APOL1-mediated monovalent cation transport contributes to APOL1-mediated podocytopathy in kidney disease

Two coding variants of apolipoprotein L1 (APOL1) called G1 and G2 explain much of the excess risk of kidney disease in African Americans. While various cytotoxic phenotypes have been reported in experimental models, the proximal mechanism by which G1 and G2 cause kidney disease is poorly understood. Here, we leveraged three experimental models and a recently reported small molecule blocker of APOL1 protein, VX-147, to identify the upstream mechanism of G1-induced cytotoxicity. In HEK293 cells, we demonstrated that G1-mediated Na+ import/K+ efflux triggered activation of G protein-coupled receptor (GPCR)-IP3-mediated calcium release from the endoplasmic reticulum (ER), impaired mitochondrial ATP production, and impaired translation, which were all reversed by VX-147. In human podocyte-like epithelial cells (HUPEC), we demonstrated that G1 caused cytotoxicity that was again reversible by VX-147. Finally, in podocytes isolated from APOL1 G1 transgenic mice, we showed that Interferon gamma (IFNγ)-mediated induction of G1 caused K+ efflux, activation of GPCR-IP3 signaling, and inhibition of translation, podocyte injury, and proteinuria, all reversed by VX-147. Together, these results establish APOL1-mediated Na+/K+ transport as the proximal driver of APOL1-mediated kidney disease.