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Issler N, Afonso S, Weissman I, Jordan K, Cebrian-Serrano A, Meindl K, Dahlke E, Tziridis K, Yan G, Robles-López JM, Tabernero L, Patel V, Kesselheim A, Klootwijk ED, Stanescu HC, Dumitriu S, Iancu D, Tekman M, Mozere M, Jaureguiberry G, Outtandy P, Russell C, Forst AL, Sterner C, Heinl ES, Othmen H, Tegtmeier I, Reichold M, Schiessl IM, Limm K, Oefner P, Witzgall R, Fu L, Theilig F, Schilling A, Shuster Biton E, Kalfon L, Fedida A, Arnon-Sheleg E, Ben Izhak O, Magen D, Anikster Y, Schulze H, Ziegler C, Lowe M, Davies B, Böckenhauer D, Kleta R, Falik Zaccai TC, Warth R. A Founder Mutation in EHD1 Presents with Tubular Proteinuria and Deafness. J Am Soc Nephrol 2022; 33:732-745. [PMID: 35149593 PMCID: PMC8970462 DOI: 10.1681/asn.2021101312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The endocytic reabsorption of proteins in the proximal tubule requires a complex machinery and defects can lead to tubular proteinuria. The precise mechanisms of endocytosis and processing of receptors and cargo are incompletely understood. EHD1 belongs to a family of proteins presumably involved in the scission of intracellular vesicles and in ciliogenesis. However, the relevance of EHD1 in human tissues, in particular in the kidney, was unknown. METHODS Genetic techniques were used in patients with tubular proteinuria and deafness to identify the disease-causing gene. Diagnostic and functional studies were performed in patients and disease models to investigate the pathophysiology. RESULTS We identified six individuals (5-33 years) with proteinuria and a high-frequency hearing deficit associated with the homozygous missense variant c.1192C>T (p.R398W) in EHD1. Proteinuria (0.7-2.1 g/d) consisted predominantly of low molecular weight proteins, reflecting impaired renal proximal tubular endocytosis of filtered proteins. Ehd1 knockout and Ehd1R398W/R398W knockin mice also showed a high-frequency hearing deficit and impaired receptor-mediated endocytosis in proximal tubules, and a zebrafish model showed impaired ability to reabsorb low molecular weight dextran. Interestingly, ciliogenesis appeared unaffected in patients and mouse models. In silico structural analysis predicted a destabilizing effect of the R398W variant and possible inference with nucleotide binding leading to impaired EHD1 oligomerization and membrane remodeling ability. CONCLUSIONS A homozygous missense variant of EHD1 causes a previously unrecognized autosomal recessive disorder characterized by sensorineural deafness and tubular proteinuria. Recessive EHD1 variants should be considered in individuals with hearing impairment, especially if tubular proteinuria is noted.
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Affiliation(s)
- Naomi Issler
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Sara Afonso
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | - Irith Weissman
- Pediatric Nephrology, Galilee Medical Center, Nahraia, Israel
| | - Katrin Jordan
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | | | - Katrin Meindl
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | - Eileen Dahlke
- Institute of Anatomy, University of Kiel, Kiel, Germany
| | - Konstantin Tziridis
- Ear, Nose, and Throat Clinic, University Hospital Erlangen, Erlangen, Germany
| | - Guanhua Yan
- Division of Molecular and Cellular Function, University of Manchester, United Kingdom
| | - José M. Robles-López
- Division of Molecular and Cellular Function, University of Manchester, United Kingdom
| | - Lydia Tabernero
- Division of Molecular and Cellular Function, University of Manchester, United Kingdom
| | - Vaksha Patel
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Anne Kesselheim
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Enriko D. Klootwijk
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Horia C. Stanescu
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Simona Dumitriu
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Daniela Iancu
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Mehmet Tekman
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Monika Mozere
- Department of Renal Medicine, University College London, London, United Kingdom
| | | | - Priya Outtandy
- Department of Renal Medicine, University College London, London, United Kingdom
| | | | - Anna-Lena Forst
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | | | | | - Helga Othmen
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | - Ines Tegtmeier
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | - Markus Reichold
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
| | | | - Katharina Limm
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Peter Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Ralph Witzgall
- Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany
| | - Lifei Fu
- Structural Biology, University of Regensburg, Regensburg, Germany
| | | | - Achim Schilling
- Ear, Nose, and Throat Clinic, University Hospital Erlangen, Erlangen, Germany
| | | | - Limor Kalfon
- Institute of Human Genetics, Galilee Medical Center, Nahraia, Israel
| | - Ayalla Fedida
- Institute of Human Genetics, Galilee Medical Center, Nahraia, Israel
| | | | - Ofer Ben Izhak
- Department of Pathology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Daniella Magen
- Pediatric Nephrology Institute, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | | | - Holger Schulze
- Ear, Nose, and Throat Clinic, University Hospital Erlangen, Erlangen, Germany
| | | | - Martin Lowe
- Division of Molecular and Cellular Function, University of Manchester, United Kingdom
| | - Benjamin Davies
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Detlef Böckenhauer
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Robert Kleta
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Tzipora C. Falik Zaccai
- The Azrieli Faculty of Medicine, Bar Ilan, Safed, Israel
- Institute of Human Genetics, Galilee Medical Center, Nahraia, Israel
| | - Richard Warth
- Medical Cell Biology, University of Regensburg, Regensburg, Germany
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