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Proteinuria: is it all in the foot?
Pierre Ronco
Pierre Ronco
Published August 1, 2007
Citation Information: J Clin Invest. 2007;117(8):2079-2082. https://doi.org/10.1172/JCI32966.
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Commentary

Proteinuria: is it all in the foot?

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Abstract

Despite significant advances in our understanding of the molecular structure and composition of the glomerular filtration barrier, the mechanisms underlying the presence of excess protein in the urine (proteinuria) in acquired human kidney diseases remain elusive. In a study appearing in this issue of the JCI, Sever and associates use a combination of biochemical, genetic, and in vivo approaches in mice to demonstrate a pivotal role of cathepsin L and its substrate the GTPase dynamin, in the induction of proteinuria and associated foot process effacement in glomerular podocytes (see the related article beginning on page 2095).

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Pierre Ronco

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Figure 1

The glomerular filtration barrier.

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The glomerular filtration barrier.
Blood enters the glomerular capillari...
Blood enters the glomerular capillaries and is filtered across the endothelium and the glomerular basement membrane and through the filtration slits between podocyte foot processes to produce the primary urine filtrate. In healthy glomeruli, this barrier restricts the passage of macromolecules. In this issue of the JCI, Sever et al. (10) show that CatL, the expression of which is increased in human proteinuric diseases and in an LPS-induced mouse model of proteinuria, causes proteinuria and foot process effacement through cleavage of the GTPase dynamin, an actin-binding protein. The same effects are induced by gene delivery into mice of dynK44A — a mutant form of dynamin that does not bind GTP — or of the CatL-cleaved product of dynamin (p40). Conversely, gene delivery into proteinuric mice of dynL356Q and dynR725A, two CatL-resistant dynamin mutants, reverses proteinuria and foot process effacement. Figure modified from ref. 28.

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