ENaC regulation by biliary factors

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Patients with advanced liver disease often experience fluid retention and electrolyte disturbances due in part to activation of the renin-angiotensin-aldosterone system. Aldosterone activates the epithelial Na+ channel (ENaC) in the distal nephron, enhancing urinary Na+ retention and K+ excretion. But many liver disease patients experience fluid retention without apparent activation of the renin-angiotensin-aldosterone system. Liver disease patients also frequently exhibit elevated plasma bile acids and hyperbilirubinemia. Preliminary data show that specific bile acids and conjugated bilirubin activate ENaC in vitro and that taurocholic acid activates ENaC in isolated collecting ducts. The central hypothesis of our proposal is that urinary bile acids and possibly conjugated bilirubin directly activate ENaC, promoting Na+ and fluid retention and K+ excretion. The goal of this proposal is to determine whether this regulation occurs in vivo and to determine the molecular mechanism of regulation. Preliminary data suggest that urine from patients with alcoholic hepatitis contains concentrations of activating bile acids and conjugated bilirubin sufficient to activate the channel, and indeed activate the channel. We will determine whether urine from alcoholic hepatitis patients activates ENaC in experimental cells. We further hypothesize that elevated biliary factors activate ENaC in the distal nephron, promoting Na+ retention and K+ excretion. We will test this hypothesis in isolated collecting ducts. We will also test this hypothesis in vivo by chronically administering biliary factors and quantifying changes in weight, blood K+, urinary Na+ and K+, plasma aldosterone, and total body water. Preliminary data suggest that taurocholic acid promotes Na+ retention, K+ loss, and volume expansion. We will determine the contribution of ENaC to observed changes by using drugs to block ENaC, and by using genetic changes to increase the channel's sensitivity to biliary factors or to decrease ENaC's contribution to renal Na+ and K+ handling. Experiments will also investigate the molecular mechanism of ENaC regulation by bile acids. We hypothesize that activating bile acids interact directly with the channel to enhance channel activity. We will use derivatized bile acids to detect direct binding, and key chemical and biophysical properties of the both the channel and bile acids to dissect the interaction. Key experiments will be performed in multiple cell models, including Xenopus oocytes, cultured epithelial cells, and mouse collecting ducts. Direct ENaC activation by biliary factors elevated in liver disease has not been previously investigated, and may contribute to the volume overload, edema, and electrolyte imbalances associated with liver disease.