A Novel Role of Hyaluronan and its Membrane Receptors, CD44 and RHAMM in Obesity-Related Glomerulopathy

Obesity-related glomerulopathy (ORG) contributes to diabetic nephropathy and kidney cancer, leading to chronic/end-stage kidney disease. To date, treatments for ORG are limited because of incomplete understanding of the disease pathogenesis. Here, we identified a novel role for hyaluronan (HA) and its membrane receptors, CD44 and RHAMM in obesity-associated renal inflammation, fibrosis, tubular injury, and kidney dysfunction. Pharmacological and genetic ablation of HA, CD44 or RHAMM reversed these renal disorders induced by high fat diet feeding in mice in vivo. Increased HA content, and CD44 and RHAMM expression damaged the kidney via activation of TGF-β1/Smad2/3, P38/JNK MAPK and ROCK/ERK pathways. We further established a link between renal insulin resistance and ECM remodelling using human kidney cells in vitro, shedding mechanistic insight into the role of HA, CD44 and RHAMM in the pathogenesis of ORG. Furthermore, in human kidney biopsies gene expression of CD44 and RHAMM was increased in chronic kidney disease and diabetic nephropathy, and their levels were correlated with markers of kidney (dys)function (GFR, serum creatinine, proteinuria). Our findings provide evidence for HA-CD44/RHAMM as a potential therapeutic target in ORG and consequent prevention of chronic kidney disease.