Excretion of epidermal growth factor-like material in acute Henoch-Schönlein purpura nephritis

Possible pathologenic role of interleukin-5 and eosino cationic protein in Henoch-Schönlein purpura nephritis

BACKGROUND

The mechanism for the onset of Henoch-Schönlein purpura nephritis is unknown. In order to identify the pathogenesis of nephritis, laboratory findings and serum cytokines between Henoch-Schönlein purpura (HSP) patients without nephritis and with nephritis were investigated.

METHODS

We enrolled 32 patients who had been diagnosed with HSP from January 1993 to December 1998. These patients were divided into two groups. Group 1 consisted 12 patients without nephritis and group 2 consisted 20 patients with nephritis. We evaluated laboratory findings such as eosinophil counts, serum IgE, eosino cationic protein (ECP), and serum cytokine (interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-13 interferon-gamma and tumor necrotic factor-alpha) concentrations between both groups.

RESULTS

At the acute phase, serum IL-5 and ECP concentrations in group 2 were higher than those in group 1 (59.4 +/- 32.7 pg/mL vs. 10.8 +/- 12.8 pg/mL, P < 0.05, 24.3 +/- 5.1 microg/L vs. 8.9 +/- 4.2 microg/L, P < 0.05, respectively). Serum IL-4 concentrations at the acute phase in group 1 were higher than those in group 2 (40.2 +/- 21.5 pg/mL vs. 10.7 +/- 5.4 pg/mL, P < 0.01). In group 2, serum IL-5 concentrations at the acute phase were higher than those at recovery phase.

CONCLUSIONS

These findings suggest that IL-5 and eosinophil activation may be one of the factors involved in the mechanism for onset of nephritis.

Impaired activation of the fibrinolytic system in children with Henoch-Schönlein purpura: beneficial effect of hydrocortisone plus Sigma-aminocaproic acid therapy on disappearance rate of cutaneous vasculitis and fibrinolysis

Systemic vasculitis is a predominant clinical symptom in Henoch-Schönlein purpura (HSP), and some studies suggested that decreased blood fibrinolytic activity, as well as blood platelets, is of importance in the development of cutaneous vasculitis. Although patients with HSP have normal blood coagulation, little is known about the fibrinolytic system. On the other hand, it is known that the focus of Sigma-aminocaproic acid (EACA) activity in vivo is probably the blood platelet-vessel wall interaction or a vascular component alone. The aim of this study was, therefore, to investigate blood coagulation and fibrinolytic system as well as the effect of hydrocortisone (H) plus EACA therapy (Group I) on plasma antithrombin-III (AT-III), alpha1-proteinase inhibitor (alpha1-PI), alpha2-antiplasmin (alpha2-A), alpha2-macroglobulin (alpha2-M) activity, fibrinogen and plasminogen concentrations in plasma, euglobulin clot lysis time (ELT), and disappearance rate of cutaneous vasculitis in 14 children with HSP aged 7.6 +/- 3.1 (SD) years. Ten patients (8.6 +/- 2.5 years old) were treated with H alone (Group II), and 8 healthy, age-matched children served as controls. Plasma proteinase inhibitor activity was estimated with the kinetic method using Boehringer chromozyme tests before administration of H (9.2 +/- 3.3 mg/kg/d, i.v.) plus EACA (140 +/- 52 mg/kg/d, p.o.) for 5.93 +/- 2.05 days, and 24 hours after the last dose of EACA, as well as before and after treatment with H alone (8.25 +/- 1.74 mg/kg/24 h, i.v.) for 7.1 +/- 1.2 days. It was found that patients with HSP had the initial fibrinogen and plasminogen plasma concentrations significantly increased compared with the controls (Group I: 3.93 +/- 1.3 g/L and 124 +/- 38%; Group II: 4.24 +/- 0.89 g/L and 134 +/- 42% vs. 2.96 +/- 0.34 g/L, and 90 +/- 14%, respectively). Also, there was a marked decrease of the initial plasma alpha2-A activity in Group II compared with the controls (0.69 +/- 0.29 vs. 0.94 +/- 0.11 IU/mL, respectively, t = 2.33, P <.045). Both treatment regimens significantly improved fibrinolysis, which manifested as a shortening of ELT, but the mean values of this parameter remained within normal range. After treatment with H plus EACA, the skin lesions started to disappear significantly faster compared with the H alone regimen (2.28 +/- 0.45 days vs. 4.12 +/- 1.05, t = 4.41, P <.0023). In four of six patients receiving H plus EACA therapy, an approximately 20% decrease of systolic and diastolic arterial blood pressure lasting for 5 to 7 hours after administration of EACA was observed. These results may suggest that children with HSP have impaired plasma fibrinolytic activity and that an increased release of plasminogen activator inhibitor-1 (PAI-1) might be, at least in part, responsible for this phenomenon. Concomitant use of H (approximately 10 mg/kg/d) plus EACA (approximately 100 mg/kg/d) for a few days opens new therapeutic possibilities in some children with HSP.

Role of extracellular matrix and Ras in regulation of glomerular epithelial cell proliferation

Signals from extracellular matrix (ECM) to growth factor receptors regulate glomerular epithelial cell (GEC) proliferation. Epidermal growth factor (EGF), basic fibroblast growth factor, hepatocyte growth factor (HGF), or thrombin stimulated proliferation of GECs when the cells were adherent to collagen matrices, but not plastic substratum. Furthermore, EGF, HGF, or thrombin activated p42 mitogen-activated protein (MAP) kinase in collagen-adherent GECs, whereas activation was weak in GECs on plastic. To further examine the interaction of ECM with the Ras-MAP kinase cascade, GECs were stably transfected with a constitutively active Ras mutant (V12Ras). Low or moderate levels of V12Ras expression did not affect basal MAP kinase activity but, unlike parental GECs, in clones that express V12Ras, EGF was able to induce proliferation and activate MAP kinase when these cells were adherent to plastic. In parental and V12Ras-transfected GECs, MAP kinase activation was inhibited by cytochalasin D. Thus, adhesion of GECs to ECM facilitates proliferation and MAP kinase activation by mitogens acting via tyrosine kinase or non-tyrosine kinase receptors. Activation of pathway(s) downstream of V12Ras supplants signals from ECM that enable proliferation. These signals may involve the actin cytoskeleton.

Extracellular matrix is required for MAP kinase activation and proliferation of rat glomerular epithelial cells

This study examined the role of extracellular matrix (ECM) in the regulation of glomerular epithelial cell (GEC) proliferation. Epidermal growth factor (EGF) stimulated proliferation of GEC when the cells were adherent to collagen matrices, but not plastic substratum. Significant and prolonged EGF receptor (R) tyrosine autophosphorylation (which reflects EGF-R kinase activation) was induced by EGF only in GEC adherent to collagen. In addition, EGF stimulated the activity and tyrosine phosphorylation of p42 mitogen-activated protein (MAP) kinase (ERK2) in collagen-adherent GEC, but not in cells on plastic. An inhibitor of the p-42 MAP kinase pathway, PD98059, blocked EGF-induced MAP kinase activity and proliferation. Thus, adhesion to ECM enables EGF to induce proliferation of GEC, by facilitating activation of EGF-R and the p42 MAP kinase pathway. Signals from ECM to growth factor receptor tyrosine kinases may regulate cell turnover in the glomerulus under normal conditions and during immune glomerular injury.

Extracellular matrix modulates epidermal growth factor receptor activation in rat glomerular epithelial cells

To understand how glomerular epithelial cell (GEC) proliferation may be regulated in health and disease, we studied the effects of type I collagen extracellular matrices (ECM) on EGF receptor (EGF-R) activation in cultured rat GEC. EGF stimulated proliferation of GEC adherent to ECM, but not of GEC on a plastic substratum. Significant and prolonged EGF-R tyrosine autophosphorylation (which reflects receptor kinase activation) was induced by EGF in GEC adherent to collagen, but EGF did not stimulate EGF-R autophosphorylation in GEC on plastic (at 37 degrees C). However, EGF-R autophosphorylation increased significantly in plastic-adherent GEC that were stimulated with EGF at 4 degrees C or in the presence of vanadate, an inhibitor of phosphotyrosine phosphatases. Furthermore, dephosphorylation of EGF-R was enhanced in GEC on plastic as compared with collagen. At 4 degrees C, [125I]EGF binding was not different between substrata, and there was negligible accumulation of intracellular [125I]EGF (which reflects EGF-R internalization). At 37 degrees C, EGF-R internalization was reduced significantly in collagen-adherent GEC as compared with GEC on plastic. Thus, contact with ECM facilitates proliferation and EGF-R activation in GEC. The enhanced activity of EGF-R tyrosine kinase may be due to ECM-induced reduction in EGF-R internalization and dephosphorylation by phosphotyrosine phosphatase(s). Signals from ECM to growth factor receptors may regulate cell turnover in the glomerulus under normal conditions and during immune glomerular injury.

Epidermal growth factor and phorbol myristate acetate increase expression of the mRNA for cytosolic phospholipase A2 in glomerular mesangial cells

We have previously shown that phospholipase A2 (PLA2) activity is rapidly activated by epidermal growth factor (EGF) and phorbol 12-myristate 13-acetate (PMA) in renal mesangial cells and other cell systems in a manner that suggests a covalent modification of the PLA2 enzyme(s). This PLA2 activity is cytosolic (cPLA2) and is distinct from secretory forms of PLA2, which are also stimulated in mesangial cells in response to cytokines and other agonists. However, longer-term regulation of cPLA2 in renal cells may also occur at the level of gene expression. Cultured rat mesangial cells were used as a model system to test the effects of EGF and PMA on the regulation of cPLA2 gene expression. EGF and PMA both produced sustained increases in cPLA2 mRNA levels, with a parallel increase in enzyme activity over time. Inhibition of protein synthesis by cycloheximide increased basal cPLA2 mRNA accumulation in serum-starved mesangial cells, and the combination of EGF and cycloheximide resulted in super-induction of cPLA2 gene expression compared with EGF alone. Actinomycin D treatment entirely abrogated the effect of EGF on cPLA2 mRNA accumulation. These findings suggest that regulation of cPLA2 is achieved by factors controlling gene transcription and possibly mRNA stability, in addition to previously characterized posttranslational modifications.

Immunoreactive low-molecular-weight epidermal growth factor in urine of patients with renal cell carcinoma

A specific heterogeneous enzyme-linked immunosorbent assay (ELISA) has been established in order to determine levels of low-molecular-weight epidermal growth factor (EGF) in the urine of patients with renal cell carcinoma who had undergone unilateral radical nephrectomy. Urine specimens, i.e., 20 pre- and postsurgical specimens from a group of patients and 22 from a control group, were assayed after the urine had been freed from high-molecular-weight proteins (greater than 30 kDa) and salts. EGF levels were expressed as urinary EGF/creatinine ratios, and a highly significant decrease (alpha = 0.0005 by Student's t-test) of urinary EGF was found in the patient group prior to surgery. The cancer patients also showed an additional loss of urinary EGF after unilateral nephrectomy (alpha = 0.0005 by Student's t-test). These data correlate with our previous findings that pro-EGF gene expression is decreased in human renal carcinoma and support the concept that low-molecular-weight urinary EGF is derived from high-molecular-weight kidney pro-EGF.

Expression of growth-related genes in human fetal kidney

By the end of gestation, nephron formation in the human kidney is complete. Following local induction of metanephric mesenchyma, committed cells of each primitive renal vesicle must undergo a phase of rapid cell division. In order to identify genes which might regulate these events, we examined the expression profile of 22 proto-oncogenes in fetal versus adult human kidney. Among those expressed at especially high levels in the fetal tissue was the gene for epidermal growth factor receptor (EGFR). We were able to detect mRNA (by polymerase chain reaction [PCR] amplification) and peptide (by specific radioimmunoassay) for transforming growth factor-alpha (TGF-alpha) in fetal kidney, whereas epidermal growth factor (EGF) peptide was undetectable in midgestation kidney and amniotic fluid. TGF-alpha/EGFR interactions may direct renal cell proliferation in fetal life.

Expression of transforming growth factor-alpha and epidermal growth factor receptor in human fetal kidneys

Beginning at the fifth week of fetal life, successive generations of individual nephrons are induced by contact between metanephric mesenchyme and ureteric bud. Following phenotypic transformation, cells of each primitive renal vesicle undergo a phase of rapid cell division. In order to identify genes which might regulate nephron development in man, we screened adult and fetal kidney RNA for expression of a panel of growth-related genes. Among the genes which were expressed at higher levels in fetal kidney was the epidermal growth factor (EGF) receptor. There is controversy as to the most likely physiologic EGF receptor ligand in fetal kidney; we were able to identify a transcript for transforming growth factor-alpha (TGF-alpha) but not EGF on Northern blots of fetal kidney RNA. Since the abundance of TGF-alpha mRNA is low, we confirmed its presence by polymerase chain reaction amplification. Using specific radioimmunoassays, we also provide direct evidence for TGF-alpha but not EGF peptide in extracts of fetal kidney and mid-gestational amniotic fluid. We suggest that TGF-alpha/EGF receptor interactions may serve an important function in development of human fetal kidney.