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The citrate transporter SLC13A5 as a therapeutic target for kidney disease: evidence from Mendelian randomization to inform drug development

Gill, D. and Zagkos, L. and Gill, R. and Benzing, T. and Jordan, J. and Birkenfeld, A.L. and Burgess, S. and Zahn, G. (2023) The citrate transporter SLC13A5 as a therapeutic target for kidney disease: evidence from Mendelian randomization to inform drug development. BMC Medicine, 21 (1), p. 504. BioMed Central (BMC). doi: 10.1186/s12916-023-03227-5. ISSN 1741-7015.

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Official URL: https://dx.doi.org/10.1186/s12916-023-03227-5

Abstract

Background Solute carrier family 13 member 5 (SLC13A5) is a Na+-coupled citrate co-transporter that mediates entry of extracellular citrate into the cytosol. SLC13A5 inhibition has been proposed as a target for reducing progression of kidney disease. The aim of this study was to leverage the Mendelian randomization paradigm to gain insight into the efects of SLC13A5 inhibition in humans, towards prioritizing and informing clinical development eforts. Methods The primary Mendelian randomization analyses investigated the efect of SLC13A5 inhibition on measures of kidney function, including creatinine and cystatin C-based measures of estimated glomerular fltration rate (creatinine-eGFR and cystatin C-eGFR), blood urea nitrogen (BUN), urine albumin-creatinine ratio (uACR), and risk of chronic kidney disease and microalbuminuria. Secondary analyses included a paired plasma and urine metabolome-wide association study, investigation of secondary traits related to SLC13A5 biology, a phenome-wide association study (PheWAS), and a proteome-wide association study. All analyses were compared to the efect of genetically predicted plasma citrate levels using variants selected from across the genome, and statistical sensitivity analyses robust to the inclusion of pleiotropic variants were also performed. Data were obtained from large-scale genetic consortia and biobanks, with sample sizes ranging from 5023 to 1,320,016 individuals. Results We found evidence of associations between genetically proxied SLC13A5 inhibition and higher creatinine-eGFR (p=0.002), cystatin C-eGFR (p=0.005), and lower BUN (p=3× 10−4). Statistical sensitivity analyses robust to the inclusion of pleiotropic variants suggested that these efects may be a consequence of higher plasma citrate levels. There was no strong evidence of associations of genetically proxied SLC13A5 inhibition with uACR or risk of CKD or microalbuminuria. Secondary analyses identifed evidence of associations with higher plasma calcium levels (p=6× 10−13) and lower fasting glucose (p=0.02). PheWAS did not identify any safety concerns. Conclusions This Mendelian randomization analysis provides human-centric insight to guide clinical development of an SLC13A5 inhibitor. We identify plasma calcium and citrate as biologically plausible biomarkers of target engagement, and plasma citrate as a potential biomarker of mechanism of action. Our human genetic evidence corroborates evidence from various animal models to support efects of SLC13A5 inhibition on improving kidney function.

Item URL in elib:https://elib.dlr.de/202837/
Document Type:Article
Title:The citrate transporter SLC13A5 as a therapeutic target for kidney disease: evidence from Mendelian randomization to inform drug development
Authors:
AuthorsInstitution or Email of AuthorsAuthor's ORCID iDORCID Put Code
Gill, D.Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UKhttps://orcid.org/0000-0001-7312-7078UNSPECIFIED
Zagkos, L.Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UKUNSPECIFIEDUNSPECIFIED
Gill, R.Primula Group Ltd, London, UKUNSPECIFIEDUNSPECIFIED
Benzing, T.Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, GermanyUNSPECIFIEDUNSPECIFIED
Jordan, J.UNSPECIFIEDhttps://orcid.org/0000-0003-4518-0706UNSPECIFIED
Birkenfeld, A.L.Department of Diabetology Endocrinology and Nephrology, Internal Medicine IV, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, GermanyUNSPECIFIEDUNSPECIFIED
Burgess, S.Medical Research Council Biostatistics Unit at the University of Cambridge, Cambridge, UKUNSPECIFIEDUNSPECIFIED
Zahn, G.Eternygen GmbH, Müllerstrasse 178, 13353 Berlin, GermanyUNSPECIFIEDUNSPECIFIED
Date:December 2023
Journal or Publication Title:BMC Medicine
Refereed publication:Yes
Open Access:Yes
Gold Open Access:Yes
In SCOPUS:Yes
In ISI Web of Science:Yes
Volume:21
DOI:10.1186/s12916-023-03227-5
Page Range:p. 504
Publisher:BioMed Central (BMC)
ISSN:1741-7015
Status:Published
Keywords:SLC13A5; Citrate; Kidney; Renal function; Mendelian randomization; Drug development
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Research under Space Conditions
DLR - Research theme (Project):R - CardioBrain
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Deposited By: Schrage, Larissa
Deposited On:16 Feb 2024 09:28
Last Modified:20 Feb 2024 07:23

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