BICC1 Interacts with PKD1 and PKD2 to Drive Cystogenesis in ADPKD

Reviewer #1 (Public review):

In this manuscript, Tran et al. investigate the interaction between BICC1 and ADPKD genes in renal cystogenesis. Using biochemical approaches, they reveal a physical association between Bicc1 and PC1 or PC2 and identify the motifs in each protein required for binding. Through genetic analyses, they demonstrate that Bicc1 inactivation synergizes with Pkd1 or Pkd2 inactivation to exacerbate PKD-associated phenotypes in Xenopus embryos and potentially in mouse models. Furthermore, by analyzing a large cohort of PKD patients, the authors identify compound BICC1 variants alongside PKD1 or PKD2 variants in trans, as well as homozygous BICC1 variants in patients with early-onset and severe disease presentation. They also show that these BICC1 variants repress PC2 expression in cultured cells.

Overall, the concept that BICC1 variants modify PKD severity is plausible, the data are robust, and the conclusions are largely supported. However, several aspects of the study require clarification and discussion:

(1) The authors devote significant effort to characterizing the physical interaction between Bicc1 and Pkd2. However, the study does not examine or discuss how this interaction relates to Bicc1's well-established role in posttranscriptional regulation of Pkd2 mRNA stability and translation efficiency.

(2) Bicc1 inactivation appears to downregulate Pkd1 expression, yet it remains unclear whether Bicc1 regulates Pkd1 through direct interaction or by antagonizing miR-17, as observed in Pkd2 regulation. This should be further examined or discussed.

(3) The evidence supporting Bicc1 and ADPKD gene cooperativity, particularly with Pkd1, in mouse models is not entirely convincing, likely due to substantial variability and the aggressive nature of Bpk/Bpk mice. Increasing the number of animals or using a milder Bicc1 strain, such as jcpk heterozygotes, could help substantiate the genetic interaction.

Reviewer #2 (Public review):

Tran and colleagues report evidence supporting the expected yet undemonstrated interaction between the Pkd1 and Pkd2 gene products Pc1 and Pc2 and the Bicc1 protein in vitro, in mice, and collaterally, in Xenopus and HEK293T cells. The authors go on to convincingly identify two large and non-overlapping regions of the Bicc1 protein important for each interaction and to perform gene dosage experiments in mice that suggest that Bicc1 loss of function may compound with Pkd1 and Pkd2 decreased function, resulting in PKD-like renal phenotypes of different severity. These results led to examining a cohort of very early onset PKD patients to find three instances of co-existing mutations in PKD1 (or PKD2) and BICC1. Finally, preliminary transcriptomics of edited lines gave variable and subtle differences that align with the theme that Bicc1 may contribute to the PKD defects, yet are mechanistically inconclusive.

These results are potentially interesting, despite the limitation, also recognized by the authors, that BICC1 mutations seem exceedingly rare in PKD patients and may not "significantly contribute to the mutational load in ADPKD or ARPKD". The manuscript has several intrinsic limitations that must be addressed.

The manuscript contains factual errors, imprecisions, and language ambiguities. This has the effect of making this reviewer wonder how thorough the research reported and analyses have been.

Reviewer #3 (Public review):

Summary:

This study investigates the role of BICC1 in the regulation of PKD1 and PKD2 and its impact on cytogenesis in ADPKD. By utilizing co-IP and functional assays, the authors demonstrate physical, functional, and regulatory interactions between these three proteins.

Strengths:

(1) The scientific principles and methodology adopted in this study are excellent, logical, and reveal important insights into the molecular basis of cystogenesis.

(2) The functional studies in animal models provide tantalizing data that may lead to a further understanding and may consequently lead to the ultimate goal of finding a molecular therapy for this incurable condition.

(3) In describing the patients from the Arab cohort, the authors have provided excellent human data for further investigation in large ADPKD cohorts. Even though there was no patient material available, such as HUREC, the authors have studied the effects of BICC1 mutations and demonstrated its functional importance in a Xenopus model.

Weaknesses:

This is a well-conducted study and could have been even more impactful if primary patient material was available to the authors. A further study in HUREC cells investigating the critical regulatory role of BICC1 and potential interaction with mir-17 may yet lead to a modifiable therapeutic target.

Conclusion:
The authors achieve their aims. The results reliably demonstrate the physical and functional interaction between BICC1 and PKD1/PKD2 genes and their products.

The impact is hopefully going to be manifold:

(1) Progressing the understanding of the regulation of the expression of PKD1/PKD2 genes.

(2) Role of BiCC1 in mir/PKD1/2 complex should be the next step in the quest for a modifiable therapeutic target.

Author response:

Reviewer #1 (Public Review):

In this manuscript, Tran et al. investigate the interaction between BICC1 and ADPKD genes in renal cystogenesis. Using biochemical approaches, they reveal a physical association between Bicc1 and PC1 or PC2 and identify the motifs in each protein required for binding. Through genetic analyses, they demonstrate that Bicc1 inactivation synergizes with Pkd1 or Pkd2 inactivation to exacerbate PKD-associated phenotypes in Xenopus embryos and potentially in mouse models. Furthermore, by analyzing a large cohort of PKD patients, the authors identify compound BICC1 variants alongside PKD1 or PKD2 variants in trans, as well as homozygous BICC1 variants in patients with early-onset and severe disease presentation. They also show that these BICC1 variants repress PC2 expression in cultured cells.

Overall, the concept that BICC1 variants modify PKD severity is plausible, the data are robust, and the conclusions are largely supported. However, several aspects of the study require clarification and discussion:

(1) The authors devote significant effort to characterizing the physical interaction between Bicc1 and Pkd2. However, the study does not examine or discuss how this interaction relates to Bicc1's well-established role in posttranscriptional regulation of Pkd2 mRNA stability and translation efficiency.

The reviewer is correct that the present study has not addressed the downstream consequences of this interaction considering that Bicc1 is a posttranscriptional regulator of Pkd2 (and potentially Pkd1). We think that the complex of Bicc1/Pkd1/Pkd2 retains Bicc1 in the cytoplasm and thus restrict its activity in participating in posttranscriptional regulation. As we do not have yet experimental data to support this model, we have not included this model in the manuscript. Yet, we will update the discussion of the manuscript to further elaborate on the potential mechanism of the Bicc1/Pkd1/Pkd2 complex.

(2) Bicc1 inactivation appears to downregulate Pkd1 expression, yet it remains unclear whether Bicc1 regulates Pkd1 through direct interaction or by antagonizing miR-17, as observed in Pkd2 regulation. This should be further examined or discussed.

This is a very interesting comment. The group of Vishal Patel published that PKD1 is regulated by a mir-17 binding site in its 3’UTR (PMID: 35965273). We, however, have not evaluated whether BICC1 participates in this regulation. A definitive answer would require us utilize some of the mice described in above reference, which is beyond the scope of this manuscript. We, however, will revise the discussion to elaborate on this potential mechanism.

(3) The evidence supporting Bicc1 and ADPKD gene cooperativity, particularly with Pkd1, in mouse models is not entirely convincing, likely due to substantial variability and the aggressive nature of Bpk/Bpk mice. Increasing the number of animals or using a milder Bicc1 strain, such as jcpk heterozygotes, could help substantiate the genetic interaction.

We have initially performed the analysis using our Bicc1 complete knockout, we previously reported on (PMID 20215348) focusing on compound heterozygotes. Yet, like the Pkd1/Pkd2 compound heterozygotes (PMID 12140187) no cyst development was observed until we sacrificed the mice at P21. Our strain is similar to the above mentioned jcpk, which is characterized by a short, abnormal transcript thought to result in a null allele (PMID: 12682776). We thank the reviewer for pointing use to the reference showing the heterozygous mice show glomerular cysts in the adults (PMID: 7723240). This suggestion is an interesting idea we will investigate. In general, we agree with the reviewer that the better understanding the contribution of Bicc1 to the adult PKD phenotype will be critical. To this end, we are currently generating a floxed allele of Bicc1 that will allow us to address the cooperativity in the adult kidney, when e.g. crossed to the Pkd1^RC/RC mice. Yet, these experiments are unfortunately beyond the scope of this manuscript.

Reviewer #2 (Public Review):

Tran and colleagues report evidence supporting the expected yet undemonstrated interaction between the Pkd1 and Pkd2 gene products Pc1 and Pc2 and the Bicc1 protein in vitro, in mice, and collaterally, in Xenopus and HEK293T cells. The authors go on to convincingly identify two large and non-overlapping regions of the Bicc1 protein important for each interaction and to perform gene dosage experiments in mice that suggest that Bicc1 loss of function may compound with Pkd1 and Pkd2 decreased function, resulting in PKD-like renal phenotypes of different severity. These results led to examining a cohort of very early onset PKD patients to find three instances of co-existing mutations in PKD1 (or PKD2) and BICC1. Finally, preliminary transcriptomics of edited lines gave variable and subtle differences that align with the theme that Bicc1 may contribute to the PKD defects, yet are mechanistically inconclusive.

These results are potentially interesting, despite the limitation, also recognized by the authors, that BICC1 mutations seem exceedingly rare in PKD patients and may not "significantly contribute to the mutational load in ADPKD or ARPKD". The manuscript has several intrinsic limitations that must be addressed.

As mentioned above, the study was designed to explore whether there is an interaction between BICC1 and the PKD1/PKD2 and whether this interaction is functionally important. How this translates into the clinical relevance will require additional studies (and we have addressed this in the discussion of the manuscript).

The manuscript contains factual errors, imprecisions, and language ambiguities. This has the effect of making this reviewer wonder how thorough the research reported and analyses have been.

We respectfully disagree with the reviewer on the latter interpretation. The study was performed with rigor. We have carefully assessed the critiques raised by the reviewer. Most of the criticisms raised by the reviewer will be easily addressed in the revised version of the manuscript. Yet, none of the critiques raised by the reviewer seems to directly impact the overall interpretation of the data.

Reviewer #3 (Public Review):

Summary:

This study investigates the role of BICC1 in the regulation of PKD1 and PKD2 and its impact on cytogenesis in ADPKD. By utilizing co-IP and functional assays, the authors demonstrate physical, functional, and regulatory interactions between these three proteins.

Strengths:

(1) The scientific principles and methodology adopted in this study are excellent, logical, and reveal important insights into the molecular basis of cystogenesis.

(2) The functional studies in animal models provide tantalizing data that may lead to a further understanding and may consequently lead to the ultimate goal of finding a molecular therapy for this incurable condition.

(3) In describing the patients from the Arab cohort, the authors have provided excellent human data for further investigation in large ADPKD cohorts. Even though there was no patient material available, such as HUREC, the authors have studied the effects of BICC1 mutations and demonstrated its functional importance in a Xenopus model.

Weaknesses:

This is a well-conducted study and could have been even more impactful if primary patient material was available to the authors. A further study in HUREC cells investigating the critical regulatory role of BICC1 and potential interaction with mir-17 may yet lead to a modifiable therapeutic target.

This is an excellent suggestion. We agree with the reviewer that it would have been interesting to analyze HUREC material from the affected patients. Unfortunately, besides DNA and the phenotypic analysis described in the manuscript neither human tissue nor primary patient-derived cells collected before the two patients with the BICC1 p.Ser240Pro mutation passed away. To address this missing link, we have – as a first pass - generated HEK293T cells carrying the BICC1 p.Ser240Pro variant. While these admittingly are not kidney epithelial cells, they indeed show a reduced level of PC2 expression. These data are shown in the manuscript. We have not yet addressed how this relates to its crosstalk with miR-17.

Conclusion:

The authors achieve their aims. The results reliably demonstrate the physical and functional interaction between BICC1 and PKD1/PKD2 genes and their products.

The impact is hopefully going to be manifold:

(1) Progressing the understanding of the regulation of the expression of PKD1/PKD2 genes.

(2) Role of BiCC1 in mir/PKD1/2 complex should be the next step in the quest for a modifiable therapeutic target.