CXCR4 induces podocyte injury and proteinuria by activating β-catenin signaling

Background: C-X-C chemokine receptor type 4 (CXCR4) plays a crucial role in mediating podocyte dysfunction, proteinuria and glomerulosclerosis. However, the underlying mechanism remains poorly understood. Here we studied the role of β-catenin in mediating CXCR4-triggered podocyte injury. Methods: Mouse models of proteinuric kidney diseases were used to assess CXCR4 and β-catenin expression. We utilized cultured podocytes and glomeruli to delineate the signal pathways involved. Conditional knockout mice with podocyte-specific deletion of CXCR4 were generated and used to corroborate a role of CXCR4/β-catenin in podocyte injury and proteinuria. Results: Both CXCR4 and β-catenin were induced and colocalized in the glomerular podocytes in several models of proteinuric kidney diseases. Activation of CXCR4 by its ligand SDF-1α stimulated β-catenin activation but did not affect the expression of Wnt ligands in vitro. Blockade of β-catenin signaling by ICG-001 preserved podocyte signature proteins and inhibited Snail1 and MMP-7 expression in vitro and ex vivo. Mechanistically, activation of CXCR4 by SDF-1α caused the formation of CXCR4/β-arrestin-1/Src signalosome in podocytes, which led to sequential phosphorylation of Src, EGFR, ERK1/2 and GSK-3β and ultimately β-catenin stabilization and activation. Silencing β-arrestin-1 abolished this cascade of events and inhibited β-catenin in response to CXCR4 stimulation. Podocyte-specific knockout of CXCR4 in mice abolished β-catenin activation, preserved podocyte integrity, reduced proteinuria and ameliorated glomerulosclerosis after Adriamycin injury. Conclusion: These results suggest that CXCR4 promotes podocyte dysfunction and proteinuria by assembling CXCR4/β-arrestin-1/Src signalosome, which triggers a cascade of signal events leading to β-catenin activation.


Introduction
Podocyte injury and proteinuria are the major pathological features of glomerular disease, which accounts for the vast majority of chronic kidney disease (CKD) leading to end-stage renal failure. As a key component of the glomerular filtration apparatus, the integrity of podocytes and their foot processes and slit diaphragm is essential for preventing proteinuria [1,2]. Podocyte injury plays a crucial role in the pathogenesis of a wide variety of glomerular diseases ranging from focal segmental glomerulosclerosis (FSGS) to diabetic nephropathy (DN) [3,4]. Studies have shown that podocyte damage and/or depletion Ivyspring International Publisher often take place in the early stage of glomerular lesions when endothelial and mesangial cells remain relatively intact [5]. Therefore, identification of the key mediators that regulate podocyte damage would be of great significance for developing interventional strategies to slow, halt or even reverse the progression of the majority of CKD.
Although many cues can cause podocyte injury, increasing evidence demonstrates that oxidative stress is an important common culprit of podocyte damage and proteinuria [6,7]. Oxidative stress is often considered as the convergent pathway of many diverse triggers of podocyte damage [6][7][8]. We have previously shown that C-X-C chemokine receptor type 4 (CXCR4), a seven transmembrane G-proteincoupled receptor (GPCR) specific for stromal-derived factor-1α (SDF-1α), also known as CXCL12, plays a key role in mediating oxidative stress-induced podocyte damage, proteinuria, and glomerulosclerotic lesions [8]. CXCR4 is upregulated specifically in glomerular podocytes in numerous models of proteinuric CKD. Furthermore, inhibition of CXCR4 alleviates podocyte injury, proteinuria and glomerulosclerosis. Along this line, CXCR4 could be a new therapeutic target for clinical management of proteinuric CKD. However, how exactly CXCR4 activation causes podocyte damage remains to be elucidated.

Mice and genotyping
Homozygous CXCR4-floxed mice in C57BL/6J background were obtained from the Jackson Laboratories (Stock No. 008767; Bar Harbor, ME). Transgenic mice expressing Cre recombinase under the control of human podocin (NPHS2) promoter (Podo-Cre) was also obtained from Jackson Laboratories (Stock No. 008205). By mating CXCR4floxed mice with Podo-Cre transgenic mice, conditional knockout mice (Podo-CXCR4-/-) in which CXCR4 gene was specifically disrupted in podocyte (genotype: CXCR4 fl/fl ; Cre +/-) were created. These mice were crossbred with homozygous CXCR4-floxed mice to generate offspring with 50% Podo-CXCR4-/mice and 50% control mice (genotype: CXCR4 fl/fl ; Cre -/-) within the same litters. A routine PCR protocol was used for genotyping of tail DNA samples with the primer pairs as described in Table S1. All animals were born normally at the expected Mendelian frequency; and they were normal in size and did not display any gross physical or behavioral abnormalities. Animal experiments were approved by the Institutional Animal Care and Use Committee at the University of Pittsburgh and Animal Ethics Committee at the Nanfang Hospital.

Animal models
Male BALB/c mice weighing 22~24g were obtained from the Southern Medical University Animal Center (Guangzhou, China). For ADR nephropathy model, BALB/c mice were administered by a single intravenous injection of ADR (doxorubicin hydrochloride; Sigma-Aldrich, St. Louis, MO) at 10 mg/kg body weight. Groups of mice (n=6) were euthanized at 1 and 3 weeks after ADR injection, and kidney tissues collected for various analyses. Because mice with C57BL/6J background are resistant to ADR nephropathy, podo-CXCR4-/-and CXCR4-floxed (control) mice were administered with two intravenous injections of ADR at 15 mg/kg body weight, one week apart. Groups of mice (n=7) were euthanized at 2 weeks after ADR injection, and kidney tissues collected for various analyses. In addition, mouse models of proteinuric kidney diseases including angiotensin II infusion (520 ng/min/kg for 4 weeks), db/db mice (5 months) and remnant kidney model after 5/6 nephrectomy (5/6NX) (8 weeks) were used, as described previously [22,23].

SDF-1α ELISA
The enzyme-linked immunosorbent assay (ELISA) kit for mouse SDF-1α was purchased from the Cusabio Company (CSB-EQ027494MO; Wuhan, China). Serum SDF-1α level was measured according to the assay procedures specified by the manufacturer. The enzymatic reaction products were quantified in an automated microplate reader. Serum SDF-1α levels were expressed as nanogram per milliliter.

Cell culture and treatment
The conditionally immortalized mouse podocyte cell line (MPC5) was provided by Peter Mundel (Massachusetts General Hospital, Boston, MA). To propagate podocytes, cells were cultured at 33 °C in RPMI-1640 medium supplemented with 10% fetal bovine serum (FBS) and 10 units/ml mouse recombinant IFN-γ (R&D Systems, Minneapolis, MN) to enhance the expression of a thermosensitive T antigen. To induce differentiation, podocytes were grown under nonpermissive conditions at 37° C in the absence of IFN-γ. MPC5 cells were treated with SDF-1α (SRP-4388; Sigma) with different doses for various periods of time as indicated. For some experiments, MPC5 cells were pretreated with CXCR4 inhibitor AMD3100 (A5602; Sigma) at 5 µg/mL, ICG-001 (Chembest, Shanghai, China) at 5 µM and MEK1/2 inhibitor U0126 (9903; Cell Signaling Technology) at 10 µM. For some studies, podocytes were transiently transfected with ON-TARGET plus SMART pool siRNA (400 pM) specific for mouse β-arrestin-1 or control nontarget siRNA using Lipofectamine 2000 reagent according to the manufacturer's instruction (Invitrogen). Forty-eight hours after transfection, podocytes were exposed to 100 ng/mL SDF-1α for 6 h and harvested for various analyses.

Glomerular culture
Glomeruli were isolated by differential sieving technique from male Sprague Dawley rats (Harlan Sprague Dawley), as previously reported [8]. Briefly, kidneys were excised and pressed with a spatula through stainless steel screens through differential sieves (60, 100, and 200 meshes) and collected for cultivation. The purity of glomeruli was about 95% using this approach [8]. Isolated glomeruli were cultured in the noncoated 24-well plates with SDF-1α in the absence or presence of AMD3100 or ICG-001, respectively.

Urinary albumin, creatinine assay
Urinary albumin was measured by using a mouse Albumin ELISA Quantitation kit, according to the manufacturer's protocol (Bethyl Laboratories, Inc., Montgomery, TX). Urinary and serum creatinine levels were determined by use of a QuantiChrom creatinine assay kit (DICT-500; Bioassay Systems, Hayward, CA), according to the manufacturer's protocols. Urinary albumin was standardized to urine creatinine and expressed as mg/mg Ucr.

Histology and immunohistochemical staining
Paraffin-embedded mouse kidney sections (3 µm thickness) were prepared and stained with periodic acid-Schiff (PAS) and Masson's trichrome staining (MTS) reagents. Immunohistochemical staining was performed using established protocols, as described previously [8]. The antibodies used were described in Table S2.

Immunofluorescence staining and confocal microscopy
Human kidney specimens were collected from diagnostic kidney biopsies performed at Nanfang Hospital, Southern Medical University. Non-tumor renal tissues from patients who had renal cell carcinoma and underwent nephrectomy were used as a normal control. Human kidney cryosections (3 μm thickness) were prepared by a routine method. The studies involving human samples were approved by the Medical Ethics Committee at the Nanfang Hospital, Southern Medical University.
Kidney cryosections or cells cultured on coverslips were fixed with 4% paraformaldehyde for 15 min at room temperature. After blocking with 10% donkey serum for 1 h, the slides were immunostained with various primary antibodies as described in Table  S2. Sections from diseased kidneys were also stained with isotype control antibodies and no specific staining occurred.

Western blot analysis
Protein expression was analyzed by Western blot analysis, as described previously [8]. The detail information of the antibodies used were described in Table S2. Relative protein levels of Western blots were quantified with ImageJ software and reported after normalizing to the loading control.

Co-immunoprecipitation
The interaction of CXCR4 or Src with β-arrestin-1 in mouse podocytes treated with SDF-1α for 5 min was determined by co-IP as previously described [24]. Cell lysates were immunoprecipitated overnight at 4 °C with anti-CXCR4 or anti-β-arrestin-1 antibodies and protein A/G plus agarose (sc-2003; Santa Cruz Biotechnology), respectively. The precipitated complexes were washed with lysis buffer and boiled for 5 min in SDS sample buffer followed by immunoblotting with anti-CXCR4, and anti-Src anti-β-arrestin-1 antibodies, respectively. The antibodies used were described in Table S2.

Real-time RT-PCR
Total RNA isolation and real-time quantitative qRT-PCR were carried out by procedures described previously [7]. Briefly, first-strand cDNA synthesis was carried out by using a Reverse Transcription System Kit according to the instructions of the manufacturer (Promega). Real-time RT-PCR was performed on an ABI PRISM 7000 Sequence Detection System (Applied Biosystems, Foster City, CA). The PCR reaction mixture in a 25-µL volume contained 12.5 µL 2X SYBR Green PCR Master Mix (Applied Biosystems), 5 µL diluted RT product (1:10), and 0.5 µM sense and antisense primer sets. PCR reaction was run by using standard conditions. After sequential incubations at 50 °C for 2 min and 95 °C for 10 min, the amplification protocol consisted of 50 cycles of denaturing at 95 °C for 15 s and annealing and extension at 60 °C for 60 s. The mRNA levels of various genes were calculated after normalizing with β-actin. Primer sequences used in this study were listed in Table S1.

Statistical analyses
All data examined were expressed as mean ± standard error of the mean. Statistical analysis of the data was carried out using SPSS 19.0, (SPSS, Inc., Chicago, IL). Comparison between groups was made using one-way analysis of variance (ANOVA) followed by Student-Newman-Keuls test or Dunnett's T3 procedure. P < 0.05 was considered significant.

Podocyte injury is associated with CXCR4 and β-catenin induction in proteinuric CKD
ADR nephropathy, a model of human FSGS, is characterized by podocyte injury, proteinuria and glomerulosclerosis [8,25]. As shown in Figure 1A-B, ADR caused glomerular damage and inhibited podocyte-specific podocalyxin expression in a timedependent manner. Interestingly, loss of podocalyxin was closely associated with SDF-1α and CXCR4 induction and β-catenin activation at 0, 1, and 3 weeks after ADR injection, as shown by Western blot analyses of whole kidney lysates ( Figure 1A-F). Serum levels of SDF-1α protein were also elevated in mice at different time points after ADR injection ( Figure 1G).
Immunohistochemical staining confirmed that both SDF-1α and CXCR4 were upregulated in glomerular podocytes and, to a less extent, tubular epithelial cells after ADR injection ( Figure 1H). To further investigate the potential relationship between CXCR4 and β-catenin, we utilized double immunofluorescence staining for CXCR4 and β-catenin. As shown in Figure 1I, both CXCR4 and β-catenin were colocalized in the glomeruli at 3 weeks after ADR injection.
To extend this finding, we further examined the expression of CXCR4 and β-catenin in several common models of proteinuric CKD with different etiologies. As shown in Figure 1J, both CXCR4 (red) and β-catenin (green) were induced and colocalized in the glomeruli of mice in hypertensive nephropathy induced by chronic infusion of angiotensin II (Ang II), diabetic nephropathy in genetic db/db mice, and remnant kidney model induced by 5/6NX. Furthermore, CXCR4 was also induced and colocalized with β-catenin in the glomeruli of human kidney biopsies from patients with proteinuric CKD including DN, FSGS and membranous nephropathy (MN) ( Figure S1). These results suggest a potential connection between CXCR4 induction and β-catenin activation in the glomerular podocytes in a variety of proteinuric CKD.

Activation of CXCR4 activates β-catenin by a Wnt-independent mechanism
To investigate the relationship between β-catenin and CXCR4, we examined the regulation of β-catenin after CXCR4 activation in cultured podocytes in vitro. To this end, mouse podocytes (MPC5) were treated with various doses of SDF-1α, the ligand of CXCR4. As illustrated in Figure 2A-B, SDF-1α induced β-catenin activation in cultured podocytes, which peaked when SDF-1α was at 100 ng/mL, as demonstrated by Western blotting using specific antibody against active β-catenin. Timecourse studies revealed that β-catenin activation occurred rapidly, starting as early as 0.5 h, after SDF-1α incubation ( Figure 2C-D).
We then investigated the expression of the Wnt ligands in mouse podocytes. As shown in Figure 2E, a comprehensive survey was performed to assess the expression of various Wnt ligands in MPC5 cells after treatment with 100 ng/mL SDF-1α for 0.5 h by quantitative real-time RT-PCR (qRT-PCR). We found no significant change in the mRNA expression of all Wnts tested, suggesting that SDF-1α/CXCR4 signaling activates β-catenin by a mechanism independent of Wnt induction. Similar results were obtained when MPC5 cells were incubated with SDF-1α for 24 h ( Figure S2).

SDF-1α induces β-catenin activation by forming CXCR4/β-arrestin 1/Src signalosome
We sought to delineate how CXCR4 activation by SDF-1α leads to an increased β-catenin signaling in podocytes. Earlier studies suggest that β-arrestin-1, a scaffold protein, plays a crucial role in mediating the signal transduction of G protein-coupled receptor [28][29][30]. To study a potential involvement of β-arrestin-1 in proteinuric kidney diseases, we examined its expression in the nephropathies induced by ADR or chronic infusion of angiotensin II, which are associated with increased levels of oxidative stress and CXCR4 [8,31,32]. As shown in Figure S4, renal expression of β-arrestin-1 mRNA was induced in both models, suggesting a possible role of β-arrestin-1 in mediating CXCR4-triggered podocyte injury.

SDF-1α/CXCR4 induces podocyte injury through β-catenin activation in glomerular miniorgan culture
To closely model podocytes in vivo, we used glomerular mini-organ culture, an ex vivo model system that largely preserves the sophisticated three dimensional architecture of podocytes in the kidney [24,37]. As shown in Figure 5A, rat glomeruli were isolated by differential sieving technique and cultured in suspension, which retained relatively intact glomerular structure. Incubation with SDF-1α significantly inhibited nephrin and WT1 expression in cultured glomeruli ( Figure 5B-D). However, blockade of either CXCR4 signaling by AMD3100 or β-catenin signaling by ICG-001 could largely restore nephrin and WT1 (Figure 5E-G). Similar results were obtained when nephrin was assessed by immunofluorescence staining ( Figure 5H).

Podocyte-specific ablation of CXCR4 preserves podocyte integrity and mitigates proteinuria after injury
We next investigated the role of CXCR4 in podocyte injury by challenging podo-CXCR4-/-mice with ADR. As shown in Figure 6D, albuminuria in podo-CXCR4+/+ mice at 1 week after ADR was more severe than that in podo-CXCR4-/-mice. SDS-PAGE analysis of urine samples revealed that albumin was the major constituent of urinary proteins in mice after ADR injury ( Figure 6E). Similar results were obtained at 10 days after ADR injection ( Figure 6F). Of note, we presented urinary albumin in podo-CXCR4+/+ and podo-CXCR4-/-mice at 10 days after ADR, as two mice in the podo-CXCR4+/+ group died on the 12 th and 13 th day, respectively.
We examined CXCR4 expression in the kidneys of podo-CXCR4+/+ and podo-CXCR4-/-mice at 2 weeks after ADR injection. As shown in Figure 6G, immunohistochemical staining for CXCR4 revealed a podocyte-specific loss of CXCR4 protein in the kidneys of podo-CXCR4-/-mice. We further assessed podocyte injury by examining the expression of podocyte-specific markers, including WT1, nephrin and podocalyxin. As shown in Figure 6G-H, WT1-positive cells were increased in podo-CXCR4-/glomeruli at 2 weeks after ADR, compared to podo-CXCR4+/+ controls. Western blot analyses demonstrated that nephrin and podocalyxin proteins were significantly increased in podo-CXCR4-/-mice after ADR injury ( Figure 6I-J). Similar results were obtained when nephrin and podocalyxin were assessed by immunofluorescence staining ( Figure 6K).

Podocyte-specific ablation of CXCR4 ameliorates glomerulosclerosis in ADR nephropathy
We finally investigated the effect of podocytespecific ablation of CXCR4 on glomerulosclerotic lesions in ADR nephropathy. As illustrated in Figure  8A, periodic acid-Schiff (PAS) staining and Masson's trichrome staining (MTS) exhibited that ADR induced mesangial expansion, collagen deposition and glomerulosclerotic lesions in podo-CXCR4+/+ mice, whereas podocyte-specific ablation of CXCR4 substantially reduced these lesions. Similarly, immunostaining for α-SMA and fibronectin also revealed that podocyte-specific ablation of CXCR4 largely abolished the expression of α-SMA and fibronectin in the glomeruli ( Figure 8B). Western blot analyses further confirmed that podocyte-specific ablation of CXCR4 inhibited the expression of fibronectin and α-SMA in mouse kidneys after ADR injury ( Figure 8C-E). The mRNA expression of fibronectin and collagen III was also repressed in podo-CXCR4-/-mice at 2 weeks after ADR, compared to podo-CXCR4+/+ controls ( Figure 8F-G).

Discussion
In this study, we show that activation of CXCR4 by SDF-1α in vitro or ADR in vivo recruits β-arrestin-1 and Src to form the CXCR4/β-arrestin-1/Src signalosome, which transactivates EGFR leading to subsequent phosphorylation of ERK1/2 and GSK-3β. The phosphorylation of GSK-3β leads to its inactivation, resulting in the dephosphorylation and stabilization of β-catenin ( Figure 4J). This cascade of events causes β-catenin activation and its nuclear translocation, wherein it interacts with TCF/LEF transcription factors to stimulate the transcription of its target genes, resulting in podocyte injury/ dysfunction and proteinuria. These studies provide significant insights into the molecular mechanism by which CXCR4 activation causes podocyte injury and proteinuria. Our findings also underscore a novel Wnt-independent pathway that leads to β-catenin activation in glomerular podocytes in the evolution of proteinuric kidney disease.  An interesting finding of the present study is that the SDF-1α/CXCR4 induces podocyte injury by activating β-catenin through a Wnt-independent pathway. Although increasing evidence indicates that Wnt/β-catenin is implicated in mediating proteinuric CKD including ADR nephropathy, most previous studies have focused on the canonical Wnt signaling [7,12]. For instance, advanced oxidation protein products (AOPPs), a biomarker and mediator of reactive oxidative species (ROS), have been shown to induce Wnt ligands such as Wnt1 and Wnt7a in podocytes, which leads to β-catenin activation and podocyte dysfunction and damage [7]. Studies also demonstrate that TGF-β1 promotes podocyte injury and proteinuria by inducing Wnt1 expression [39]. However, CXCR4 stimulation by SDF-1α does not affect the expression of Wnt ligands at 0.5 and 24 h ( Figure 2E and Figure S2), although it clearly induces β-catenin activation in podocytes ( Figure 2). Notably, β-catenin activation triggered by SDF-1α/CXCR4 takes place very quickly, occurring as early as 30 min after SDF-1α stimulation, which is followed by β-catenin nuclear translocation (Figure 2). These observations suggest that SDF-1α/CXCR4 activates β-catenin by a mechanism independent of Wnt induction. This speculation is also in line with numerous earlier observations showing that a diverse array of factors, such as Hippo, YAP/TAZ, hedgehog and Smad7, can activate β-catenin in a Wnt-independent fashion [40][41][42][43][44]. It is also reported that SDF-1α/CXCR4 signaling can activate β-catenin in colorectal and pancreatic cancer cells [20,21]. In addition, degradation of E-cadherin by MMP-7 also leads to the dissociation of E-cadherin/β-catenin complex, resulting in the liberation and subsequent activation of β-catenin in kidney tubular cells [19]. Activation of cannabinoid receptor type 2 (CB2) also induces the formation of a β-arrestin-1/Src/β-catenin complex in renal tubular cells, which further triggers the nuclear translocation of β-catenin and causes fibrotic response [45]. Taken together, these findings underscore that Wnt-independent β-catenin activation could be a broad non-canonical mechanism that is operated in multiple cells under many circumstances.
This study has also uncovered how the formation of CXCR4/β-arrestin-1/Src signalosome leads to β-catenin activation. It appears that the formation of CXCR4/β-arrestin-1/Src signalosome triggers a sequential phosphorylation of Src, EGFR, ERK1/2 and GSK-3β ( Figure 4). This conclusion is supported by the dynamics and sequences of the phosphorylation of these proteins, as the abundances of p-Src and p-EGFR are increased as early as 5 min after incubation with SDF-1α in podocytes, while p-ERK1/2 and p-GSK-3β levels start to increase at 15 min and reach to the peak at 30 min, respectively ( Figure 4). The phosphorylation of ERK1/2 and GSK-3β is blocked by either knocking down of β-arrestin-1 or treatment with U0126, the highly selective inhibitor of ERK upstream kinases MEK1 and MEK2. This cascade of phosphorylation of signal proteins is also in line with many previous reports [34,35]. For instance, ERK activation has been shown to cause GSK-3β phosphorylation and inactivation, leading to β-catenin activation [48]. Taken together, it is conceivable that CXCR4 activation in podocytes recruits β-arrestin-1 and Src, leading to the formation of CXCR4/β-arrestin-1/Src signalosome, which causes Src phosphorylation and leads to transactivation of EGFR and its downstream ERK1/2, thereby triggering GSK-3β inactivation and β-catenin stabilization and activation ( Figure 4J). Consistent with this notion, inhibition of β-catenin signaling by ICG-001, a small molecule inhibitor that blocks β-catenin-mediated gene transcription [26], preserves podocyte integrity and prevents against podocyte damage by SDF-1α in glomerular mini-organ culture ex vivo ( Figure 5).
The important role of CXCR4 in podocyte injury and proteinuria is unambiguously confirmed in mice with podocyte-specific ablation of CXCR4 in vivo. Consistent with podocyte-specific deletion of β-catenin [12], ablation of CXCR4 does not cause overt abnormality in mice under normal physiological conditions, suggesting that CXCR4 is dispensable for podocyte maturation, survival and function. This is not totally surprising, as the levels of CXCR4 and β-catenin in normal glomeruli are hardly detectable ( Figure 1). However, podocyte-specific deletion of CXCR4 markedly reduces proteinuria after challenged with ADR and preserves podocyte integrity by restoring the expression of WT1, nephrin and podocalyxin ( Figure 6). These beneficial effects are associated with the inhibition of β-catenin, accompanied by repression of β-catenin target genes such as MMP-7, Snail1 and PAI-1 after ADR challenge (Figure 7). These observations underline the pathogenic action of CXCR4 in glomerular podocytes by activating β-catenin signaling. Therefore, targeted inhibition of this signal pathway might be an effective strategy for the prevention and treatment of proteinuric CKD.
The present study has some limitations, in which only ADR model of podocyte injury and proteinuria was used. In view of that CXCR4 and β-catenin are upregulated in the glomeruli of several CKD models (Figure 1), future studies using other models of glomerular diseases or intervention strategies are warranted. Furthermore, because mice with C57BL/6J background are generally resistant to ADR injury, high dose of this drug is required to trigger podocyte injury and proteinuria, which leads to animal loss and reduces the sample size. Of interest, the loss of animals only occurs in the podo-CXCR4+/+ mice within 2 weeks, but not in the podoc-CXCR4-/counterparts, implying that the renoprotective role of podocyte-specific deletion of CXCR4 could be underestimated in this study. More studies are needed in this area.
In summary, we show herein that CXCR4 mediates podocyte injury and proteinuria by activating β-catenin via a cascade of events involving β-arrestin-1, Src, EGFR, ERK1/2, GSK-3β. Podocyte-specific deletion of CXCR4 blunts β-catenin activation, ameliorates podocyte injury, reduces proteinuria and glomerulosclerosis, thereby halting the progression of CKD. This study provides significant insights into the mechanism by which CXCR4 mediates podocyte injury. Targeting any key step in the cascade of this signaling may open new avenues for developing the treatment of proteinuric kidney diseases.