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Kidney Week

Abstract: FR-OR104

Amphiregulin Drives Kidney Fibrosis in Mice and Its Elevated Serum Levels Correlate with CKD Outcomes in Humans

Session Information

Category: CKD (Non-Dialysis)

  • 1903 CKD (Non-Dialysis): Mechanisms


  • Kefalogianni, Eirini, Washington University in St. Louis, St. Louis, Missouri, United States
  • Keerthi raja, Manikanda raja, Washington University in St. Louis, St. Louis, Missouri, United States
  • Pliaka, Vaia, Protavio, Athens, Greece
  • Schumacher, Julian, Washington University in St. Louis, St. Louis, Missouri, United States
  • Alexopoulos, Leonidas G., National Technical Univ of Athens, Glyfada, Greece
  • Waikar, Sushrut S., Harvard Medical School , Boston, Massachusetts, United States
  • Herrlich, Andreas, Washington University in St. Louis, St. Louis, Missouri, United States

We have shown that ADAM17-released EGFR ligands in proximal tubule cells (PTCs) drive kidney fibrosis in IRI and UUO kidney injury models (Kefaloyianni et al, JCI Insight 2016). Which specific EGFR ligands are involved remains unknown. We showed that amphiregulin (AREG) is the most upregulated EGFR ligand after kidney injury in mice and the most potent EGFR ligand in inducing pro-inflammatory and pro-fibrotic genes in human PTCs (HPTCs) in vitro. Soluble AREG (sAREG) is significantly elevated in the urine of AKI and CKD patients and AREG protein is elevated in CKD biopsies, as compared to healthy controls. It is not known whether AREG has a key role in mediating injury-induced kidney fibrosis in mice and humans.


We used tamoxifen inducible AREGfl/fl-Slc34a1GCE+/--tdTomato+ (AREG-PTC KO) mice and ADAM17fl/fl-Slc34a1GCE+/--tdTomato+ (ADAM17-PTC KO) mice and their respective wt littermates, as well as HPTCs transfected with control or YAP1 siRNA. We also developed and extensively validated a sensitive bead-based ELISA for sAREG in human serum samples.


We found that sAREG can uniquely sustain EGFR activation in HPTC in vitro via YAP1-dependent upregulation of its own transcript, followed by ADAM17-dependent release of sAREG (positive feedback). In vivo, AREG-PTC-KO reduced IRI-induced sustained EGFR phosphorylation, as well as upregulation of pro-inflammatory cytokines and pro-fibrotic markers. We show that in ADAM17-PTC-KO mice, which cannot release any injury-induced EGFR ligand in PTC, injection of sAREG alone is sufficient to induce production of pro-inflammatory and pro-fibrotic factors to the levels of ADAM17 wt mice. Finally, we show that sAREG serum levels correlate positively with serum creatinine and CKD stage and negatively with eGFR in a nephrectomy cohort (n=69) of patients with various diagnosis and levels of fibrosis.


These results suggest that AREG is a major driver of kidney fibrosis in mice and humans, acting via a YAP1-dependent positive feedback loop that sustains EGFR activation and induces pro-inflammatory and pro-fibrotic cytokines, and represents a potential functional marker of fibrosis and CKD progression.


  • NIDDK Support