LncPTEC mediated homocysteine accumulation elevates oxidative stress via UBQLN1-dependent MTHFD1 ubiquitination in DKD.

Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease and chronic kidney disease. Oxidative stress, a key driver of renal fibrosis and a hallmark of DKD pathological changes, has been extensively studied for its role in DKD progression. However, its specific mechanisms remain unclear. Here, we show that homocysteine (Hcy) accumulation in proximal tubular epithelial cells (PTECs) is a significant contributor to mitochondrial oxidative stress in DKD. Through single-cell RNA sequencing (scRNA-seq) screening, we identify lncPTEC, a DKD-associated long non-coding RNA (lncRNA) from the PTEC cluster. Notably, we find that upregulated lncPTEC correlates with elevated albuminuria in DKD patients and exacerbates mitochondrial oxidative stress, epithelial-mesenchymal transition (EMT) and renal tubular fibrosis both in vitro and in vivo. Mechanistically, lncPTEC is transcriptionally upregulated by the transcription factor specificity protein 1 (SP1) under hyperglycemic conditions. Furthermore, lncPTEC directly interacts with the established key factor of Hcy metabolism, methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), promoting its ubiquitination and degradation via the ubiquitination-related protein UBQLN1. This process leads to Hcy accumulation, mitochondrial oxidative stress, and subsequent DKD progression. Hence, our findings elucidate the role of the lncPTEC/MTHFD1 axis in Hcy-mediated mitochondrial oxidative stress, offering potential diagnostic biomarkers and therapeutic targets for DKD.