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

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  • 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
  • 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

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.

Original languageEnglish
Article number7836
JournalNature Communications
Volume14
Number of pages8
ISSN2041-1723
DOIs
Publication statusPublished - 2023

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Publisher Copyright:
© 2023, The Author(s).

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