanding the role of these factors in signaling, adhesion and migration. Using both a lambda phage screen assay and mass spectrometry, we identified the Na⁺/H⁺ exchanger regulatory factor-i (NHERF-l) as a selective ligand for Podocalyxin and Endoglycan but not for the closely related CD34. Furthermore, we showed that NHERF-1 is expressed by all, lineage⁻, Sca-1⁺ and c-kit⁺ (LSK) cells, which are known to express Podocalyxin and have long-term repopulating characteristics of hematopoietic stem cells. In addition, upon IL-3 stimulation of a factor dependent cell line (FDC-P 1) these proteins re-localize and co-localize in an asymmetrical pattern. By using a lentiviral based shRNA system to silence Podocalyxin and NHERF- i proteins, we observed that migration across stromal monolayer towards a CXCL12 and SCF gradient is significantly impeded in cells that lack Podocalyxin but not NHERF-1. Following in vitro stimulation with a combination of CXCL12 and SCF we observed that Podocalyxin co-associates with CXCR4. Furthermore, cells lacking Podocalyxin have decreased phospho-AKT, a key signaling molecule downstream of c-kit and CXCR4 receptors. Taken together, our data supports the conclusion that Podocalyxin co-association with CXCR4 modulates downstream signaling to efficiently regulate HSC homing.

CD34 and its relatives, Podocalyxin and Endoglycan, comprise of a family of surface sialomucins expressed by hematopoietic stem/progenitor cells, and vascular endothelia. Recent data suggest that they serve as either pro- or anti-adhesion molecules depending on their cellular context and their post-translational modifications. We were interested in identifying Podocalyxin ligands and their cellular distribution and understanding the role of these factors in signaling, adhesion and migration. Using both a lambda phage screen assay and mass spectrometry, we identified the Na⁺/H⁺ exchanger regulatory factor-i (NHERF-l) as a selective ligand for Podocalyxin and Endoglycan but not for the closely related CD34. Furthermore, we showed that NHERF-1 is expressed by all, lineage⁻, Sca-1⁺ and c-kit⁺ (LSK) cells, which are known to express Podocalyxin and have long-term repopulating characteristics of hematopoietic stem cells. In addition, upon IL-3 stimulation of a factor dependent cell line (FDC-P 1) these proteins re-localize and co-localize in an asymmetrical pattern. By using a lentiviral based shRNA system to silence Podocalyxin and NHERF- i proteins, we observed that migration across stromal monolayer towards a CXCL12 and SCF gradient is significantly impeded in cells that lack Podocalyxin but not NHERF-1. Following in vitro stimulation with a combination of CXCL12 and SCF we observed that Podocalyxin co-associates with CXCR4. Furthermore, cells lacking Podocalyxin have decreased phospho-AKT, a key signaling molecule downstream of c-kit and CXCR4 receptors. Taken together, our data supports the conclusion that Podocalyxin co-association with CXCR4 modulates downstream signaling to efficiently regulate HSC homing. / Medicine, Faculty of / Medicine, Department of / Experimental Medicine, Division of / Graduate

Base teórica: O efeito da vitamina D e análogos sobre a redução da albuminúria na doença renal crônica tem sido demonstrado em estudos clínicos, mas os seus efeitos sobre o podócito glomerular ainda não são claros. Objetivo: Avaliar o efeito da reposição de vitamina D3 sobre a expressão das proteínas associadas ao podócito em pacientes portadores de doença renal crônica (DRC). Métodos: Foram incluídos 27 pacientes portadores de DRC e níveis séricos reduzidos de 25-hidrovitamina D [25(OH)D], com taxa de filtração glomerular estimada (TFGe) entre 15 e 89 ml/min/1,73 m2 e índice proteinúria/creatininúria (IPC) acima de 0,5. Os pacientes receberam reposição de vitamina D3 (colecalciferol) por 6 meses de acordo com o nível sérico de 25(OH)D, sendo mensurados pré e pós tratamento 25(OH)D, TFGe, IPC e outros parâmetros do metabolismo mineral e ósseo. O RNAm de nefrina, podocina, podocalixina, transient receptor potential cation channel 6 (TRPC-6) e dos fatores de crescimento vascular endotelial A (VEGF-A) e transformador beta (TGF-β1) foram quantificados em células do sedimento urinário através da reação em cadeia da polimerase em tempo real, pré e pós reposição de vitamina D3. Os RNAm dos marcadores do podócito foram correlacionados com a 25(OH)D, proteinúria e função renal no período basal e após a intervenção. Resultados: Após 6 meses de suplementação com colecalciferol, a concentração plasmática média da 25(OH)D aumentou de 19  7 ng/mL para 28  11 ng/mL (P = 0.003). A TFGe reduziu -4,71 ml/min/1,73 m2 (p=0,010 vs. basal) e não houve alteração na proteinúria após reposição de vitamina D3, bem como dos parâmetros do metabolismo mineral e ósseo. A 25(OH)D sérica correlacionou-se com a proteinúria, tanto no período basal (r=0,517, p=0,008) quanto após o tratamento (r=0,539, p=0,005). Globalmente, a variação na excreção urinária dos RNAm associados ao podócito após o tratamento não foi estatisticamente significante. Pacientes que atingiram níveis de 25(OH)D ≥20 ng/ml aos seis meses tiveram uma tendência de redução da nefrina [4,48(3,03-5,93) vs. 2,79(1,46-4,12), p=0,085] e da podocina [3,43(2,54-4,32) vs. 2,50(1,21-3,15), p=0,079]; em contrário, no grupo que permaneceu com deficiência de 25(OH)D a podocalixina aumentou significativamente [2,71(2,10- 3,42) vs. 3,63(2,64-4,52), p=0,009] e houve tendência de aumento da nefrina [3,12(2,41-3,10) vs. 4,61(2,83-6,40), p=0,072] e da podocina [3,24(2,37-4,38) vs. 3,83(2,78-4,88), p=0,091)]. Ao final de seis meses, pacientes com melhor nível de função renal (TFGe ≥30 ml/min/1,73 m2) tiveram redução do RNAm de TGF-β1 (p=0,039). Conclusão: A reposição de vitamina D3 (colecalciferol) por seis meses não reduziu a podocitúria ou a proteinúria nestes pacientes com DRC, embora tenha-se observado uma redução marginal no RNAm urinário de nefrina e podocina quando níveis suficientes de 25(OH)D foram atingidos. O uso mais precoce e mais prolongado da vitamina D3 deveria ser investigado como potencial medida de nefroproteção adicional em pacientes renais crônicos. / Background: Previous studies have demonstrated that vitamin D or analog decreases albuminuria in chronic kidney disease (CKD) patients. However, the precise mechanism underlying the potential protective effects of vitamin D on glomerular podocytes is unclear. Objective: In this study we investigated the effect of vitamin D3 supplementation on urinary podocytes protein expression. Methods: Twenty-seven CKD patients who had low baseline vitamin D [25(OH)D] levels, estimated glomerular filtration rate (eGFR) between 15 and 89 ml/min/1,73 m2, and proteinuria/creatininuria index (PCI) higher than 0,5 were studied. During 6 months, all of the patients received cholecalciferol (vitamin D3) supplementation according to 25(OH)D level. Estimated GFR, PCI, 25(OH)D levels, and bone and mineral metabolism parameters were measured at the baseline and after 6 months. In addition, messenger RNA (mRNA) of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6 (TRPC-6), vascular endothelial growth factor A (VEGF-A), and transformig growth factor β1 (TGF-β1) were quantified in urinary sediment cells using real time polymerase chain reaction before and after intervention. The podocyte markers were correlated with 25(OH)D levels, proteinuria and renal function after vitamin D3 supplementation. Results: During cholecalciferol supplementation, the mean 25(OH)D concentration increased from 19  7 ng/mL at baseline to 28  11 ng/mL at month 6 (P = 0.003). Urinary proteinuria did not change after cholecalciferol supplementation. However, eGFR decreased -4.71 ml/min/1.73 m2 (p=0.010 vs. baseline. The serum levels of 25(OH)D were correlated with proteinuria in both periods: baseline (r=0.517, p=0.008) and posttreatment (r=0.539, p=0.005). Patients who reached 25(OH)D levels ≥20 mg/ml at 6 months showed a trend of lower nephrin [4.48(3.03-5.93) vs. 2.79(1.46-4.12), p=0.085] and podocin [3.43(2.54-4.32) vs. 2,50(1.21-3.15), p=0.079]. On the other side, podocalyxin levels increased significantly [2.71(2.10-3.42) vs. 3.63(2.64-4.52), p=0.009] and both nephrin and podocin also increased but these not significant statistically [nephrin: 3.12 (2.41-3.10) vs. 4.61 (2.83-6.40), p=0,072; podocin: 3.24 (2.37-4.38) vs. 3.83 (2.78-4.88), p=0.091)]. After 6 months supplementation, patients with higher levels of renal function (eGFR ≥30 ml/min/1.73 m2) showed reduction of TGF-β1 RNAm (p=0.039). Conclusion: Vitamin D3 (cholecalciferol) supplementation during 6 months did not changed proteinuria level. However, we observed a reduction of urinary nephrin and podocin mRNA in patients who reached sufficient 25(OH)D levels. Larger studies are needed to clarify whether vitamin D3 supplementation, mainly on early stages of CKD, may have beneficial effects on lowering proteinuria and on delaying progression of CKD.

Base teórica: O efeito da vitamina D e análogos sobre a redução da albuminúria na doença renal crônica tem sido demonstrado em estudos clínicos, mas os seus efeitos sobre o podócito glomerular ainda não são claros. Objetivo: Avaliar o efeito da reposição de vitamina D3 sobre a expressão das proteínas associadas ao podócito em pacientes portadores de doença renal crônica (DRC). Métodos: Foram incluídos 27 pacientes portadores de DRC e níveis séricos reduzidos de 25-hidrovitamina D [25(OH)D], com taxa de filtração glomerular estimada (TFGe) entre 15 e 89 ml/min/1,73 m2 e índice proteinúria/creatininúria (IPC) acima de 0,5. Os pacientes receberam reposição de vitamina D3 (colecalciferol) por 6 meses de acordo com o nível sérico de 25(OH)D, sendo mensurados pré e pós tratamento 25(OH)D, TFGe, IPC e outros parâmetros do metabolismo mineral e ósseo. O RNAm de nefrina, podocina, podocalixina, transient receptor potential cation channel 6 (TRPC-6) e dos fatores de crescimento vascular endotelial A (VEGF-A) e transformador beta (TGF-β1) foram quantificados em células do sedimento urinário através da reação em cadeia da polimerase em tempo real, pré e pós reposição de vitamina D3. Os RNAm dos marcadores do podócito foram correlacionados com a 25(OH)D, proteinúria e função renal no período basal e após a intervenção. Resultados: Após 6 meses de suplementação com colecalciferol, a concentração plasmática média da 25(OH)D aumentou de 19  7 ng/mL para 28  11 ng/mL (P = 0.003). A TFGe reduziu -4,71 ml/min/1,73 m2 (p=0,010 vs. basal) e não houve alteração na proteinúria após reposição de vitamina D3, bem como dos parâmetros do metabolismo mineral e ósseo. A 25(OH)D sérica correlacionou-se com a proteinúria, tanto no período basal (r=0,517, p=0,008) quanto após o tratamento (r=0,539, p=0,005). Globalmente, a variação na excreção urinária dos RNAm associados ao podócito após o tratamento não foi estatisticamente significante. Pacientes que atingiram níveis de 25(OH)D ≥20 ng/ml aos seis meses tiveram uma tendência de redução da nefrina [4,48(3,03-5,93) vs. 2,79(1,46-4,12), p=0,085] e da podocina [3,43(2,54-4,32) vs. 2,50(1,21-3,15), p=0,079]; em contrário, no grupo que permaneceu com deficiência de 25(OH)D a podocalixina aumentou significativamente [2,71(2,10- 3,42) vs. 3,63(2,64-4,52), p=0,009] e houve tendência de aumento da nefrina [3,12(2,41-3,10) vs. 4,61(2,83-6,40), p=0,072] e da podocina [3,24(2,37-4,38) vs. 3,83(2,78-4,88), p=0,091)]. Ao final de seis meses, pacientes com melhor nível de função renal (TFGe ≥30 ml/min/1,73 m2) tiveram redução do RNAm de TGF-β1 (p=0,039). Conclusão: A reposição de vitamina D3 (colecalciferol) por seis meses não reduziu a podocitúria ou a proteinúria nestes pacientes com DRC, embora tenha-se observado uma redução marginal no RNAm urinário de nefrina e podocina quando níveis suficientes de 25(OH)D foram atingidos. O uso mais precoce e mais prolongado da vitamina D3 deveria ser investigado como potencial medida de nefroproteção adicional em pacientes renais crônicos. / Background: Previous studies have demonstrated that vitamin D or analog decreases albuminuria in chronic kidney disease (CKD) patients. However, the precise mechanism underlying the potential protective effects of vitamin D on glomerular podocytes is unclear. Objective: In this study we investigated the effect of vitamin D3 supplementation on urinary podocytes protein expression. Methods: Twenty-seven CKD patients who had low baseline vitamin D [25(OH)D] levels, estimated glomerular filtration rate (eGFR) between 15 and 89 ml/min/1,73 m2, and proteinuria/creatininuria index (PCI) higher than 0,5 were studied. During 6 months, all of the patients received cholecalciferol (vitamin D3) supplementation according to 25(OH)D level. Estimated GFR, PCI, 25(OH)D levels, and bone and mineral metabolism parameters were measured at the baseline and after 6 months. In addition, messenger RNA (mRNA) of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6 (TRPC-6), vascular endothelial growth factor A (VEGF-A), and transformig growth factor β1 (TGF-β1) were quantified in urinary sediment cells using real time polymerase chain reaction before and after intervention. The podocyte markers were correlated with 25(OH)D levels, proteinuria and renal function after vitamin D3 supplementation. Results: During cholecalciferol supplementation, the mean 25(OH)D concentration increased from 19  7 ng/mL at baseline to 28  11 ng/mL at month 6 (P = 0.003). Urinary proteinuria did not change after cholecalciferol supplementation. However, eGFR decreased -4.71 ml/min/1.73 m2 (p=0.010 vs. baseline. The serum levels of 25(OH)D were correlated with proteinuria in both periods: baseline (r=0.517, p=0.008) and posttreatment (r=0.539, p=0.005). Patients who reached 25(OH)D levels ≥20 mg/ml at 6 months showed a trend of lower nephrin [4.48(3.03-5.93) vs. 2.79(1.46-4.12), p=0.085] and podocin [3.43(2.54-4.32) vs. 2,50(1.21-3.15), p=0.079]. On the other side, podocalyxin levels increased significantly [2.71(2.10-3.42) vs. 3.63(2.64-4.52), p=0.009] and both nephrin and podocin also increased but these not significant statistically [nephrin: 3.12 (2.41-3.10) vs. 4.61 (2.83-6.40), p=0,072; podocin: 3.24 (2.37-4.38) vs. 3.83 (2.78-4.88), p=0.091)]. After 6 months supplementation, patients with higher levels of renal function (eGFR ≥30 ml/min/1.73 m2) showed reduction of TGF-β1 RNAm (p=0.039). Conclusion: Vitamin D3 (cholecalciferol) supplementation during 6 months did not changed proteinuria level. However, we observed a reduction of urinary nephrin and podocin mRNA in patients who reached sufficient 25(OH)D levels. Larger studies are needed to clarify whether vitamin D3 supplementation, mainly on early stages of CKD, may have beneficial effects on lowering proteinuria and on delaying progression of CKD.

Base teórica: O efeito da vitamina D e análogos sobre a redução da albuminúria na doença renal crônica tem sido demonstrado em estudos clínicos, mas os seus efeitos sobre o podócito glomerular ainda não são claros. Objetivo: Avaliar o efeito da reposição de vitamina D3 sobre a expressão das proteínas associadas ao podócito em pacientes portadores de doença renal crônica (DRC). Métodos: Foram incluídos 27 pacientes portadores de DRC e níveis séricos reduzidos de 25-hidrovitamina D [25(OH)D], com taxa de filtração glomerular estimada (TFGe) entre 15 e 89 ml/min/1,73 m2 e índice proteinúria/creatininúria (IPC) acima de 0,5. Os pacientes receberam reposição de vitamina D3 (colecalciferol) por 6 meses de acordo com o nível sérico de 25(OH)D, sendo mensurados pré e pós tratamento 25(OH)D, TFGe, IPC e outros parâmetros do metabolismo mineral e ósseo. O RNAm de nefrina, podocina, podocalixina, transient receptor potential cation channel 6 (TRPC-6) e dos fatores de crescimento vascular endotelial A (VEGF-A) e transformador beta (TGF-β1) foram quantificados em células do sedimento urinário através da reação em cadeia da polimerase em tempo real, pré e pós reposição de vitamina D3. Os RNAm dos marcadores do podócito foram correlacionados com a 25(OH)D, proteinúria e função renal no período basal e após a intervenção. Resultados: Após 6 meses de suplementação com colecalciferol, a concentração plasmática média da 25(OH)D aumentou de 19  7 ng/mL para 28  11 ng/mL (P = 0.003). A TFGe reduziu -4,71 ml/min/1,73 m2 (p=0,010 vs. basal) e não houve alteração na proteinúria após reposição de vitamina D3, bem como dos parâmetros do metabolismo mineral e ósseo. A 25(OH)D sérica correlacionou-se com a proteinúria, tanto no período basal (r=0,517, p=0,008) quanto após o tratamento (r=0,539, p=0,005). Globalmente, a variação na excreção urinária dos RNAm associados ao podócito após o tratamento não foi estatisticamente significante. Pacientes que atingiram níveis de 25(OH)D ≥20 ng/ml aos seis meses tiveram uma tendência de redução da nefrina [4,48(3,03-5,93) vs. 2,79(1,46-4,12), p=0,085] e da podocina [3,43(2,54-4,32) vs. 2,50(1,21-3,15), p=0,079]; em contrário, no grupo que permaneceu com deficiência de 25(OH)D a podocalixina aumentou significativamente [2,71(2,10- 3,42) vs. 3,63(2,64-4,52), p=0,009] e houve tendência de aumento da nefrina [3,12(2,41-3,10) vs. 4,61(2,83-6,40), p=0,072] e da podocina [3,24(2,37-4,38) vs. 3,83(2,78-4,88), p=0,091)]. Ao final de seis meses, pacientes com melhor nível de função renal (TFGe ≥30 ml/min/1,73 m2) tiveram redução do RNAm de TGF-β1 (p=0,039). Conclusão: A reposição de vitamina D3 (colecalciferol) por seis meses não reduziu a podocitúria ou a proteinúria nestes pacientes com DRC, embora tenha-se observado uma redução marginal no RNAm urinário de nefrina e podocina quando níveis suficientes de 25(OH)D foram atingidos. O uso mais precoce e mais prolongado da vitamina D3 deveria ser investigado como potencial medida de nefroproteção adicional em pacientes renais crônicos. / Background: Previous studies have demonstrated that vitamin D or analog decreases albuminuria in chronic kidney disease (CKD) patients. However, the precise mechanism underlying the potential protective effects of vitamin D on glomerular podocytes is unclear. Objective: In this study we investigated the effect of vitamin D3 supplementation on urinary podocytes protein expression. Methods: Twenty-seven CKD patients who had low baseline vitamin D [25(OH)D] levels, estimated glomerular filtration rate (eGFR) between 15 and 89 ml/min/1,73 m2, and proteinuria/creatininuria index (PCI) higher than 0,5 were studied. During 6 months, all of the patients received cholecalciferol (vitamin D3) supplementation according to 25(OH)D level. Estimated GFR, PCI, 25(OH)D levels, and bone and mineral metabolism parameters were measured at the baseline and after 6 months. In addition, messenger RNA (mRNA) of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6 (TRPC-6), vascular endothelial growth factor A (VEGF-A), and transformig growth factor β1 (TGF-β1) were quantified in urinary sediment cells using real time polymerase chain reaction before and after intervention. The podocyte markers were correlated with 25(OH)D levels, proteinuria and renal function after vitamin D3 supplementation. Results: During cholecalciferol supplementation, the mean 25(OH)D concentration increased from 19  7 ng/mL at baseline to 28  11 ng/mL at month 6 (P = 0.003). Urinary proteinuria did not change after cholecalciferol supplementation. However, eGFR decreased -4.71 ml/min/1.73 m2 (p=0.010 vs. baseline. The serum levels of 25(OH)D were correlated with proteinuria in both periods: baseline (r=0.517, p=0.008) and posttreatment (r=0.539, p=0.005). Patients who reached 25(OH)D levels ≥20 mg/ml at 6 months showed a trend of lower nephrin [4.48(3.03-5.93) vs. 2.79(1.46-4.12), p=0.085] and podocin [3.43(2.54-4.32) vs. 2,50(1.21-3.15), p=0.079]. On the other side, podocalyxin levels increased significantly [2.71(2.10-3.42) vs. 3.63(2.64-4.52), p=0.009] and both nephrin and podocin also increased but these not significant statistically [nephrin: 3.12 (2.41-3.10) vs. 4.61 (2.83-6.40), p=0,072; podocin: 3.24 (2.37-4.38) vs. 3.83 (2.78-4.88), p=0.091)]. After 6 months supplementation, patients with higher levels of renal function (eGFR ≥30 ml/min/1.73 m2) showed reduction of TGF-β1 RNAm (p=0.039). Conclusion: Vitamin D3 (cholecalciferol) supplementation during 6 months did not changed proteinuria level. However, we observed a reduction of urinary nephrin and podocin mRNA in patients who reached sufficient 25(OH)D levels. Larger studies are needed to clarify whether vitamin D3 supplementation, mainly on early stages of CKD, may have beneficial effects on lowering proteinuria and on delaying progression of CKD.