Vasopressin Induces Urinary Uromodulin Secretion By Activating PKA (Protein Kinase A)

Urinary uromodulin, secreted by renal tubular cells, protects against urinary tract infections and kidney stones. In contrast, the intracellular accumulation of uromodulin is associated with hypertension and chronic kidney disease. However, the physiological stimuli for urinary uromodulin secretion remain largely unknown. Here, we showed that desmopressin, a vasopressin type 2 receptor agonist, dramatically increased short-term tubular uromodulin secretion in mice. Immunofluorescence studies and ultracentrifugation-based polymerization assay suggested that desmopressin induced intraluminal polymeric filaments of uromodulin, indicating physiologically functional secretion. As a result of increased excretion, uromodulin abundance in the murine kidney was clearly reduced by desmopressin. We investigated kidney epithelial cells stably expressing uromodulin to clarify the molecular mechanism. Apical uromodulin secretion was clearly increased in response to vasopressin/cAMP signaling, consistent with in vivo experiments. We also demonstrated that the response was dependent on epithelial cell polarity and cyclic AMP-dependent PKA (protein kinase A) signaling pathway. cAMP-mediated activation of proteases was suggested to be involved. In contrast, basolateral secretion of uromodulin was independent of cAMP signaling. Our work revealed vasopressin/cAMP/PKA signaling as a physiological stimulus of urinary uromodulin secretion. This finding may provide the basis for novel treatment strategies for urinary tract infections, kidney stones, and potentially hypertension and chronic kidney disease.

Automated summary

Desmopressin, a vasopressin type 2 receptor agonist, significantly increases short-term tubular uromodulin secretion in mice and reduces uromodulin abundance in the kidney. It activates uromodulin secretion in kidney epithelial cells through vasopressin/cAMP signaling, dependent on epithelial cell polarity and cyclic AMP-dependent PKA pathway. This discovery of vasopressin/cAMP/PKA signaling as a physiological stimulus for urinary uromodulin secretion may lead to novel treatment strategies for urinary tract infections, kidney stones, hypertension, and chronic kidney disease.