Nature Communications (Nov 2023)

Strong protective effect of the APOL1 p.N264K variant against G2-associated focal segmental glomerulosclerosis and kidney disease

  • Yask Gupta,
  • David J. Friedman,
  • Michelle T. McNulty,
  • Atlas Khan,
  • Brandon Lane,
  • Chen Wang,
  • Juntao Ke,
  • Gina Jin,
  • Benjamin Wooden,
  • Andrea L. Knob,
  • Tze Y. Lim,
  • Gerald B. Appel,
  • Kinsie Huggins,
  • Lili Liu,
  • Adele Mitrotti,
  • Megan C. Stangl,
  • Andrew Bomback,
  • Rik Westland,
  • Monica Bodria,
  • Maddalena Marasa,
  • Ning Shang,
  • David J. Cohen,
  • Russell J. Crew,
  • William Morello,
  • Pietro Canetta,
  • Jai Radhakrishnan,
  • Jeremiah Martino,
  • Qingxue Liu,
  • Wendy K. Chung,
  • Angelica Espinoza,
  • Yuan Luo,
  • Wei-Qi Wei,
  • Qiping Feng,
  • Chunhua Weng,
  • Yilu Fang,
  • Iftikhar J. Kullo,
  • Mohammadreza Naderian,
  • Nita Limdi,
  • Marguerite R. Irvin,
  • Hemant Tiwari,
  • Sumit Mohan,
  • Maya Rao,
  • Geoffrey K. Dube,
  • Ninad S. Chaudhary,
  • Orlando M. Gutiérrez,
  • Suzanne E. Judd,
  • Mary Cushman,
  • Leslie A. Lange,
  • Ethan M. Lange,
  • Daniel L. Bivona,
  • Miguel Verbitsky,
  • Cheryl A. Winkler,
  • Jeffrey B. Kopp,
  • Dominick Santoriello,
  • Ibrahim Batal,
  • Sérgio Veloso Brant Pinheiro,
  • Eduardo Araújo Oliveira,
  • Ana Cristina Simoes e Silva,
  • Isabella Pisani,
  • Enrico Fiaccadori,
  • Fangming Lin,
  • Loreto Gesualdo,
  • Antonio Amoroso,
  • Gian Marco Ghiggeri,
  • Vivette D. D’Agati,
  • Riccardo Magistroni,
  • Eimear E. Kenny,
  • Ruth J. F. Loos,
  • Giovanni Montini,
  • Friedhelm Hildebrandt,
  • Dirk S. Paul,
  • Slavé Petrovski,
  • David B. Goldstein,
  • Matthias Kretzler,
  • Rasheed Gbadegesin,
  • Ali G. Gharavi,
  • Krzysztof Kiryluk,
  • Matthew G. Sampson,
  • Martin R. Pollak,
  • Simone Sanna-Cherchi

DOI
https://doi.org/10.1038/s41467-023-43020-9
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 8

Abstract

Read online

Abstract African Americans have a significantly higher risk of developing chronic kidney disease, especially focal segmental glomerulosclerosis -, than European Americans. Two coding variants (G1 and G2) in the APOL1 gene play a major role in this disparity. While 13% of African Americans carry the high-risk recessive genotypes, only a fraction of these individuals develops FSGS or kidney failure, indicating the involvement of additional disease modifiers. Here, we show that the presence of the APOL1 p.N264K missense variant, when co-inherited with the G2 APOL1 risk allele, substantially reduces the penetrance of the G1G2 and G2G2 high-risk genotypes by rendering these genotypes low-risk. These results align with prior functional evidence showing that the p.N264K variant reduces the toxicity of the APOL1 high-risk alleles. These findings have important implications for our understanding of the mechanisms of APOL1-associated nephropathy, as well as for the clinical management of individuals with high-risk genotypes that include the G2 allele.