Significance StatementHyperphosphatemia is a major complication in the later stages of CKD, causing vascular calcification. We have identified 54 kidney-enriched genes, 19 of which are expressed in renal primary proximal tubule cells. One of the proximal tubule–specific genes, TMEM174, interacted with NPT2A, and its knockdown attenuated the reduction of NPT2A protein by fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) treatments in proximal tubule cells. TMEM174 knockout mice had significantly increased levels of serum phosphate, FGF23, and PTH, resulting in vascular calcification.BackgroundThe proximal tubules play a critical role in phosphate (Pi) homeostasis by reabsorbing Pi via sodium-dependent Pi cotransporters. NPT2A is a major proximal-specific Pi cotransporter, whose expression is regulated by circulating hormones, such as parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). In this study, we aimed to find a novel regulator in Pi homeostasis.MethodsUsing RNA-seq and RT-qPCR analysis, we identified proximal tubule cell–enriched genes. We next used RNAi screening of the identified proximal tubular cell–enriched genes to identify a novel proximal tubule–specific gene that contributes to FGF23- and PTH-mediated inhibition of Pi uptake and NPT2 reduction. We created mice lacking this novel regulator of Pi homeostasis to examine whether the novel regulator contributes to Pi homeostasis in vivo.ResultsWe identified 54 kidney-enriched genes, 19 of which are expressed in renal primary proximal tubule cells. One of the proximal tubule–specific genes, TMEM174, interacted with NPT2A, and its knockdown blocked the reduction of NPT2A protein by FGF23 and PTH treatments in human and opossum proximal tubule cells. TMEM174 KO mice had significantly increased levels of serum Pi, FGF23, and PTH, resulting in vascular calcification.ConclusionsTMEM174 is a novel regulator of Pi homeostasis that interacts with NPT2A.