FASEB Bio Advances

The Piezo1 hypothesis of renal anemia

Peter Kotanko, David J. Jörg, Nadja Grobe, Christoph Zaba


Erythropoietin deficiency is an extensively researched cause of renal anemia. The etiology and consequences of shortened red blood cell (RBC) life span in chronic kidney disease (CKD) are less well understood. Traversing capillaries requires RBC geometry changes, a process enabled by adaptions of the cytoskeleton. These changes are mediated by transient activation of the mechanosensory Piezo1 channel, resulting in calcium influx. Importantly, prolonged Piezo1 activation shortens RBC life span, presumably through activation of calcium-dependent intracellular pathways triggering RBC death. Two Piezo1-activating small molecules, Jedi1 and Jedi2, share remarkable structural similarities with 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), a uremic retention solute cleared by the healthy kidney. We hypothesize that in CKD the accumulation of CMPF leads to prolonged activation of Piezo1 (similar in effect to Jedi1 and Jedi2), thus reducing RBC life span. This hypothesis can be tested through bench experiments and, ultimately, by studying the effect of CMPF removal on renal anemia.

About the Author

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD, is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as vice chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked from 1982 to 1989 in the Department of Physiology and the University Clinic of Internal Medicine in Innsbruck, Austria. From 1995 to 1996 he trained in nephrology at the Hammersmith Hospital, London, United Kingdom.

Nadja Grobe, MS, PhD

Manager of Laboratory Research

Nadja received her MS and PhD in biochemistry from the Martin Luther University Halle-Wittenberg, Germany. Prior to joining RRI in 2017, she gained more than 10 years of experience in guiding and implementing chemistry, biochemistry, and biomedical-focused research teams in nonprofit, academia, and government. Her previous research has been funded by the American Heart Association, the National Institutes of Health, and the American Society of Nephrology.