Lysosomal enzymuria is a feature of hereditary Fanconi syndrome and is related to elevated CI-mannose-6-P-receptor excretion.

BACKGROUND: Lysosomal enzymuria is usually considered to be a non-specific marker of renal injury, but little is known about lysosomal enzyme excretion in renal proximal tubular cell disorders such as the renal Fanconi syndrome (FS). We examined excretion of two lysosomal enzymes and the cation-independent mannose-6-phosphate receptor (CI-MPR) in patients with inherited FS. METHODS: The lysosomal enzyme cathepsin D was measured by ELISA and isolated by pepstatin-agarose affinity chromatography; N-acetyl-beta-d-glucosaminidase (NAG) was assayed colorimetrically, as was the cytosolic enzyme lactate dehydrogenase (LDH). Cathepsin D, procathepsin D and CI-MPR were also detected by western blotting. No patient had a serum creatinine concentration >170 micromol/L. Soluble CI-MPR, isolated from fetal calf serum and bound to agarose, was used to probe cathepsin D for mannose-6-phosphate (M6P). RESULTS: Increased excretion of cathepsin D (mean = 44-fold) and NAG (mean = 12-fold) was found in FS patients: Dent's disease (n = 5), cystinosis (n = 4), Lowe syndrome (n = 3) and 'autosomal dominant idiopathic FS' (ADIF) (n = 2). Increased cathepsin D excretion was confirmed by western blotting; excretion of procathepsin D and LDH was not increased. When compared with control subjects, CI-MPR excretion was also increased in FS (n = 6). Thus, significantly increased excretion of lysosomal enzymes and CI-MPR was found in all cases of FS examined. Cathepsin D binding to CI-MPR-agarose was inhibited by M6P. CONCLUSIONS: We conclude that underlying gene defects in FS may disrupt normal membrane trafficking of CI-MPR, leading to mistrafficking of lysosomal enzymes via a default pathway from the Golgi to the apical surface of proximal tubule cells rather than to lysosomes. Lysosomal enzymes are then secreted into the tubular fluid and excreted in the urine. This contrasts with the widely held view that cell necrosis is the cause of lysosomal enzymuria in renal disease. Moreover, cathepsin D in FS urine is M6P-tagged.

Quantitative amino acid and proteomic analysis: very low excretion of polypeptides >750 Da in normal urine.

BACKGROUND: Quantitative data on protein and polypeptide excretion in normal urine are lacking. In Fanconi syndrome, failure of proximal tubular protein reabsorption leads to 'tubular' proteinuria, but little is known about peptide excretion. METHODS: Urine from normal (N=5) and Fanconi patients (Dent's disease, N=2; Lowe syndrome, N=3) was fractionated by size-exclusion chromatography into proteins (>10 kD) and smaller polypeptides. Each fraction was subjected to amino acid analysis after acid hydrolysis. In complementary proteomic approaches, urinary polypeptides were each subjected to reversed-phase high-performance liquid chromatography (HPLC) followed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and nano-flow liquid chromatography directly coupled to electrospray ionization/tandem mass spectrometry (NanoLC-ESI-MS/MS) before and after tryptic digestion. RESULTS: Based on amino acid composition, normal human urine, excluding Tamm-Horsfall protein, contains 33.7 +/- 10.7 mg protein per 24 hr (mean +/- SEM) protein defined as polypeptide >10 kD; peptide content in range 750 Da to 10 kD is 22.0 +/- 9.6 mg. Fanconi patients excrete greatly increased amounts of protein, 1740 +/- 660 mg/24 hr, and peptide, 446 +/- 145 mg/24 hr. Peptides 2 to 5 kD were present in 12.9- +/- 3.9-fold excess in Fanconi compared with normal urine. In contrast, free amino acid excretion in Fanconi was elevated only 2.14- +/- 0.73-fold. Mass spectrometric techniques determined that the major form of albumin in both normal and Fanconi urine was the full-length protein, and did not detect significant peptides of nonrenal origin. CONCLUSION: There is only very low excretion of polypeptides >750 Da in normal human urine. In Fanconi syndrome, excretion of unknown peptides of mass 2 to 5 kD, possibly relevant to the development of renal failure, is greatly increased.