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      Quantitative proteomics reveals novel therapeutic and diagnostic markers in hypertension

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          Abstract

          Hypertension is a prevalent disorder in the world representing one of the major risk factors for heart attack and stroke. These risks are increased in salt sensitive individuals. Hypertension and salt sensitivity are complex phenotypes whose pathophysiology remains poorly understood and, remarkably, salt sensitivity is still laborious to diagnose.

          Here we present a urinary proteomic study specifically designed to identify urinary proteins relevant for the pathogenesis of hypertension and salt sensitivity. Despite previous studies that underlined the association of UMOD gene variants with hypertension, this work provides novel evidence showing different uromodulin protein level in the urine of hypertensive patients compared to healthy individuals. Notably, we also show that patients with higher level of uromodulin are homozygous for UMOD risk variant and display a decreased level of salt excretion, highlighting the essential role of UMOD in the regulation of salt reabsorption in hypertension. Additionally, we found that urinary nephrin 1, a marker of glomerular slit diaphragm, may predict a salt sensitive phenotype and positively correlate with increased albuminuria associated with this type of hypertension.

          Highlights

          • We identified urinary proteins differently excreted in hypertensive patients.

          • Nephrin 1 might predict salt sensitive phenotype and glomerular complications.

          • Uromodulin impacts salt homeostasis in hypertension.

          • We provide new insights into the pathogenesis of hypertension and salt sensitivity.

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          Most cited references42

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          Gene Ontology: tool for the unification of biology

          Genomic sequencing has made it clear that a large fraction of the genes specifying the core biological functions are shared by all eukaryotes. Knowledge of the biological role of such shared proteins in one organism can often be transferred to other organisms. The goal of the Gene Ontology Consortium is to produce a dynamic, controlled vocabulary that can be applied to all eukaryotes even as knowledge of gene and protein roles in cells is accumulating and changing. To this end, three independent ontologies accessible on the World-Wide Web (http://www.geneontology.org) are being constructed: biological process, molecular function and cellular component.
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            The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease.

            In recent years, the focus of interest on the role of the renin-angiotensin system (RAS) in the pathophysiology of hypertension and organ injury has changed to a major emphasis on the role of the local RAS in specific tissues. In the kidney, all of the RAS components are present and intrarenal angiotensin II (Ang II) is formed by independent multiple mechanisms. Proximal tubular angiotensinogen, collecting duct renin, and tubular angiotensin II type 1 (AT1) receptors are positively augmented by intrarenal Ang II. In addition to the classic RAS pathways, prorenin receptors and chymase are also involved in local Ang II formation in the kidney. Moreover, circulating Ang II is actively internalized into proximal tubular cells by AT1 receptor-dependent mechanisms. Consequently, Ang II is compartmentalized in the renal interstitial fluid and the proximal tubular compartments with much higher concentrations than those existing in the circulation. Recent evidence has also revealed that inappropriate activation of the intrarenal RAS is an important contributor to the pathogenesis of hypertension and renal injury. Thus, it is necessary to understand the mechanisms responsible for independent regulation of the intrarenal RAS. In this review, we will briefly summarize our current understanding of independent regulation of the intrarenal RAS and discuss how inappropriate activation of this system contributes to the development and maintenance of hypertension and renal injury. We will also discuss the impact of antihypertensive agents in preventing the progressive increases in the intrarenal RAS during the development of hypertension and renal injury.
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              Common noncoding UMOD gene variants induce salt-sensitive hypertension and kidney damage by increasing uromodulin expression

              Elevated blood pressure (BP) and chronic kidney disease (CKD) are complex traits representing major global health problems 1,2 . Multiple genome-wide association studies (GWAS) identified common variants giving independent susceptibility for CKD and hypertension in the promoter of the UMOD gene 3-9 , encoding uromodulin, the major protein secreted in the normal urine. Despite compelling genetic evidence, the underlying biological mechanism is not understood. Here, we demonstrate that UMOD risk variants directly increase UMOD expression in vitro and in vivo. We modeled this effect in transgenic mice and showed that uromodulin overexpression leads to salt-sensitive hypertension and to age-dependent renal lesions that are similarly observed in elderly subjects homozygous for UMOD risk variants. We demonstrate that the link between uromodulin and hypertension is caused by activation of the renal sodium co-transporter NKCC2. This very mechanism is relevant in humans, as pharmacological inhibition of NKCC2 is more effective in lowering BP in hypertensive patients homozygous for UMOD risk variants. Our findings establish a link between the genetic susceptibility to hypertension and CKD, the control of uromodulin expression and its role in a salt-reabsorbing tubular segment of the kidney. These data point to uromodulin as a novel therapeutic target to lower BP and preserve renal function.
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                Author and article information

                Contributors
                Journal
                BBA Clin
                BBA Clin
                BBA Clinical
                Elsevier
                2214-6474
                22 October 2014
                December 2014
                22 October 2014
                : 2
                : 79-87
                Affiliations
                [a ]IFOM-FIRC Institute of Molecular Oncology, Milan, Italy
                [b ]Chair of Nephrology, Department of Cardio-Vascular Medicine, Second University of Naples, Naples, Italy
                [c ]Genomics of Renal Diseases and Hypertension Unit, Division of Genetics & Cell Biology, San Raffaele Scientific Institute, Milan, Italy
                [d ]Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy
                [e ]Chair of Nephrology, University Vita-Salute San Raffaele, Milan, Italy
                Author notes
                [* ]Corresponding author at: IFOM-FIRC Institute of Molecular Oncology, Via Adamello 16, 20139 Milano, Italy. Tel.: + 39 02574303873; fax: + 39 02574303244. angela.bachi@ 123456ifom.eu
                Article
                S2214-6474(14)00024-5
                10.1016/j.bbacli.2014.10.001
                4633972
                26672470
                c3a02144-17e0-4b93-9d2e-aed08f11eaea
                © 2014 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                : 5 August 2014
                : 1 October 2014
                : 6 October 2014
                Categories
                Regular Article

                bp, blood pressure,lc–ms/ms, liquid chromatography coupled to tandem mass spectrometry,bmi, body mass index,ss, salt sensitive,sr, salt resistant,sbp, systolic bp,dbp, diastolic bp,mq, maxquant,go, gene ontology,mbp, mean bp.,salt sensitive hypertension,urinary biomarker,quantitative proteomics,uromodulin,salt homeostasis,nephrinuria,glomerular injury

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