Genetic knockout and pharmacologic inhibition of NCX2 cause natriuresis and hypercalciuria

• NCX2 is expressed on the basolateral membrane of the distal nephron.
• Functional inhibition of NCX2 causes natriuresis and hypercalciuria.
• NCX2 is involved in Na+ and Ca2+ reabsorption of the kidney.

The Na+/Ca2+ exchanger (NCX) is a bidirectional transporter that is controlled by membrane potential and transmembrane gradients of Na+ and Ca2+. Although two isoforms of NCX1 and NCX2 are coexpressed on the basolateral membrane of the distal nephron, the functional significance of these isoforms is not entirely clear. Therefore, we used NCX1- and NCX2-heterozygote knockout mice (KO) and their double KO, as well as isoform-selective NCX inhibitors, to determine the roles of NCX isoforms in urine formation and electrolyte excretion in mice. NCX inhibitors, particularly NCX2-sensitive inhibitors, caused a dose-dependent natriuresis and in a higher dose, moreover, hypercalciuria. Consistently, NCX1-KO possessed normal renal function similar to wild-type mice (WT), whereas NCX2-KO and double KO exhibited moderate natriuresis and hypercalciuria. Notably, renal responses to YM-244769 were equivalently observed in NCX1-KO and WT, but disappeared in NCX2-KO and double KO. Thus, functional inhibition of NCX2 initially causes natriuresis, and further inhibition of NCX2 produces hypercalciuria, suggesting that the functional significance of NCX2 lies in Na+ and Ca2+ reabsorption of the kidney.