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Cytosine methylation changes in enhancer regions of core pro-fibrotic genes characterize kidney fibrosis development
Open accessAbstract
Background: One in eleven people is affected by chronic kidney disease, a condition characterized by kidney fibrosis and progressive loss of kidney function. Epidemiological studies indicate that adverse intrauterine and postnatal environments have a long-lasting role in chronic kidney disease development. Epigenetic information represents a plausible carrier for mediating this programming effect. Here we demonstrate that genome-wide cytosine methylation patterns of healthy and chronic kidney disease tubule samples obtained from patients show significant differences. Results: We identify differentially methylated regions and validate these in a large replication dataset. The differentially methylated regions are rarely observed on promoters, but mostly overlap with putative enhancer regions, and they are enriched in consensus binding sequences for important renal transcription factors. This indicates their importance in gene expression regulation. A core set of genes that are known to be related to kidney fibrosis, including genes encoding collagens, show cytosine methylation changes correlating with downstream transcript levels. Conclusions: Our report raises the possibility that epigenetic dysregulation plays a role in chronic kidney disease development via influencing core pro-fibrotic pathways and can aid the development of novel biomarkers and future therapeutics.
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![Figure 4 Chronic kidney disease differentially methylated regions are enriched for kidney-specific transcription factor binding sites. (A) The DMR and DHS sites contain consensus sequences. The transcription factor binding site motifs and their statistical enrichment from the de novo searched consensus sequences in DMR and DHS sites. (B) A specific example of an intronic DMR (within the EZR gene). The genomic location of the DMR is at the top, followed by the RefSeq representation of EZR; fetal kidney (FK)-specific DHS tracks (in blue); HKC8 cell-specific H3K4me1 and H3K4me3 tracks; HKC8 cell specific ChromHMM annotation of the locus (yellow, enhancer; red, promoter; green, transcription-associated region; the full color coding key is shown bottom right) - the sequences contain consensus-binding sites for the key kidney transcription factor SIX2/3, with the SIX2/3 binding motif illustrated as a sequence logo plot below; and adult kidney (AK)-specific H3K4me1 (blue) and H3K4me3 (green) tracks [19].](/paper-figures/0c2861daea084dfd8156508351f3cb95/cytosine-methylation-changes-in-enhancer-regions-of-core-pro-fibrotic-genes-figure-4.jpg)



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“In a genome-wide DNA methylation study of human kidney tubules, several genes that are associated with kidney fibrosis were characterized by methylation changes and alterations of downstream transcript levels in CKD samples compared with controls197.”
From The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease (2018) · cites this paper as [197]
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Chromatin dynamics at the core of kidney fibrosis
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“The result showed that 4751 differentially methylated regions (DMRs) were identified in 26 diabetic and hypertensive CKD samples based on the comparison with control samples [97].”
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Epigenetic Unsilencing Reverses Renal Fibrosis
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Lecamwasam, A., Ekinci, E. I., Saffery, R., & Dwyer, K. M. (2020) · Biomedicines · doi:10.3390/biomedicines8090341 · Cited by 4
Diabetic Kidney Disease: From Pathophysiology to Treatment Perspectives
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Identification of a foetal epigenetic compartment in adult human kidney
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DNA methylation predicts infection risk in kidney transplant recipients
Hsu, F., Pickering, H. C., Rubbi, L., Thompson, M. J., Reed, E. F., Pellegrini, M. A., & Schaenman, J. M. D. (2025) · Life Science Alliance · doi:10.26508/lsa.202403124 · Cited by 2
“…of evidence suggest that DNA methylation is associated with post-renal transplant (post-Tx) complications such as ischemia – reperfusion injury (Zhao et al, 2017), graft fi brosis (Ko et al, 2013; Sagy et al, 2024), and alloimmune response (Braza et al, 2015; Hu et al, 2016; Cristoferi et al, 2022).”
From GWAS Signals to Causal Genes in Chronic Kidney Disease
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“Site-specific methylation data can help to identify differentially methylated CpG sites within specific gene regions, such as promoter regions or enhancers, which may be particularly important for regulating gene expression (Hu et al. 2014; Ko et al. 2013).”
Mitochondria and Chronic Kidney Disease: A Molecular Update
Skelly, R., Maxwell, A. P., & McKnight, A. J. (2019) · doi:10.32392/biomed.36 · Cited by 2
Epigenetics: Future prospective in human disorders and therapeutics
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Epigenetic Regulation of Intestinal Fibrosis
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The role of epigenetic mechanisms in the pathogenesis of diabetic nephropathy
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Metadata
- Authors
- Ko, Y.-A., Mohtat, D., Suzuki, M., Park, A. S. D., Izquierdo, M. C., Han, S. Y., Kang, H. M., Si, H., Hostetter, T., Pullman, J. M., Fazzari, M., Verma, A., Zheng, D., Greally, J. M., & Susztak, K.
- Affiliations
- University of Pennsylvania (US)
- Albert Einstein College of Medicine (US)
- Case Western Reserve University (US)
- Montefiore Medical Center (US)
- Corresponding author
- Greally, John M
- ORCID
- Venue
- Genome Biology
- Published
- 2013-12-10
- Volume
- 14
- Issue
- 10
- Pages
- R108-R108
- ISSN
- 1465-6906 (ISSN-L)
- 1474-760X
- PMC
- PMC4053753
- OpenAlex
- W2130816592
- Cited by
- 225
- References
- 35
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 19 · 2023: 9 · 2022: 10 · 2021: 14 · 2020: 16 · 2019: 24 · 2018: 29 · 2017: 20 · 2016: 16 · 2015: 30 · 2014: 16 · 2013: 3
- FWCI
- 9.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Genome biology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK087635)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Genomics and Chromatin Dynamics
- Keywords
- cytosine methylation, renal fibrosis, chronic kidney disease, differentially methylated regions, enhancers, epigenetic dysregulation, collagen genes, gene expression regulation, developmental programming, biomarkers
- MeSH terms
- Aged, Base Sequence, Binding Sites, Cytosine, Enhancer Elements, Genetic, Fibrosis, Gene Expression Regulation, Humans, Kidney, Middle Aged, Transcription Factors, Transcription, Genetic, Reproducibility of Results, Cluster Analysis, Case-Control Studies, DNA Methylation, Gene Expression Profiling, Renal Insufficiency, Chronic, Gene Regulatory Networks, Position-Specific Scoring Matrices, Nucleotide Motifs
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