The Hyaluronan Synthase isoforms direct distinct patterns of fibroblast activation linked to fibrosis progression versus resolution following renal ischaemia

Background The stroma plays a key role during renal development and in regeneration after injury. However, following injury, the stroma expands driving progressive fibrosis. Hyaluronan (HA) is a glycosaminoglycan that is absent in healthy kidney stroma but highly expressed in disease. To understand strategies to modulate stromal HA towards therapeutic advantage, this study compares HA and HA Synthase (HAS) enzyme expression in kidney development, health, disease, and recovery. Methods Rats underwent ischaemia reperfusion injury (IRI) with/without ischaemic preconditioning (IPC) and kidneys histologically analysed. Kidneys from C57BL/6 embryos and HAS1/3-/- mice were also analysed and parallel mechanistic cell studies performed using primary human fibroblasts. Results In health, stromal HA was absent from the renal cortex. HAS1 was expressed in some epithelial cells, whilst HAS2 was not expressed. Following IRI there was increased stromal HA in areas of chronic fibrosis, alongside increased HAS2 (but not HAS1) expression. In contrast, during development prominent stromal HA matrices were evident in areas of tubular generation, with strong HAS1 (not HAS2) expression. Following IPC+IRI, stromal HA and HAS2 were attenuated; whilst HAS1+ cells expanded but were distinct from α-SMA+ myofibroblasts. Cell studies demonstrated that HAS1+ fibroblasts had a functionally distinct phenotype, with enhanced migration and FAP expression but attenuated α-SMA, EDA-FN and COL1A1 expression, whereas HAS2+ fibroblasts demonstrated a classic α-SMA+ contractile myofibroblast phenotype with high EDA-FN and COL1A1. Conclusions HA is a key regulator of stromal fibroblast heterogeneity, with HAS1 and HAS2 defining phenotypically distinct populations that may influence divergent renal outcomes following injury. SIGNIFICANCE STATEMENT Hyaluronan (HA) is a matrix glycosaminoglycans that is absent in healthy kidney cortex but demonstrates increased expression in the renal stroma during progressive fibrosis. This study makes comparisons of HA accumulation, localisation, and HA Synthase (HAS) protein expression during kidney development, in health, following ischaemic kidney injury and during renal recovery. The study identifies that different HAS isoenzymes (HAS1 and HAS2) mediate distinct functional fibroblast phenotypes in vitro and are localised in distinct stromal localisations and cell sub-populations in vivo . The data provides interesting insights into HA dependent regulation of fibroblast stromal heterogeneity and identifies the novel finding that HAS1 defines cell populations that are associated with kidney recovery following ischaemic injury and are protective against progressive renal fibrosis. ### Competing Interest Statement The authors have declared no competing interest.