Collecting Duct-Targeted Lipid Nanoparticles Deliver Pkd2 mRNA to Restore Polycystin-2 and Attenuate ADPKD

Abstract

Autosomal dominant polycystic kidney disease (ADPKD), a leading genetic cause of kidney failure, is caused by mutations in the PKD1 or PKD2 genes, resulting in functional polycystin 1 (PC1) or polycystin 2 (PC2) deficiency, and is characterized by progressive cyst expansion in the kidneys. However, no approved therapy directly restores polycystin expression, and current treatments target downstream pathways rather than the genetic defect. Gene replacement therapy offers a direct route to functional rescue, but efficient delivery to cyst-lining renal epithelia remains a major barrier. To meet this challenge, we developed a lipid nanoparticle (LNP) that incorporates a collecting duct (CD) targeting peptide (CD LNPs) to enable delivery of Pkd2 mRNA (CD-mPkd2) to renal CD epithelia, the predominant site of cyst origin. CD LNPs increased renal accumulation and targeted CD cells in vivo, outperforming non-targeted formulations. In a Pkd2-deficient mouse model, repeated administration of CD-mPkd2 induced reversal of established cystic disease, restored renal architecture, and reduced the fibrotic and inflammatory microenvironment characteristic of ADPKD. Furthermore, CD-mPkd2 was well tolerated without detectable off-target toxicity. Given that PC2 supplementation can attenuate disease in Pkd1-deficient models, we further demonstrate that a single dose of CD-mPkd2 reduces cyst burden and improves renal function across this distinct genetic background. These findings establish CD-mPkd2 as a potential therapeutic strategy for ADPKD across genetic backgrounds.