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Heparan sulfate (HS) glycosaminoglycans are deemed essential to the glomerular filtration barrier, including the glomerular endothelial glycocalyx. Animal studies have shown that loss of HS results in a thinner glycocalyx. Also, decreased glomerular HS expression is observed in various proteinuric renal diseases in humans. A case report of a patient with an <jats:italic>EXT1<\/jats:italic> mutation indicated that this could result in a specific renal phenotype. This patient suffered from multiple osteochondromas, an autosomal dominant disease caused by mono-allelic germline mutations in the <jats:italic>EXT1<\/jats:italic> or <jats:italic>EXT2<\/jats:italic> gene. These studies imply that HS is indeed essential to the glomerular filtration barrier. However, loss of HS did not lead to proteinuria in various animal models. We demonstrate that multiple osteochondroma patients do not have more microalbuminuria or altered glycocalyx properties compared to age-matched controls (<jats:italic>n<\/jats:italic>\u2009=\u200919). A search for all Dutch patients registered with both osteochondroma and kidney biopsy (<jats:italic>n<\/jats:italic>\u2009=\u200939) showed that an <jats:italic>EXT1<\/jats:italic> or <jats:italic>EXT2<\/jats:italic> mutation does not necessarily lead to specific glomerular morphological phenotypic changes. In conclusion, this study shows that a heterozygous mutation in the HS backbone elongating enzymes EXT1 and EXT2 in humans does not result in (micro)albuminuria, a specific renal phenotype or changes to the endothelial glycocalyx, adding to the growing knowledge on the role of EXT1 and EXT2 genes in pathophysiology.<\/jats:p>","DOI":"10.1007\/s00438-022-01854-w","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T06:03:06Z","timestamp":1643695386000},"page":"397-405","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Mutations in the heparan sulfate backbone elongating enzymes EXT1 and EXT2 have no major effect on endothelial glycocalyx and the glomerular filtration barrier"],"prefix":"10.1007","volume":"297","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7251-026X","authenticated-orcid":false,"given":"Ramzi","family":"Khalil","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margien G. 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