Essential roles of CFEX-mediated Cl--oxalate exchange in proximal tubule NaCl transport and prevention of urolithiasis

The majority of the Na+ and Cl- filtered by the kidney is reabsorbed in the proximal tubule. In this nephron segment, a significant fraction of Cl- is transported via apical membrane Cl--base exchange: Cl-- formate exchange, Cl--oxalate exchange, Cl--OH- exchange, and Cl--HCO3- exchange. A search for the transporter responsible for apical membrane Cl--formate exchange in the proximal tubule led to the identification of CFEX (SLC26A6). Functional expression studies in Xenopus oocytes demonstrated that CFEX is capable of mediating not only Cl--formate exchange but also Cl--oxalate exchange, Cl--OH- exchange, and Cl--HCO3- exchange. Studies in CFEX-null mice have begun to elucidate which of the anion exchange activities mediated by CFEX is important for renal physiology and pathophysiology in vivo. Measurements of transport in renal brush border vesicles isolated from CFEX-null mice demonstrated that CFEX primarily mediates Cl--oxalate exchange rather than Cl-- formate exchange. Microperfusion studies in CFEX-null mice revealed that CFEX plays an essential role in mediating oxalate-dependent NaCl absorption in the proximal tubule. CFEX-null mice were found to have hyperoxaluria and a high incidence of calcium oxalate urolithiasis. The etiology of hyperoxaluria in CFEX-null mice was observed to be a defect in oxalate secretion in the intestine, leading to enhanced net absorption of ingested oxalate and elevation of plasma oxalate. Thus, by virtue of its function as a Cl--oxalate exchanger, CFEX plays essential roles both in proximal tubule NaCl transport and in the prevention of hyperoxaluria and calcium oxalate nephrolithiasis.