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Islamuddin M, Qin X. Renal macrophages and NLRP3 inflammasomes in kidney diseases and therapeutics. Cell Death Discov 2024; 10:229. [PMID: 38740765 DOI: 10.1038/s41420-024-01996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Macrophages are exceptionally diversified cell types and perform unique features and functions when exposed to different stimuli within the specific microenvironment of various kidney diseases. In instances of kidney tissue necrosis or infection, specific patterns associated with damage or pathogens prompt the development of pro-inflammatory macrophages (M1). These M1 macrophages contribute to exacerbating tissue damage, inflammation, and eventual fibrosis. Conversely, anti-inflammatory macrophages (M2) arise in the same circumstances, contributing to kidney repair and regeneration processes. Impaired tissue repair causes fibrosis, and hence macrophages play a protective and pathogenic role. In response to harmful stimuli within the body, inflammasomes, complex assemblies of multiple proteins, assume a pivotal function in innate immunity. The initiation of inflammasomes triggers the activation of caspase 1, which in turn facilitates the maturation of cytokines, inflammation, and cell death. Macrophages in the kidneys possess the complete elements of the NLRP3 inflammasome, including NLRP3, ASC, and pro-caspase-1. When the NLRP3 inflammasomes are activated, it triggers the activation of caspase-1, resulting in the release of mature proinflammatory cytokines (IL)-1β and IL-18 and cleavage of Gasdermin D (GSDMD). This activation process therefore then induces pyroptosis, leading to renal inflammation, cell death, and renal dysfunction. The NLRP3-ASC-caspase-1-IL-1β-IL-18 pathway has been identified as a factor in the development of the pathophysiology of numerous kidney diseases. In this review, we explore current progress in understanding macrophage behavior concerning inflammation, injury, and fibrosis in kidneys. Emphasizing the pivotal role of activated macrophages in both the advancement and recovery phases of renal diseases, the article delves into potential strategies to modify macrophage functionality and it also discusses emerging approaches to selectively target NLRP3 inflammasomes and their signaling components within the kidney, aiming to facilitate the healing process in kidney diseases.
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Affiliation(s)
- Mohammad Islamuddin
- Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University School of Medicine, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA.
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
| | - Xuebin Qin
- Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University School of Medicine, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA.
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
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2
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Tam FW, Tumlin J, Barratt J, Rovin BH, Roberts IS, Roufosse C, Cook HT, Bhangal G, Brown AL, Busch M, Dudhiya F, Duliege AM, Fraser DJ, Gale DP, Huang CC, Lai PC, Lee M, Masuda ES, McAdoo SP, Rosenkranz AR, Sommerer C, Sunder-Plassmann G, Szeto CC, Tang SC, Williamson DE, Willcocks L, Vielhauer V, Kim MJ, Todd L, Zayed H, Tong-Starksen S, Lafayette R. Randomized Trial on the Effect of an Oral Spleen Tyrosine Kinase Inhibitor in the Treatment of IgA Nephropathy. Kidney Int Rep 2023; 8:2546-2556. [PMID: 38106605 PMCID: PMC10719605 DOI: 10.1016/j.ekir.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction We reported increased spleen tyrosine kinase (SYK) expression in kidney biopsies of patients with IgA nephropathy (IgAN) and that inhibition of SYK reduces inflammatory cytokines production from IgA stimulated mesangial cells. Methods This study was a double-blind, randomized, placebo-controlled phase 2 trial of fostamatinib (an oral SYK inhibitor) in 76 patients with IgAN. Patients were randomized to receive placebo, fostamatinib at 100 mg or 150 mg twice daily for 24 weeks on top of maximum tolerated dose of renin-angiotensin system inhibitors. The primary end point was reduction of proteinuria. Secondary end points included change from baseline in estimated glomerular filtration rate (eGFR) and kidney histology. Results Although we could not detect significant reduction in proteinuria with fostamatinib overall, in a predetermined subgroup analysis, there was a trend for dose-dependent reduction in median proteinuria (from baseline to 24 weeks by 14%, 27%, and 36% in the placebo, fostamatinib 100 mg, and 150 mg groups, respectively) in patients with baseline urinary protein-to-creatinine ratios (UPCR) more than 1000 mg/g. Kidney function (eGFR) remained stable in all groups. Fostamatinib was well-tolerated. Side effects included diarrhea, hypertension, and increased liver enzymes. Thirty-nine patients underwent repeat biopsy showing reductions in SYK staining associated with therapy at low dose (-1.5 vs. 1.7 SYK+ cells/glomerulus in the placebo group, P < 0.05). Conclusions There was a trend toward reduction in proteinuria with fostamatinib in a predefined analysis of high risk patients with IgAN despite maximal care, as defined by baseline UPCR greater than 1000 mg/g. Further study may be warranted.
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Affiliation(s)
- Frederick W.K. Tam
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James Tumlin
- Department of Nephrology, Emory University School Medicine, Atlanta, Georgia, USA
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Brad H. Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ian S.D. Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospital NHS FT, Oxford, UK
| | - Candice Roufosse
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - H. Terence Cook
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gurjeet Bhangal
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Martin Busch
- Department of Internal Medicine III, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Fayaz Dudhiya
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Anne-Marie Duliege
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Donald J. Fraser
- Wales Kidney Research Unit, Cardiff University, School of Medicine, Heath Park, Cardiff, UK
| | - Daniel P. Gale
- Department of Renal Medicine, University College London, London, UK
| | - Chiu-Ching Huang
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chin Lai
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Lee
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Esteban S. Masuda
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Stephen P. McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China
| | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | - Volker Vielhauer
- Medizinische Klinik und Poliklinik IV, Nephrologisches Zentrum, Klinikum der Universität München, Munich, Germany
| | - Min Jeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Leslie Todd
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Hany Zayed
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Sandra Tong-Starksen
- Department of Clinical Development, Rigel Pharmaceuticals, Inc., South San Francisco, California, USA
| | - Richard Lafayette
- Department of Nephrology, Stanford University Medical Center, Stanford, California, USA
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3
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Chen T, Cao Q, Wang R, Zheng G, Azmi F, Lee VW, Wang YM, Li H, Yu D, Rogers NM, Alexander SI, Harris DCH, Wang Y. Attenuation of renal injury by depleting cDC1 and by repurposing Flt3 inhibitor in anti-GBM disease. Clin Immunol 2023; 250:109295. [PMID: 36933629 DOI: 10.1016/j.clim.2023.109295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/15/2023] [Indexed: 03/18/2023]
Abstract
Previous studies found cDC1s to be protective in early stage anti-GBM disease through Tregs, but pathogenic in late stage Adriamycin nephropathy through CD8+ T cells. Flt3 ligand is a growth factor essential for cDC1 development and Flt3 inhibitors are currently used for cancer treatment. We conducted this study to clarify the role and mechanisms of effects of cDC1s at different time points in anti-GBM disease. In addition, we aimed to utilize drug repurposing of Flt3 inhibitors to target cDC1s as a treatment of anti-GBM disease. We found that in human anti-GBM disease, the number of cDC1s increased significantly, proportionally more than cDC2s. The number of CD8+ T cells also increased significantly and their number correlated with cDC1 number. In XCR1-DTR mice, late (day 12-21) but not early (day 3-12) depletion of cDC1s attenuated kidney injury in mice with anti-GBM disease. cDC1s separated from kidneys of anti-GBM disease mice were found to have a pro-inflammatory phenotype (i.e. express high level of IL-6 and IL-12) in late but not early stage. In the late depletion model, the number of CD8+ T cells was also reduced, but not Tregs. CD8+ T cells separated from kidneys of anti-GBM disease mice expressed high levels of cytotoxic molecules (granzyme B and perforin) and inflammatory cytokines (TNF-α and IFN-γ), and their expression reduced significantly after cDC1 depletion with diphtheria toxin. These findings were reproduced using a Flt3 inhibitor in wild type mice. Therefore, cDC1s are pathogenic in anti-GBM disease through activation of CD8+ T cells. Flt3 inhibition successfully attenuated kidney injury through depletion of cDC1s. Repurposing Flt3 inhibitors has potential as a novel therapeutic strategy for anti-GBM disease.
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Affiliation(s)
- Titi Chen
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.
| | - Qi Cao
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Ruifeng Wang
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Nephrology, The Second Hospital of Anhui Medical University, Anhui 230000, China
| | - Guoping Zheng
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Farhana Azmi
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Vincent W Lee
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Yuan Ming Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Hongqi Li
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; The Department of Gerontology, Anhui Provincial Hospital, the first affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
| | - Di Yu
- Faculty of Medicine, The University of Queensland Diamantina Institute, St Lucia, QLD 4072, Australia
| | - Natasha M Rogers
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - David C H Harris
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Yiping Wang
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
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Grynberg K, Tian L, Tesch G, Ozols E, Mulley WR, Nikolic-Paterson DJ, Ma FY. Mice with Established Diabetes Show Increased Susceptibility to Renal Ischemia/Reperfusion Injury: Protection by Blockade of Jnk or Syk Signaling Pathways. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:441-453. [PMID: 34954209 DOI: 10.1016/j.ajpath.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Patients with diabetes are at an increased risk for acute kidney injury (AKI) after renal ischemia/reperfusion injury (IRI). However, there is a lack preclinical models of IRI in established diabetes. The current study characterized renal IRI in mice with established diabetes and investigated potential therapies. Diabetes was induced in C57BL/6J mice by low-dose streptozotocin injection. After 7 weeks of sustained diabetes, mice underwent 13 minutes of bilateral renal ischemia and were euthanized after 24 hours of reperfusion. Age-matched, nondiabetic controls underwent the same surgical procedure. Renal IRI induced two- and sevenfold increases in plasma creatinine level in nondiabetic and diabetic mice, respectively (P < 0.001). Kidney damage, as indicated by histologic damage, tubular cell death, tubular damage markers, and inflammation, was more severe in the diabetic IRI group. The diabetic IRI group showed greater accumulation of spleen tyrosine kinase (Syk)-expressing cells, and increased c-Jun N-terminal kinase (Jnk) signaling in tubules compared to nondiabetic IRI. Prophylactic treatment with a Jnk or Syk inhibitor substantially reduced the severity of AKI in the diabetic IRI model, with differential effects on neutrophil infiltration and Jnk activation. In conclusion, established diabetes predisposed mice to renal IRI-induced AKI. Two distinct proinflammatory pathways, JNK and SYK, were identified as potential therapeutic targets for anticipated AKI in patients with diabetes.
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Affiliation(s)
- Keren Grynberg
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Lifang Tian
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Greg Tesch
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Elyce Ozols
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - David J Nikolic-Paterson
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.
| | - Frank Y Ma
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
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5
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Bell RMB, Conway BR. Macrophages in the kidney in health, injury and repair. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 367:101-147. [PMID: 35461656 DOI: 10.1016/bs.ircmb.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Macrophages are a key component of the renal mononuclear phagocyte system, playing a major role in defense against infection, renal injury and repair. Yolk sac macrophage precursors seed the early embryonic kidney and are important for renal development. Later, renal macrophages are derived from hematopoietic stem cells and in adult life, there is a significant contribution from circulating monocytes, which is enhanced in response to infection or injury. Macrophages are highly plastic and can alter their phenotype in response to cues from parenchymal renal cells. Danger-associated molecules released from injured kidney cells may activate macrophages toward a pro-inflammatory phenotype, mediating further recruitment of inflammatory cells, exacerbating renal injury and activating renal fibroblasts to promote scarring. In acute kidney injury, once the injury stimulus has abated, macrophages may adopt a more reparative phenotype, dampening the immune response and promoting repair of renal tissue. However, in chronic kidney disease ongoing activation of pro-inflammatory monocytes and persistence of reparative macrophages leads to glomerulosclerosis and tubulointerstitial fibrosis, the hallmarks of end-stage kidney disease. Several strategies to inhibit the recruitment, activation and secretory products of pro-inflammatory macrophages have proven beneficial in pre-clinical models and are now undergoing clinical trials in patients with kidney disease. In addition, macrophages may be utilized in cell therapy as a "Trojan Horse" to deliver targeted therapies to the kidney. Single-cell RNA sequencing has identified a previously unappreciated spectrum of macrophage phenotypes, which may be selectively present in injury or repair, and ongoing functional analyses of these subsets may identify more specific targets for therapeutic intervention.
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Affiliation(s)
- Rachel M B Bell
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Bryan R Conway
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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6
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Tang PMK, Chen H, Tang Y, Nikolic-Paterson DJ, Lan HY. Editorial: Immune Landscape of Kidney Pathology. Front Physiol 2022; 12:827537. [PMID: 35145431 PMCID: PMC8822390 DOI: 10.3389/fphys.2021.827537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Patrick Ming-Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Patrick Ming-Kuen Tang
| | - Haiyong Chen
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying Tang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - David J. Nikolic-Paterson
- Department of Nephrology, Monash University, Clayton, VIC, Australia
- Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Hui Yao Lan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Guangdong-Hong Kong Joint Laboratory on Immunological and Genetic Kidney Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Hui Yao Lan
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7
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McAdoo SP, Prendecki M, Tanna A, Bhatt T, Bhangal G, McDaid J, Masuda ES, Cook HT, Tam FWK, Pusey CD. Spleen tyrosine kinase inhibition is an effective treatment for established vasculitis in a pre-clinical model. Kidney Int 2020; 97:1196-1207. [PMID: 32305129 PMCID: PMC7242903 DOI: 10.1016/j.kint.2019.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 12/31/2022]
Abstract
The anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are a group of life-threatening multi-system diseases characterized by necrotising inflammation of small blood vessels and crescentic glomerulonephritis. ANCA are thought to play a direct pathogenic role. Previous studies have shown that spleen tyrosine kinase (SYK) is phosphorylated during ANCA-induced neutrophil activation in vitro. However, the role of SYK in vivo is unknown. Here, we studied its role in the pathogenesis of experimental autoimmune vasculitis, a pre-clinical model of myeloperoxidase-ANCA-induced pauci-immune systemic vasculitis in the Wistar Kyoto rat. Up-regulation of SYK expression in inflamed renal and pulmonary tissue during early autoimmune vasculitis was confirmed by immunohistochemical and transcript analysis. R406, the active metabolite of fostamatinib, a small molecule kinase inhibitor with high selectivity for SYK, inhibited ANCA-induced pro-inflammatory responses in rat leucocytes in vitro. In an in vivo study, treatment with fostamatinib for 14 days after disease onset resulted in rapid resolution of urinary abnormalities, significantly improved renal and pulmonary pathology, and preserved renal function. Short-term exposure to fostamatinib did not significantly affect circulating myeloperoxidase-ANCA levels, suggesting inhibition of ANCA-induced inflammatory mechanisms in vivo. Finally, SYK expression was demonstrated within inflammatory glomerular lesions in ANCA-associated glomerulonephritis in patients, particularly within CD68+ve monocytes/macrophages. Thus, our data indicate that SYK inhibition warrants clinical investigation in the treatment of AAV.
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Affiliation(s)
- Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK.
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - Anisha Tanna
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - Tejal Bhatt
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - Gurjeet Bhangal
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - John McDaid
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | | | - H Terence Cook
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - Frederick W K Tam
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
| | - Charles D Pusey
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London UK
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8
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McAdoo S, Tam FWK. Role of the Spleen Tyrosine Kinase Pathway in Driving Inflammation in IgA Nephropathy. Semin Nephrol 2019; 38:496-503. [PMID: 30177021 PMCID: PMC6135887 DOI: 10.1016/j.semnephrol.2018.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Summary: IgA nephropathy is the most common type of primary glomerulonephritis worldwide. At least 25% of patients may progress to kidney failure requiring dialysis or transplantation. Treatment of IgA nephropathy using generalized immunosuppression is controversial, with concerns regarding the balance of safety and efficacy in a nonspecific approach. This review describes the recent scientific evidence, and a current clinical trial, investigating whether spleen tyrosine kinase (SYK) may be a novel and selective therapeutic target for IgA nephropathy. SYK, a cytoplasmic tyrosine kinase, has a pivotal role as an early intermediate in intracellular signal transduction cascades for the B-cell receptor and the immunoglobulin Fc receptor, and thus is critical for B-cell proliferation, differentiation, and activation, and for mediating proinflammatory responses after Fc-receptor engagement in various cell types. In renal biopsy specimens of patients with IgA nephropathy, increased expression and phosphorylation of SYK were detected, and this correlated with the histologic features of mesangial and endocapillary proliferation. In cell culture studies, patient-derived IgA1 stimulated mesangial cell SYK activation, cell proliferation, and cytokine production, and these responses were attenuated by pharmacologic or molecular inhibition of SYK. A global, randomized, double-blind, placebo-controlled trial investigating the safety and efficacy of fostamatinib (an oral prodrug SYK inhibitor) in the treatment of patients with IgA nephropathy is ongoing, which may provide important evidence of the safety and efficacy of targeting this pathway in clinical disease.
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Affiliation(s)
- Stephen McAdoo
- Renal and Vascular Inflammation Section, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Frederick W K Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom..
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9
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Macrophages: versatile players in renal inflammation and fibrosis. Nat Rev Nephrol 2019; 15:144-158. [PMID: 30692665 DOI: 10.1038/s41581-019-0110-2] [Citation(s) in RCA: 513] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 12/15/2022]
Abstract
Macrophages have important roles in immune surveillance and in the maintenance of kidney homeostasis; their response to renal injury varies enormously depending on the nature and duration of the insult. Macrophages can adopt a variety of phenotypes: at one extreme, M1 pro-inflammatory cells contribute to infection clearance but can also promote renal injury; at the other extreme, M2 anti-inflammatory cells have a reparative phenotype and can contribute to the resolution phase of the response to injury. In addition, bone marrow monocytes can differentiate into myeloid-derived suppressor cells that can regulate T cell immunity in the kidney. However, macrophages can also promote renal fibrosis, a major driver of progression to end-stage renal disease, and the CD206+ subset of M2 macrophages is strongly associated with renal fibrosis in both human and experimental diseases. Myofibroblasts are important contributors to renal fibrosis and recent studies provide evidence that macrophages recruited from the bone marrow can transition directly into myofibroblasts within the injured kidney. This process is termed macrophage-to-myofibroblast transition (MMT) and is driven by transforming growth factor-β1 (TGFβ1)-Smad3 signalling via a Src-centric regulatory network. MMT may serve as a key checkpoint for the progression of chronic inflammation into pathogenic fibrosis.
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10
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Han Y, Ma FY, Di Paolo J, Nikolic-Paterson DJ. An inhibitor of spleen tyrosine kinase suppresses experimental crescentic glomerulonephritis. Int J Immunopathol Pharmacol 2018; 32:2058738418783404. [PMID: 29923438 PMCID: PMC6024518 DOI: 10.1177/2058738418783404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Non-selective inhibitors of spleen tyrosine kinase (SYK) efficiently suppress
disease in T cell-dependent models of crescentic glomerulonephritis. However,
the therapeutic potential of selective SYK inhibitors in this disease has not
been established. In addition, we lack knowledge regarding SYK expression in
non-myeloid cells in glomerulonephritis. We addressed these two issues in a rat
model of nephrotoxic serum nephritis (NTN) using a SYK inhibitor, GS-492429.
Disease was induced in Sprague-Dawley rats (Study 1) or Wistar-Kyoto (WKY) rats
(Study 2) by immunization with sheep IgG and administration of sheep anti-rat
nephrotoxic serum. Animals were untreated or received GS-492429 (30 mg/kg/bid)
or vehicle treatment from 2 h before nephrotoxic serum injection until being
killed 3 or 24 h later (Study 1) or 14 days later (Study 2). Two-colour confocal
microscopy found that SYK expression in NTN kidney was restricted to myeloid
cells and platelets, with no evidence of SYK expression by T cells, mesangial
cells, podocytes or tubular epithelial cells. In Study 1, GS-492429 treatment
significantly reduced glomerular neutrophil and macrophage infiltration, with
protection from glomerular thrombosis and proteinuria. In Study 2, GS-492429
treatment reduced glomerular crescent formation by 70% on day 14 NTN in
conjunction with reduced glomerular thrombosis, glomerulosclerosis and tubular
damage. This was accompanied by a marked reduction in markers of inflammation
(CCL2, TNF-α, NOS2, MMP-12). Importantly, the protective effects of GS-492429
were independent of T cell infiltration and activation and independent of
JAK/STAT3 signalling. In conclusion, this study demonstrates that a SYK
inhibitor can suppress the development of crescentic glomerulonephritis through
effects upon myeloid cells and platelets.
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Affiliation(s)
- Yingjie Han
- 1 Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia.,2 Monash University Centre for Inflammatory Diseases, Monash Medical Centre, Clayton, VIC, Australia
| | - Frank Y Ma
- 1 Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia.,2 Monash University Centre for Inflammatory Diseases, Monash Medical Centre, Clayton, VIC, Australia
| | | | - David J Nikolic-Paterson
- 1 Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia.,2 Monash University Centre for Inflammatory Diseases, Monash Medical Centre, Clayton, VIC, Australia
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11
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Abraham AP, Ma FY, Mulley WR, Nikolic-Paterson DJ, Tesch GH. Matrix metalloproteinase-12 deficiency attenuates experimental crescentic anti-glomerular basement membrane glomerulonephritis. Nephrology (Carlton) 2018; 23:183-189. [DOI: 10.1111/nep.12964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Abu P. Abraham
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
- Monash University, Centre for Inflammatory Diseases; Melbourne Victoria Australia
| | - Frank Y. Ma
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
- Monash University, Centre for Inflammatory Diseases; Melbourne Victoria Australia
| | - William R. Mulley
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
- Monash University, Centre for Inflammatory Diseases; Melbourne Victoria Australia
| | - David J. Nikolic-Paterson
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
- Monash University, Centre for Inflammatory Diseases; Melbourne Victoria Australia
| | - Greg H. Tesch
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
- Monash University, Centre for Inflammatory Diseases; Melbourne Victoria Australia
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12
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Ma TKW, McAdoo SP, Tam FWK. Targeting the tyrosine kinase signalling pathways for treatment of immune-mediated glomerulonephritis: from bench to bedside and beyond. Nephrol Dial Transplant 2017; 32:i129-i138. [PMID: 28391340 PMCID: PMC5410974 DOI: 10.1093/ndt/gfw336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022] Open
Abstract
Glomerulonephritis (GN) affects patients of all ages and is an important cause of morbidity and mortality. Non-selective immunosuppressive drugs have been used in immune-mediated GN but often result in systemic side effects and occasionally fatal infective complications. There is increasing evidence from both preclinical and clinical studies that abnormal activation of receptor and non-receptor tyrosine kinase signalling pathways are implicated in the pathogenesis of immune-mediated GN. Activation of spleen tyrosine kinase (SYK), Bruton's tyrosine kinase (BTK), platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR) and discoidin domain receptor 1 (DDR1) have been demonstrated in anti-GBM disease. SYK is implicated in the pathogenesis of ANCA-associated GN. SYK, BTK, PDGFR, EFGR, DDR1 and Janus kinase are implicated in the pathogenesis of lupus nephritis. A representative animal model of IgA nephropathy (IgAN) is lacking. Based on the results from in vitro and human renal biopsy study results, a phase II clinical trial is ongoing to evaluate the efficacy and safety of fostamatinib (an oral SYK inhibitor) in high-risk IgAN patient. Various tyrosine kinase inhibitors (TKIs) have been approved for cancer treatment. Clinical trials of TKIs in GN may be justified given their long-term safety data. In this review we will discuss the current unmet medical needs in GN treatment and research as well as the current stage of development of TKIs in GN treatment and propose an accelerated translational research approach to investigate whether selective inhibition of tyrosine kinase provides a safer and more efficacious option for GN treatment.
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Affiliation(s)
- Terry King-Wing Ma
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK.,Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Stephen P McAdoo
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Frederick Wai Keung Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
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13
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Inhibition of Spleen Tyrosine Kinase Reduces Renal Allograft Injury in a Rat Model of Acute Antibody-Mediated Rejection in Sensitized Recipients. Transplantation 2017; 101:e240-e248. [DOI: 10.1097/tp.0000000000001826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Luque Y, Cathelin D, Vandermeersch S, Xu X, Sohier J, Placier S, Xu-Dubois YC, Louis K, Hertig A, Bories JC, Vasseur F, Campagne F, Di Santo JP, Vosshenrich C, Rondeau E, Mesnard L. Glomerular common gamma chain confers B- and T-cell–independent protection against glomerulonephritis. Kidney Int 2017; 91:1146-1158. [DOI: 10.1016/j.kint.2016.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 12/22/2022]
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15
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Webster P, Pusey C. Crescentic glomerulonephritis: beyond the immune system. Nat Rev Nephrol 2017; 13:198-200. [DOI: 10.1038/nrneph.2017.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Zhu F, Bai X, Chen X. B lymphocytes in renal interstitial fibrosis. J Cell Commun Signal 2017; 11:213-218. [PMID: 28210941 DOI: 10.1007/s12079-017-0382-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022] Open
Abstract
Fibrosis is defined as an excessive deposition of extracellular matrix (ECM), which leads to the destruction of organ structure and impairment of organ function. Fibrosis occurs not only in kidney but also in lung, liver, heart, and skin. Common pathways of fibrosis are thought to exist. Renal interstitial fibrosis is a complex process that involves multiple molecular signaling and multiple cellular components, in which B cells appear to be one of the emerging important players. B cells may affect fibrosis through cytokine production and through interaction with other cells including fibroblasts, macrophages and T cells. This review summarizes recent research findings of B cells in fibrosis and provides an insight of how the future therapeutics of fibrosis could be developed from a B-cell point of view.
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Affiliation(s)
- Fengge Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xueyuan Bai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
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17
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Ryan J, Kanellis J, Blease K, Ma FY, Nikolic-Paterson DJ. Spleen Tyrosine Kinase Signaling Promotes Myeloid Cell Recruitment and Kidney Damage after Renal Ischemia/Reperfusion Injury. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2032-2042. [DOI: 10.1016/j.ajpath.2016.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
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18
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Ma TKW, McAdoo SP, Tam FWK. Spleen Tyrosine Kinase: A Crucial Player and Potential Therapeutic Target in Renal Disease. Nephron Clin Pract 2016; 133:261-9. [PMID: 27476075 DOI: 10.1159/000446879] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/24/2016] [Indexed: 02/06/2023] Open
Abstract
Spleen tyrosine kinase (Syk), a 72 kDa cytoplasmic non-receptor protein-tyrosine kinase, plays an important role in signal transduction in a variety of cell types. Ever since its discovery in the early 1990s, there has been accumulating evidence to suggest a pathogenic role of Syk in various allergic disorders, autoimmune diseases and malignancies. Additionally, there is emerging data from both pre-clinical and clinical studies that Syk is implicated in the pathogenesis of proliferative glomerulonephritis (GN), including anti-glomerular basement membrane disease, anti-neutrophil cytoplasmic antibody-associated GN, lupus nephritis and immunoglobulin A nephropathy (IgAN). Moreover, recent animal studies have shed light on the importance of Syk in mediating acute renal allograft rejection, Epstein Barr virus-associated post-transplant lymphoproliferative disease and kidney fibrosis. Fostamatinib, an oral Syk inhibitor, has undergone clinical testing in rheumatoid arthritis, refractory immune thrombocytopenic purpura, leukemia and lymphoma. The recent STOP-IgAN trial showed that the addition of non-selective immunosuppressive therapy to intensive supportive care did not improve clinical outcomes in high-risk IgAN patients. A Syk-targeted approach may be beneficial and is currently being evaluated in a phase II randomized controlled trial. In this review, we will discuss the pathogenic role of Syk and potential use of Syk inhibitor in a variety of renal diseases.
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Affiliation(s)
- Terry King-Wing Ma
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
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