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Dryad

In vivo expression of VCAM1 precedes nephron loss following kidney tubular necrosis

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Sep 19, 2025 version files 56.24 GB

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Abstract

Nephron loss is a key event during the onset and progression of chronic kidney disease, yet the mechanisms determining whether tubules undergo successful repair or progress to atrophy remain poorly understood. While fibrosis has been proposed to drive progressive organ damage, antifibrotic therapies have failed in clinical trials. Here, we reveal that tubular VCAM1-expression precedes nephron loss, fibrosis, and long-term kidney dysfunction. Using serial intravital microscopy in transgenic mice, we track tubulointerstitial remodeling between injured and intact tissue over 3 weeks. VCAM1 is rapidly induced in a distinct subset of injured tubules, preceding atrophy with sustained fibroblast recruitment. However, fibroblasts remain confined to injury sites and do not cause secondary damage in uninjured tubules. Finally, in human kidney transplant biopsies, tubular VCAM1 expression - but not KIM1 - correlates negatively with early and 12-month graft function, underscoring its potential as a biomarker of adverse outcomes. These findings position VCAM1 as an early indicator of tubular fate and nephron loss.