A Drosophila model for Dent disease reveals impaired ER export of Cubilin as pathogenic mechanism

Mutations in the CLCN5 gene encoding the chloride-hydrogen exchanger ClC-5 cause Dents disease, a genetic disorder of the endolysosomal pathway in the proximal tubules of the kidneys. Many patients also develop glomerular lesions, but the underlying mechanism is unclear. We have established an in vivo model for Dents disease using Drosophila nephrocytes that share similarities with podocytes and proximal tubular cells. Upon depletion of ClC-c, the fly homologue of CLCN5, the endocytic receptor Cubilin was lost from the cortex of nephrocytes, which led to a strong decrease in albumin uptake and slit diaphragm (SD) turnover. Moreover, the actin and microtubular cytoskeleton as well as Rab11-marked recycling endosomes showed a strong cortical accumulation, whereas cholesterol-enriched autophagic compartments emerged in the perinuclear area. Cubilin exhibited a mild mislocalization to cortical early and late endosomal compartments and, in addition, strongly accumulated in the endoplasmic reticulum (ER). This was accompanied by a fragmentation of the ER morphology and an increase in ER exit sites and associated Golgi stacks. These secretory pathway phenotypes were also observed upon silencing of a subunit of the vacuolar H+-ATPase (V-ATPase) suggesting that they depend on acidification. Therefore, we speculate that ClC-c and the V-ATPase together acidify the Golgi to allow proper glycosylation and surface trafficking of Cubilin (or its binding partner Amnionless). Interestingly, ER retention of Cubilin was confirmed in ClC-5 knockout mice, underscoring the relevance of this pathomechanism for Dents disease. Translational statementIn this work, we study the function of the fly ortholog of CLCN5 whose mutations cause Dents disease, a devastating hereditary kidney disease. By demonstrating that the protein uptake receptor Cubilin is retained in the ER upon ClC-c/ClC-5 depletion in flies and mice, we provide an unexpected new disease mechanism for this disease. Future therapeutic strategies may be directed at improving ER export through acidification of the Golgi apparatus.