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LRP2

Low-density lipoprotein receptor-related protein 2 (LRP2), also known as megalin or 330, is a large encoded by the gene located on 2q31.1. This multi-ligand endocytic receptor is primarily expressed in absorptive epithelial cells, such as those lining the proximal tubules of the , and plays a critical role in the reabsorption and intracellular trafficking of diverse filtered molecules, including lipoproteins, vitamins (such as A and D), hormones, sterols, and drugs like aminoglycosides. By mediating , LRP2 prevents the loss of essential nutrients in urine and supports physiological processes like immune function, stress response, and , often in cooperation with the co-receptor cubilin. Structurally, LRP2 features an extensive extracellular domain comprising approximately 36 class A repeats for binding, 17 (EGF)-like domains, and 8 β-propeller modules, which together form a flexible homodimer approximately 270 in length at neutral . This architecture enables -dependent conformational changes: at the cell surface ( ~7.5), it adopts an open state for capture, while in acidic endosomes ( ~5.2), it compacts to facilitate release and receptor , ensuring efficient endocytic cycles. Beyond the kidney, LRP2 is expressed in tissues like the , eyes, ears, lungs, intestine, , and reproductive organs, where it influences development, nutrient uptake, and signaling pathways involving molecules such as and sonic . Pathogenic variants in LRP2, including missense mutations that disrupt homodimer assembly or ligand binding, cause autosomal recessive disorders such as Donnai-Barrow syndrome (also known as facio-oculo-acoustico-renal syndrome), characterized by facial dysmorphisms, ocular , , , and renal malformations due to defective . Common polymorphisms in the gene have also been associated with elevated cholesterol levels, increased cardiovascular risk, prostate progression via altered androgen uptake, and gout susceptibility.

Gene

Genomic location and organization

The human LRP2 gene is located on the long (q) arm of at cytogenetic band 2q31.1, with genomic coordinates spanning from base pair 169,127,109 to 169,362,534 on the reverse strand (GRCh38.p14 assembly), encompassing approximately 235 kb. The gene comprises 79 exons in its canonical transcript (ENST00000649046.1), which encodes the full-length protein and is part of the Select set, with the exons distributed across the genomic span to form a complex intron-exon architecture typical of large receptor genes. The organization of LRP2 includes a promoter region in the 5' upstream area, characterized by a CpG island that spans the first exon and extends into proximal promoter sequences, potentially influencing through methylation-sensitive mechanisms. This CpG island, identified through , exhibits features consistent with or tissue-specific promoters. Evolutionarily, the LRP2 is highly among vertebrates, underscoring its fundamental role in cellular processes. Orthologs include Lrp2 in mice, located on (positions 69,254,684–69,416,409, GRCm39), which shares a similar multi-exon structure, and lrp2a in (Danio rerio), reflecting syntenic and preserved across these . This extends to key regulatory elements, highlighting the evolutionary stability of the gene's architecture from teleosts to mammals.

Expression patterns

LRP2, encoding the megalin protein, exhibits prominent mRNA and protein expression in absorptive epithelia across various tissues, with particularly high levels in the proximal tubules (segments S1-S3), where it localizes to the apical membrane of epithelial cells for endocytic functions. Expression is also substantial in the gland, of the , and visceral , reflecting its role in and uptake in these specialized barriers. In the , quantitative mRNA analysis shows RPKM values of 33.6, while expression reaches 14.6 RPKM, underscoring tissue-specific abundance. During embryogenesis, LRP2 expression is upregulated in neural crest derivatives, including the neuroepithelium and cephalic neural crest cells, contributing to patterning of the ventral telencephalon and overall cranial development. It is also highly expressed in the yolk sac and placenta, where it supports maternal-fetal nutrient transfer from early gestational stages onward. In human fetal tissues (10-20 weeks gestation), LRP2 mRNA is detectable in kidney, heart, and intestine, with protein localization emerging in embryonic epithelia by mid-gestation. LRP2 expression is regulated by hormonal and nutritional factors, including induction by in renal proximal tubules, which enhances its role in vitamin D metabolism and reabsorption. positively modulates LRP2 mRNA levels in epithelial cells, promoting its expression during development and in response to signaling. Additional regulators, such as (PPAR) α and γ ligands, further upregulate expression in and other tissues.

Protein

Structure

LRP2 encodes megalin, a ~ kDa type I transmembrane composed of 4,655 that functions as an endocytic receptor predominantly expressed on the apical surface of polarized epithelial cells. The protein assembles into a homodimer, with each protomer featuring a large extracellular (~4,400 ), a single transmembrane (22 ), and a short cytoplasmic (213 ). The extracellular region is heavily glycosylated, contributing to its mature mass and stability, while the cytoplasmic includes a C-terminal NPVY that facilitates clathrin-mediated through interactions with adaptor proteins. The domain architecture of megalin's extracellular domain is characteristic of the receptor family, consisting of four clusters (R1–R4) of ligand-binding class A () repeats (totaling 36 repeats, L1–L36), eight β-propeller modules (P1–P8, corresponding to class B repeats with YWTD motifs), and 17 EGF-like domains (E1–E17) interspersed between the clusters. These modules are organized in a modular fashion: R1 includes repeats L1–L2 followed by EGF-like domains E1–E2 and β-propeller P1; subsequent clusters follow a similar pattern with increasing numbers of repeats (R2: 9 , R3: 10 , R4: 15 ) and intervening β-propellers and EGF domains. This arrangement enables the receptor's multiligand specificity and structural flexibility. Recent high-resolution cryo-electron structures of full-length megalin (residues 28–4,413 modeled) have elucidated its pH-dependent conformational dynamics as a homodimer (~1.1–1.3 MDa total mass). At extracellular 7.5, the protomers adopt an extended, open "" conformation (dimensions ~270 × 265 × 160 ), with the repeats flexibly extended and solvent-exposed for access, stabilized by pH-sensitive residues at homodimer and intra-protomer interfaces. In contrast, at endosomal acidic 5.2, the structure compacts (~225 × 205 × 160 ), with repeats folding back against the β-propellers, promoting and receptor recycling. These transitions highlight megalin's role as a tuned for endocytic trafficking.

Post-translational modifications

LRP2, also known as megalin, is heavily glycosylated, featuring over 70 predicted N- and O-linked glycosylation sites across its large extracellular domain, which contribute significantly to its molecular mass and functional properties. N-glycosylation occurs at approximately 30 consensus sites (Asn-X-Ser/Thr), with complex glycoforms modulating ligand interactions, such as those with albumin and vitamin D-binding protein, while also ensuring proper protein folding and stability during biosynthesis. O-glycosylation, mediated by enzymes like GALNT11, targets specific serine/threonine residues in linker regions between ligand-binding repeats, enhancing endocytosis efficiency and kidney function by facilitating megalin's trafficking to the apical membrane. These modifications are indispensable, as deglycosylated LRP2 exhibits reduced ligand binding affinity and impaired membrane localization. Phosphorylation of LRP2's short cytoplasmic tail regulates its endocytic dynamics and surface expression. The conserved NPXY (where X is ) undergoes , serving as a docking site for adaptor proteins like Disabled-2 (DAB2) that mediate clathrin-dependent , though does not disrupt this interaction. Additionally, a proximal PPPSP is constitutively phosphorylated by glycogen synthase kinase 3 (GSK3), promoting receptor recycling and preventing lysosomal degradation; disruption of this site leads to reduced surface levels and altered trafficking. family kinases also contribute to events, particularly in signaling contexts, such as transthyretin-induced of NMDA receptors via megalin, where enhances endocytic signaling. These events collectively fine-tune LRP2's role in by balancing , recycling, and degradation pathways. In endosomes, proteolytic cleavage by metalloproteases generates a soluble ectodomain fragment and an intracellular domain (ICD), facilitating ligand release for or while the ICD may influence via regulated intramembrane . This cleavage, often triggered by low or specific ligands, supports receptor to the plasma membrane or directs it toward lysosomal pathways, ensuring efficient turnover in high-endocytic tissues like the .

Function

Endocytic mechanism

LRP2, also known as megalin, facilitates primarily through a clathrin-dependent pathway. The cytoplasmic tail of LRP2 contains FXNPXY motifs, including a critical NPVY , which recruits the adaptor protein disabled-2 (Dab2) to initiate clustering into -coated pits. Dab2 bridges LRP2 to the AP-2 adaptor complex, promoting assembly of lattices at the plasma membrane and subsequent vesicle formation for . This process ensures efficient uptake of diverse ligands in a regulated manner. Following , LRP2-ligand complexes traffic to early endosomes, where the acidic environment triggers pH-dependent conformational changes in the receptor. At neutral extracellular (approximately 7.4), LRP2 maintains an extended, open structure with solvent-exposed ligand-binding repeats, enabling high-affinity capture of substrates. In contrast, the low of endosomes (around 5.5) induces compaction of the ectodomain through intramolecular interactions, particularly involving β-propeller domains, which disrupts binding and promotes for subsequent sorting. This mechanism allows LRP2 to release ligands while preserving its own integrity for reuse. Dissociated LRP2 then follows a itinerary through Rab11a-positive endosomes, which facilitates its rapid return to the plasma membrane in a microtubule-dependent process. This fast- pathway, with an half-time of about 1-2 minutes and half-time of 9-10 minutes, supports multiple cycles of , underscoring LRP2's role as a high-capacity receptor. However, a portion of internalized LRP2 is diverted to late endosomes and lysosomes for , helping to maintain steady-state receptor levels; the receptor exhibits a long of approximately 5 hours, indicating predominant over .

Tissue-specific roles

In the kidney, LRP2, also known as megalin, plays a pivotal role in the of filtered proteins in the proximal tubules, partnering with the (CUBAM) to internalize ligands such as and low-molecular-weight proteins, thereby preventing . This endocytic activity is essential for the uptake of vitamin D-binding protein (VDBP) complexed with 25-hydroxyvitamin D, facilitating the recovery and activation of metabolites within renal epithelial cells. In the lungs, LRP2 mediates the transepithelial clearance of and other proteins from the alveolar space, contributing to maintenance of pulmonary and protection against protein accumulation in conditions like acute lung injury. In the , LRP2 contributes to the clearance of amyloid-beta (Aβ) peptides, primarily at the and blood- barrier, where it mediates the of Aβ from the cerebrospinal fluid into the bloodstream, helping maintain neuronal . Expression in capillaries supports limited Aβ efflux across the blood- barrier, though its role there is secondary to other receptors like LRP1. In the intestine, LRP2 facilitates the absorption of nutrients such as by binding and internalizing folate-binding protein-folate complexes in epithelial cells of the . Within the , LRP2 facilitates the of () from the follicular by thyrocytes, directing it toward rather than lysosomal degradation, which supports the recycling of iodine and thyroid hormone precursors for efficient hormone synthesis and secretion. This process is pH-independent and receptor-mediated, ensuring bypasses degradative pathways to preserve glandular function. In the eye, LRP2 is crucial for retinal development, particularly in the (RPE) and , where it mediates the clearance of sonic hedgehog (SHH) signaling molecules to regulate and prevent excessive mitogenic activity at the retinal margin. It also influences and during embryogenesis, with deficiency leading to structural abnormalities such as retinal thinning and chorioretinal atrophy. In reproductive organs, including the , testis, and , LRP2 supports and . In cells of the , it internalizes essential molecules like vitamins and lipoproteins through in vesicular structures, aiding fetal during . In the testis and , LRP2 mediates the uptake of androgens and estrogens bound to , contributing to reproductive organ . In the , LRP2 maintains by facilitating the uptake and transport of and other ligands in epithelial cells of the and , contributing to normal auditory function. However, it also mediates the of ototoxic agents like aminoglycosides, leading to damage and . Its expression in absorptive epithelia helps regulate ion and hormone balance essential for sensory integrity.

Interactions

Ligand binding

LRP2, also known as megalin, functions as a multiligand endocytic receptor with the capacity to bind over 75 diverse ligands, earning it the designation of a "professional scavenger receptor" due to its role in clearing a wide array of extracellular molecules from circulation and ultrafiltrate. This broad specificity enables LRP2 to mediate the uptake and recycling of essential nutrients while eliminating potentially harmful substances, particularly in tissues like the kidney proximal tubule and brain choroid plexus. The ligand repertoire of LRP2 encompasses low-molecular-weight proteins such as , lipoproteins including (LDL) via apolipoproteins B and E, vitamin carriers like and vitamin D-binding protein, hormones such as insulin and , and toxins exemplified by cadmium-bound . Additional ligands include protease-inhibitor complexes, lipocalins like neutrophil gelatinase-associated lipocalin, and amyloid-beta peptides (Aβ40 and Aβ42), reflecting LRP2's versatility in handling proteins, lipids, and small molecules across physiological contexts. These interactions support LRP2's function by facilitating the reabsorption of filtered proteins in the and nutrient transport in other epithelia. Ligand binding primarily occurs through the receptor (LDLR) class A repeats (L1–L36), organized into four clusters (R1–R4) within the extracellular domain, where conserved calcium-coordination sites involving acidic residues enable calcium-dependent interactions. These repeats, also known as complement-type repeats, provide the structural basis for high-affinity binding, with specific clusters like implicated in key recognition. Binding affinity is modulated by environmental factors, including , where high-affinity interactions (e.g., dissociation constant K_D ≈ 5.8 nM for receptor-associated protein) occur at neutral 7.5 on the cell surface, while acidification to 5.2 in endosomes promotes ligand release through conformational changes in homodimer interfaces. , particularly N-linked forms, further influences specificity and stability, as variations in glycoforms alter interactions with certain s like insulin.

Protein-protein interactions

LRP2, also known as megalin, engages in critical protein-protein interactions that facilitate its roles in endocytic trafficking and signaling, primarily through associations with adaptor proteins, co-receptors, and PDZ- scaffolds. These interactions occur via specific motifs in LRP2's cytoplasmic tail, such as NPXY and FXNPXY sequences, which serve as binding sites for various partners. Adaptor proteins disabled-2 (Dab2) and autosomal recessive protein (ARH, also known as LDLRAP1) are essential for recruiting and assembling the endocytic machinery at LRP2's location on the plasma membrane. Dab2 binds directly to the NPXY motifs in LRP2's tail through its phosphotyrosine-binding (PTB) , promoting -coated formation and ; this interaction is mutually regulatory, as Dab2 localization in renal epithelial cells depends on LRP2, and its absence leads to reduced LRP2 surface expression. Similarly, ARH interacts with LRP2's first FXNPXY motif via its PTB , enabling and AP-2 recruitment while directing LRP2 toward the endocytic recycling compartment by coupling it to motors for transport; disruption of this binding impairs LRP2's trafficking efficiency and increases its degradation. As a co-receptor, LRP2 forms a functional with cubilin, enhancing ligand uptake in the kidney , where the two proteins co-localize on the apical membrane. Cubilin, a large peripheral membrane protein lacking a , associates with LRP2 and amnionless (AMN) to form the CUBAM , in which LRP2 provides the endocytic by internalizing the entire assembly via clathrin-mediated pathways; this cooperation is vital for reabsorbing filtered proteins, as evidenced by in models lacking either receptor. LRP2 also interacts with PDZ-domain proteins such as Na+/H+ exchanger regulatory factor 1 (NHERF1) to link it to the actin cytoskeleton and modulate signaling. NHERF1 binds an internal PDZ-binding motif in LRP2's C-terminal tail via its PDZ2 domain, scaffolding LRP2 with ezrin-radixin-moesin (ERM) proteins to stabilize its apical positioning and facilitate cytoskeletal anchoring; this interaction regulates LRP2 expression levels, as NHERF1 knockdown increases LRP2 abundance, and supports downstream signaling cascades in renal cells.

Clinical significance

Associated genetic disorders

Mutations in the LRP2 gene, encoding the multiligand endocytic receptor megalin, cause , an autosomal recessive multisystem disorder. This condition results from biallelic loss-of-function variants, including nonsense, frameshift, and splice site that disrupt megalin function, leading to impaired in affected tissues. The disorder was first linked to LRP2 through genetic mapping and sequencing in affected families, confirming its role as the causative gene. DBS is characterized by distinctive facial dysmorphism, such as , a broad or flat , and , often evident at birth. , typically profound and bilateral, develops in early infancy or childhood in nearly all affected individuals. Low-molecular-weight proteinuria is a hallmark renal feature, resulting from defective reabsorption of proteins like and vitamin D-binding protein in the proximal tubules due to megalin deficiency. Additional manifestations may include developmental delay, ocular anomalies, and , contributing to variable expressivity. The mutation spectrum of LRP2 in includes numerous reported pathogenic variants, predominantly truncating mutations that result in absent or severely dysfunctional megalin protein. Examples include homozygous variants like c.4968C>G (p.Tyr1656*) and frameshift indels leading to premature termination. Missense variants, such as c.9032G>A (p.Arg3011Lys), are less common but can also impair receptor trafficking or . These variants are distributed across the , with hotspots in the extracellular -binding domains, correlating with the pleiotropic phenotypes observed. Recent studies as of 2025 have also implicated LRP2 variants in nonsyndromic pathological , where downregulation of LRP2 in may influence eye growth and differentiation, suggesting a broader role beyond classic . Facio-oculo-acoustico-renal (FOAR) represents a phenotypic overlap with and is considered allelic, caused by similar biallelic LRP2 mutations emphasizing ocular, auditory, and features. Rare associations link LRP2 to the Heymann nephritis antigen complex, though this pertains to experimental models of rather than inherited disorders.

Role in acquired diseases

LRP2, also known as megalin, plays a critical role in acquired diseases through its involvement in and clearance of ligands, where altered expression or function contributes to in multiple organs. In the , downregulation of LRP2 in impairs reabsorption in proximal tubules, leading to low molecular weight and due to overload from filtered proteins and activation of the renin-angiotensin system. Similarly, LRP2 mediates the uptake of nephrotoxic agents like gentamicin, which binds specific residues (Trp1126, Asp1129-1133, Ser1135) on the receptor, causing lysosomal accumulation, mitochondrial dysfunction, and in renal tubular cells. Anti-LRP2 nephropathy, a rare acquired disorder reported in patients over 60, is associated with autoantibodies against LRP2 often linked to monoclonal gammopathies or malignancies, leading to tubular dysfunction and . In the , reduced LRP2 expression in the of patients hinders the clearance of amyloid-beta (Aβ) peptides via interactions with and (binding sites aa 1111-1210), promoting protein accumulation and neurodegeneration; this is exacerbated by polymorphisms such as rs3755166 (G/A), which correlate with a 20% decrease in expression and increased disease risk. LRP2 also contributes to cancer progression in acquired malignancies. In , tumors frequently acquire LRP2 expression (detected in 65% of primary samples and 57% of metastases, compared to 21% of nevi), localizing to endocytic vesicles and promoting and survival; siRNA knockdown reduces EdU-positive proliferating s by up to 42% and viability by 30%, while increasing . Recent analyses as of 2025 confirm LRP2 expression associates with a transitory state influenced by interferon-gamma signaling in T cell-inflamed tumors. Polymorphisms in LRP2 influence aggressiveness by modulating androgen uptake in tumor s, with variants enhancing receptor activity linked to faster progression and recurrence, whereas those reducing activity slow tumor growth. Additionally, LRP2 variants are associated with elevated (LDL) and levels, increasing the risk of through impaired clearance. In hypertension, LRP2 dysfunction in the exacerbates sodium retention via modulation of the sodium-hydrogen exchanger 3 (NHE3), contributing to elevated .

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