# Metabolic reprogramming and FGF21 signaling in kidney health and polycystic kidney diseases

> **NIH NIH R01** · UNIVERSITY OF IOWA · 2022 · $396,609

## Abstract

Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease caused by
mutations in the PKD1 or PKD2 genes. Many patients often lose kidney function due to limited therapies to delay
disease progression. The kidney is a highly metabolically active organ that relies on specialized tubular epithelial
cells to reabsorb most of the filtered water and solutes in the body. Normal kidney tubules are highly enriched in
mitochondria and preferentially use fatty acid oxidation (FAO), which generates more adenosine triphosphate
(ATP) than glucose metabolism. However, one hallmark of metabolic derangement in ADPKD is decreased fatty
acid oxidation (FAO) and increased aerobic glycolysis (Warburg effect). This metabolic derangement supports the
growth of cysts that eventually lead to renal failure. We propose to study: 1) the role of enhancing FAO in delaying
progression of ADPKD, 2) the role of ketogenic diet, FGF21 signaling and ketone body oxidation in ADPKD.
Although dietary restrictions, such as time-restricted feeding or the condition of ketosis have been shown to
ameliorate renal cyst progression in animal models of PKD1 mutation, the detail molecular mechanisms are not
fully elucidated. The clinical application of long-term dietary intervention is challenging because of non-compliance
and high dropout rates. There is, therefore, a critical need to determine the roles of metabolic reprogramming and
the molecular mechanisms underlying beneficial effects of dietary intervention, such as a ketogenic diet. We
propose to investigate the effect of 5 genetic mouse models of enhanced FAO, decreased FGF21 signaling or
impaired ketone body oxidation in the kidney-tubule specific PKD1 deletion mouse model of ADPKD. The
metabolic status will be elucidated using metabolic flux analysis, metabolomics and targeted proteomics of
metabolic proteins. In addition to mouse experiments, mechanistic studies will be performed using human cell line
with PKD1 mutation. Finally, human induced pluripotent stem cell derived kidney organoids from ADPKD patients
will be applied to confirm the results observed in mouse models and PKD1 cell line. Upon completion of the
proposed research, the expected outcomes are an understanding of the role of metabolic reprogramming and
FGF21 and the mechanisms underlying the beneficial effects of ketosis in ADPKD progression. These findings are
expected to have an important impact by contributing to a conceptual framework that will subsequently drive
development of novel dietary interventions or supplements for ADPKD patients, facilitated by the use of iPS-
derived kidney organoids generated from ADPKD patients.

## Key facts

- **NIH application ID:** 10495449
- **Project number:** 1R01DK133118-01
- **Recipient organization:** UNIVERSITY OF IOWA
- **Principal Investigator:** Dao-Fu Dai
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $396,609
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10495449

## Citation

> US National Institutes of Health, RePORTER application 10495449, Metabolic reprogramming and FGF21 signaling in kidney health and polycystic kidney diseases (1R01DK133118-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10495449. Licensed CC0.

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