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463 Identification of molecular and cellular events during recurrence of focal segmental glomerulosclerosis in human allografts

Published online by Cambridge University Press:  11 April 2025

Haseeb Zubair
Affiliation:
University of Maryland School of Medicine, Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Thomas V Rousselle
Affiliation:
Institute for Genome Sciences, School of Medicine, University of Maryland School; Baltimore, MD 21201, USA
Amol C Shetty
Affiliation:
Institute for Genome Sciences, School of Medicine, University of Maryland School; Baltimore, MD 21201, USA
Azim Shafquat
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Akalin Enver
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Manish Talwar
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Daniel G Maluf
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Gallon Lorenzo
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Valeria R Mas
Affiliation:
Surgical Sciences Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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Abstract

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Objectives/Goals: The identification of the cascade of molecular and cellular events occurring during the progression of focal segmental glomerulosclerosis in human kidney biopsies from kidney transplant (KTx) recipients (KTR) with normal function or recurrent FSGS to determine potential targets of intervention and therapy. Methods/Study Population: In this study, we evaluate the molecular and cellular events associated with primary FSGS in both native and transplant kidneys. We collected biopsy samples from the native normal kidney (nNK, n = 3), normal functioning allografts (NKTx, n = 3), primary FSGS in the native kidney (nFSGS, n = 1), recurrent FSGS (KTxFSGS, n = 5). KTxFSGS comprises a collection of longitudinal samples with biopsy also collected at the subsequent recurrence. Blood samples were collected during biopsy collection. Biopsies were preserved in RNAlater at the time of collection. 10X genomics chromium single nuclei RNA sequencing (snRNAseq) was performed using isolated nuclei. Data was analyzed using Seurat on R. Conditionally immortalized podocytes were treated with a patient serum to determine the change in expression observed in snRNAseq data. Results/Anticipated Results: Recurrence rates of primary FSGS are high in kidney allograft recipients up to 25–50% in first, and up to 80% in second transplants, often leading to graft loss. Our findings reveal that podocyte detachment is driven by metabolic and structural dysregulation rather than cell death, increasing VEGFA expression and disrupting glomerular endothelial cell growth and permeability. Parietal epithelial cells initially compensate by dedifferentiating toward podocytes but later increase collagen deposition, contributing to glomerular sclerosis. Increased interactions of glomerular cells with B cells exacerbate extracellular matrix deposition and scarring. We also observed tubular sclerosis and disruption of the regenerative potential of proximal tubular cells, with increased interaction with T cells. Discussion/Significance of Impact: These findings offer new insights into the pathogenesis of recurrent FSGS and suggest potential therapeutic targets and establishes a foundation for future studies to further evaluate the role of metabolic dysfunction as the cause of podocyte injury and loss.

Type
Precision Medicine/Health
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2025. The Association for Clinical and Translational Science