Uromodulin p.His36Tyr promotes macrophage pyroptosis via App-Cd74 signaling to drive renal inflammation in ADTKD.

Wu, Qian-Qian; Peng, Si-Qi; Zhang, Yi-Lin; Yang, Yan; Shi, Wen; Wen, Xian-Li; Liu, Zhi-Ying; Zhou, Xu-Jie et al. · Nat Commun · 2026

basic_science · Level V

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Abstract

Autosomal dominant tubulointerstitial kidney disease -UMOD is characterized by progressive renal interstitial inflammation and fibrosis. However, its underlying mechanisms remain unclear. Here, we identify a large ADTKD pedigree harboring a novel UMOD p.H36Y mutation. Using CRISPR/Cas9 technology, we generated a Umod<sup>H36Y/+</sup> mouse model that recapitulates the key phenotypes observed in affected individuals, including renal dysfunction, cyst formation, and interstitial inflammation. Multi-omics analyses in kidneys from male Umod<sup>H36Y/+</sup> mice revealed marked macrophage pyroptosis. Mechanistically, the Umod p.H36Y variant activated the amyloid precursor protein (App)-Cd74 axis which mediated the crosstalk between renal mutant tubular cells and macrophages. This axis sustains NF-κB pathway activation in macrophages, initiating pyroptosis and pro-inflammatory cytokine release. The same mechanism is recapitulated in the UMOD p.Trp31Cys cell model. Notably, Pharmacologic inhibition using ARN2966, a small-molecule App inhibitor, attenuated renal injury in male Umod<sup>H36Y/+</sup> mice. Collectively, these findings uncover a targetable pathway in ADTKD-UMOD.