Friday, October 31, 2025 10/31/2025

Molecular and Cellular Mechanisms of the Lysosomal Storage Disease Cystinosis

Award Number: R01DK110162
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/09/2017
PERIOD OF PERFORMANCE END DATE: 05/30/2026

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Molecular and Cellular Mechanisms of the Lysosomal Storage Disease Cystinosis - SUMMARY Lysosomal function is crucial for cell homeostasis, autophagy, nutrient sensing, apoptosis and tissue remodeling. In lysosomal storage disorders (LSDs), characterized by genetic defects leading to anomalous accumulation of metabolites in lysosomes, cells are affected by lysosomal malfunction frequently leading to cell death. Cystinosis is a lysosomal storage disorder resulting from defects in the cystine transporter cystinosin (CTNS). Increased levels of intra-lysosomal cystine lead to cell malfunction and progressive tissue deterioration, which is especially manifested in kidneys. As with most LSDs, this leads to a slow but irreversible deterioration, organ dysfunction and early death. Patients with nephropathic cystinosis develop proximal tubule cell dedifferentiation, Fanconi syndrome and progressive renal injury, which are not corrected by the current therapy, cysteamine. Thus, cell malfunction and tissue failure occur despite cystine depletion, suggesting that cystine accumulation is not the only cause of all the defects observed in cystinosis. We recently revealed a defective mechanism of chaperone- mediated autophagy (CMA) in cystinosis. Defective CMA is directly linked to human disease, including kidney pathologies and neurological disorders. CMA defects in cystinosis are caused by mislocalization and downregulation of the only lysosomal CMA receptor, LAMP2A. Defective CMA activity correlates with high susceptibility to cell death in cystinosis. Importantly, the defect was not rescued by cystine depleting therapies supporting that it is independent of lysosomal overload. Our data highlight that CMA impairment is an important contributor to the pathogenesis of cystinosis and underline the need for new treatments to complement cystine- depletion therapies. Our research plan aims to elucidate the molecular and cellular mechanisms leading to abnormal CMA activity in cystinosis. We also propose translational approaches that utilize small-molecule activators of CMA to improve cellular function in cystinosis. Our Specific Aims are: Aim 1: To elucidate the molecular basis of the regulation of LAMP2A function in cystinosis. To this end, we will study the interplay between the CTNS protein and the CMA receptor LAMP2A and elucidate the mechanisms that mediate LAMP2A trafficking and destabilization at the lysosomal membrane in cystinosis. Aim 2: To determine the molecular basis of the regulation of CMA activity in cystinosis. We will study the mechanisms mediated by CTNS to regulate CMA function and will test the hypothesis that the rescue of CMA activity improves the function of proximal tubule cells from cystinotic patients. Aim 3: To utilize small-molecule CMA activators, in vivo, to improve renal function in cystinotic mice. We will correct cellular and renal function in cystinotic mice using CMA activators, alone, or in combination with cysteamine. Our research is highly significant because it aims to elucidate molecular mechanisms associated with a devastating human pathology and will help develop new therapies for the treatment of cystinosis and other human diseases.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $740,732 )
2025	2025	SCRIPPS RESEARCH INSTITUTE	10550 N TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	6/25/2025	NON-COMPETING CONTINUATION	$740,732
														Subtotal = $740,732

Issue Date FY: 2024 ( Subtotal = $825,215 )
2024	2024	SCRIPPS RESEARCH INSTITUTE	10550 N TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	7	8/20/2024	SUPPLEMENT FOR EXPANSION	$109,451
2024	2024	SCRIPPS RESEARCH INSTITUTE	10550 N TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	7	8/5/2024	NON-COMPETING CONTINUATION	$715,764
														Subtotal = $825,215

Issue Date FY: 2023 ( Subtotal = $833,003 )
2023	2023	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	6	6/17/2023	SUPPLEMENT FOR EXPANSION	$0
2023	2023	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	6	6/1/2023	NON-COMPETING CONTINUATION	$725,337
2023	2023	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	6	6/15/2023	SUPPLEMENT FOR EXPANSION	$107,666
														Subtotal = $833,003

Issue Date FY: 2022 ( Subtotal = $725,337 )
2022	2022	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	8/12/2022	NON-COMPETING CONTINUATION	$725,337
														Subtotal = $725,337

Issue Date FY: 2021 ( Subtotal = $786,695 )
2021	2021	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	6/17/2021	COMPETING CONTINUATION	$786,695
2021	2019	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	9/2/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $786,695

Issue Date FY: 2019 ( Subtotal = $269,382 )
2019	2019	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	6/5/2019	NON-COMPETING CONTINUATION	$269,382
														Subtotal = $269,382

Issue Date FY: 2018 ( Subtotal = $274,972 )
2018	2018	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	6/27/2018	NON-COMPETING CONTINUATION	$274,972
														Subtotal = $274,972

Issue Date FY: 2017 ( Subtotal = $290,250 )
2017	2017	SCRIPPS RESEARCH INSTITUTE, THE	10550 NORTH TORREY PINES RD	LA JOLLA	CA	92037	SAN DIEGO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	8/9/2017	NEW	$290,250
														Subtotal = $290,250

Grand Total All Awards = $4,745,586

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Molecular and Cellular Mechanisms of the Lysosomal Storage Disease Cystinosis

Award Number: R01DK110162

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/09/2017

PERIOD OF PERFORMANCE END DATE: 05/30/2026

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