Immunomodulatory Functions of Intercalated Cells in Kidney Autoimmunity

Various autoimmune diseases frequently cause both acute and chronic kidney injuries through complex mechanisms involving autoantibodies and cellular immune responses that result in tissue damage. Intercalated cells (ICs), specialized renal tubular epithelial cells responsible for proton secretion, are strategically positioned at the epithelial-immune interface, making them ideal sensors of stress signals and potential triggers of immune responses. This study investigates the molecular mechanisms by which ICs interact with immune cells to maintain renal immune homeostasis and contribute to the development of autoimmune kidney disease. We depleted Foxp3⁺ regulatory T cells (Tregs) by injecting diphtheria toxin (DT) into male and female Foxp3-DTR mice. Two weeks after depletion, we observed autoimmune inflammation marked by increased renal immune infiltration, including neutrophils, macrophages, and subsets of T and B cells, along with the formation of ectopic lymphoid-like structures and enhanced antigen presentation. We found higher levels of renal autoantibodies in urine and serum, with antibodies depositing in glomeruli and tubules. Our analysis identified several renal antigens targeted by autoantibodies, suggesting their potential role in antibody-mediated renal injury. Kidney damage included smaller glomeruli, proximal tubular injury, an increased urine albumin/creatinine ratio, and decreased urine output. Disruption of immune tolerance led to the upregulation of inflammasome-related genes and IL-33 in ICs, which acts as a key alarmin signaling damage and promoting activation and expansion of Tregs. Our findings uncover a novel IC-Treg interaction mediated by the IL-33 pathway, revealing immune-regulating mechanisms that support renal immune tolerance. Although Tregs were initially depleted, a significant rebound in their numbers and function occurred. Understanding the cellular and molecular mechanisms behind autoimmune renal injury is crucial for developing targeted therapies and identifying appropriate biomarkers.