Fatty acids and albumin are transported by distinct mechanisms in the proximal tubule

Under physiologic conditions, proximal tubules depend on basolateral fatty acid (FA) uptake for metabolism. In pathophysiologic conditions due to glomerular filtration barrier disruption, albumin-bound FA undergoes filtration and proximal tubule reabsorption, which leads to lipotoxicity and tubular atrophy. Apical proximal tubule albumin uptake is accomplished by the megalin/cubilin complex and receptor-mediated endocytosis, whereas apical proximal tubule FA uptake is primarily mediated by apical fatty acid transport protein-2 (FATP2). However, a commonly proposed (but untested) alternative model is that the intact albumin-FA complex is cotransported by megalin/cubilin-mediated endocytosis, similar to apolipoproteins. Microperfused mouse proximal tubules demonstrated divergent one- versus two-phase albumin and FA uptake kinetics, with significantly faster albumin compared with FA uptake. LLC-PK1, human proximal tubule cells (HPCT), and opossum kidney (OK) proximal tubule cell lines all expressed megalin, cubilin, and FATP2 mRNA, though in varying amounts. LLC-PK1 cells showed similar one-phase kinetics of dual fluorescently labeled albumin and FA uptake, whereas HPCT cells demonstrated one-phase albumin and two-phase FA uptake kinetics, with significantly faster albumin compared with FA uptake (similar to perfused proximal tubules). FATP2 inhibition blocked FA uptake, but had no effect on albumin uptake in LLC-PK1 and HPCT cells. Megalin and cubilin deletion in OK cells inhibited albumin uptake, but had no effect on FA uptake. We conclude that apical proximal tubule albumin and FA are transported by distinct mechanisms, implying that FAs dissociate from albumin within the proximal tubule lumen before uptake.<b>NEW & NOTEWORTHY</b> Reabsorption of aberrantly filtered albumin-bound fatty acids by the apical proximal tubule is important for chronic kidney disease progression. Whether fatty acids and albumin are taken up as intact complexes or dissociate within the lumen before uptake has been controversial. Data derived from in vitro and ex vivo models demonstrate separate albumin and fatty acid uptake kinetics, implying dissociation before uptake.