Physiological role of renal ketogenesis in sodium-water regulation

 

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Physiological role of renal ketogenesis in sodium-water regulation

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Shinji
Kume
Sho Sugahara ssho1984@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Shogo Kuwagata skuwaga@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Yuki Sasaki tanakayk@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Kosuke Yamahara yamakou@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Mako Yasuda-Yamahara mako204@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Masami Chin-Kanasaki msm@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan -
Shinji Kume skume@belle.shiga-med.ac.jp Shiga University of Medical Science Department of Nephrology Otsu-shi, Shiga Japan *
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The organ-protective effects of dietary restriction and SGLT2 inhibitors observed in large clinical trials have highlighted ketone bodies as potential mechanistic mediators. Although the liver is the main site of ketone body production, emerging evidence indicates that the kidney also has this capability. However, the physiological role of renal ketogenesis remains poorly understood. In this study, we investigated the functional significance of renal ketone bodies.

Single-cell RNA sequencing (scRNA-seq) was conducted on renal tissues from mice subjected to both fasting and non-fasting conditions. Immunostaining for Hmgcs2, the key enzyme involved in ketone body synthesis, was carried out to ascertain its localization. Mice with proximal tubule-specific knockout of Hmgcs2 (Hmgcs2ΔPT) were generated via crossing SLC34a1-CreER mice with Hmgcs2-flox mice. Both wild-type and Hmgcs2ΔPT mice underwent fasting protocols. Renal tissue ketone concentrations were analyzed through mass spectrometry imaging (MSI). Additionally, measurements of urine volume, osmolality, and electrolyte concentrations were performed.

scRNA-seq and immunostaining showed that Hmgcs2 expression was mainly localized to the proximal tubules during fasting. In Hmgcs2ΔPT mice, Hmgcs2 expression was blunted in the proximal tubules. Although blood ketone levels did not change significantly, renal tissue ketone levels during fasting determined by MSI were notably lower in Hmgcs2-PTCKO mice. These mice also had increased urine volume and higher urinary sodium excretion compared to WT controls only under fasting conditions.

These findings indicate that ketone bodies are physiologically produced in the kidneys during fasting and play a role in urine concentration. Impaired renal ketogenesis may lead to a decreased ability to concentrate urine during fasting.

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