Btg2 Promotes Focal Segmental Glomerulosclerosis via Smad3‐Dependent Podocyte‐Mesenchymal Transition

Abstract Podocyte injury plays a critical role in the progression of focal segmental glomerulosclerosis (FSGS). Here, it is reported that B‐cell translocation gene 2 (Btg2) promotes Adriamycin (ADR)‐induced FSGS via Smad3‐dependent podocyte‐mesenchymal transition. It is found that in FSGS patients and animal models, Btg2 is markedly upregulated by podocytes and correlated with progressive renal injury. Podocyte‐specific deletion of Btg2 protected against the onset of proteinuria and glomerulosclerosis in ADR‐treated mice along with inhibition of EMT markers such as α‐SMA and vimentin while restoring epithelial marker E‐cadherin. In cultured MPC5 podocytes, overexpression of Btg2 largely promoted ADR and TGF‐β1‐induced EMT and fibrosis, which is further enhanced by overexpressing Btg2 but blocked by disrupting Btg2. Mechanistically, Btg2 is rapidly induced by TGF‐β1 and then bound Smad3 but not Smad2 to promote Smad3 signaling and podocyte EMT, which is again exacerbated by overexpressing Btg2 but blocked by deleting Btg2 in MPC5 podocytes. Interestingly, blockade of Smad3 signaling with a Smad3 inhibitor SIS3 is also capable of inhibiting Btg2 expression and Btg2‐mediated podocyte EMT, revealing a TGF‐β/Smad3‐Btg2 circuit mechanism in Btg2‐mediated podocyte injury in FSGS. In conclusion, Btg2 is pathogenic in FSGS and promotes podocyte injury via a Smad3‐dependent EMT pathway.