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Stamellou E, Seikrit C, Tang SCW, Boor P, Tesař V, Floege J, Barratt J, Kramann R. IgA nephropathy. Nat Rev Dis Primers 2023; 9:67. [PMID: 38036542 DOI: 10.1038/s41572-023-00476-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
IgA nephropathy (IgAN), the most prevalent primary glomerulonephritis worldwide, carries a considerable lifetime risk of kidney failure. Clinical manifestations of IgAN vary from asymptomatic with microscopic or intermittent macroscopic haematuria and stable kidney function to rapidly progressive glomerulonephritis. IgAN has been proposed to develop through a 'four-hit' process, commencing with overproduction and increased systemic presence of poorly O-glycosylated galactose-deficient IgA1 (Gd-IgA1), followed by recognition of Gd-IgA1 by antiglycan autoantibodies, aggregation of Gd-IgA1 and formation of polymeric IgA1 immune complexes and, lastly, deposition of these immune complexes in the glomerular mesangium, leading to kidney inflammation and scarring. IgAN can only be diagnosed by kidney biopsy. Extensive, optimized supportive care is the mainstay of therapy for patients with IgAN. For those at high risk of disease progression, the 2021 KDIGO Clinical Practice Guideline suggests considering a 6-month course of systemic corticosteroid therapy; however, the efficacy of systemic steroid treatment is under debate and serious adverse effects are common. Advances in understanding the pathophysiology of IgAN have led to clinical trials of novel targeted therapies with acceptable safety profiles, including SGLT2 inhibitors, endothelin receptor blockers, targeted-release budesonide, B cell proliferation and differentiation inhibitors, as well as blockade of complement components.
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Affiliation(s)
- Eleni Stamellou
- Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Claudia Seikrit
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Peter Boor
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Pathology, RWTH Aachen University, Aachen, Germany
| | - Vladimir Tesař
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rafael Kramann
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, Netherlands.
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Zanoni F, Abinti M, Belingheri M, Castellano G. Present and Future of IgA Nephropathy and Membranous Nephropathy Immune Monitoring: Insights from Molecular Studies. Int J Mol Sci 2023; 24:13134. [PMID: 37685941 PMCID: PMC10487514 DOI: 10.3390/ijms241713134] [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: 07/05/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
IgA Nephropathy (IgAN) and Membranous Nephropathy (MN) are primary immune-mediated glomerular diseases with highly variable prognosis. Current guidelines recommend that greater immunologic activity and worse prognosis should guide towards the best treatment in an individualized approach. Nevertheless, proteinuria and glomerular filtration rate, the current gold standards for prognosis assessment and treatment guidance in primary glomerular diseases, may be altered with chronic damage and nephron scarring, conditions that are not related to immune activity. In recent years, thanks to the development of new molecular technologies, among them genome-wide genotyping, RNA sequencing techniques, and mass spectrometry, we have witnessed an outstanding improvement in understanding the pathogenesis of IgAN and MN. In addition, recent genome-wide association studies have suggested potential targets for immunomodulating agents, stressing the need for the identification of specific biomarkers of immune activity. In this work, we aim to review current evidence and recent progress, including the more recent use of omics techniques, in the identification of potential biomarkers for immune monitoring in IgAN and MN.
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Affiliation(s)
- Francesca Zanoni
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.A.); (M.B.); (G.C.)
| | - Matteo Abinti
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.A.); (M.B.); (G.C.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mirco Belingheri
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.A.); (M.B.); (G.C.)
| | - Giuseppe Castellano
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.A.); (M.B.); (G.C.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Du Y, Cheng T, Liu C, Zhu T, Guo C, Li S, Rao X, Li J. IgA Nephropathy: Current Understanding and Perspectives on Pathogenesis and Targeted Treatment. Diagnostics (Basel) 2023; 13:diagnostics13020303. [PMID: 36673113 PMCID: PMC9857562 DOI: 10.3390/diagnostics13020303] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, with varied clinical and histopathological features between individuals, particularly across races. As an autoimmune disease, IgAN arises from consequences of increased circulating levels of galactose-deficient IgA1 and mesangial deposition of IgA-containing immune complexes, which are recognized as key events in the widely accepted "multi-hit" pathogenesis of IgAN. The emerging evidence further provides insights into the role of genes, environment, mucosal immunity and complement system. These developments are paralleled by the increasing availability of diagnostic tools, potential biomarkers and therapeutic agents. In this review, we summarize current evidence and outline novel findings in the prognosis, clinical trials and translational research from the updated perspectives of IgAN pathogenesis.
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Aymonnier K, Amsler J, Lamprecht P, Salama A, Witko‐Sarsat V. The neutrophil: A key resourceful agent in immune‐mediated vasculitis. Immunol Rev 2022; 314:326-356. [PMID: 36408947 DOI: 10.1111/imr.13170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.
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Affiliation(s)
- Karen Aymonnier
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Jennifer Amsler
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology University of Lübeck Lübeck Germany
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital University College London London UK
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Chen XQ, Tu L, Tang Q, Huang L, Qin YH. An Emerging Role for Neutrophil Extracellular Traps in IgA Vasculitis: A Mini-Review. Front Immunol 2022; 13:912929. [PMID: 35799774 PMCID: PMC9253285 DOI: 10.3389/fimmu.2022.912929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV) is the most common systemic small vessel vasculitis in childhood. Its clinical manifestations are non-thrombocytopenic purpura, accompanied by gastrointestinal tract, joint, kidney and other organ system involvement. The pathogenesis of IgAV has not been fully elucidated. It may be related to many factors including genetics, infection, environmental factors, and drugs. The most commonly accepted view is that galactose-deficient IgA1 and the deposition of IgA and complement C3 in small blood vessel walls are key contributors to the IgAV pathogenesis. Extensive neutrophil extracellular traps (NETs) in the peripheral circulation and skin, kidney, and gastrointestinal tissue of patients with IgAV has been identified in the past two years and is associated with disease activity. This mini-review provides a possible mechanism for NETs involvement in the pathogenesis of IgAV.
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Abstract
PURPOSE OF REVIEW Growing evidence show the importance of gut/kidney axis in renal diseases. Advances in gut microbiome sequencing, associated metabolites, detection of gut permeability and inflammation provide new therapeutic strategies targeting gut for kidney diseases and particularly for Immunoglobulin A (IgA) nephropathy (IgAN). RECENT FINDINGS The diversity and composition of gut flora have been recently deeply explored in kidney diseases. Modulation and depletion of microbiota in animal models allowed the understanding of molecular mechanisms involved in the crosstalk between gut, immune system and kidney. New clinical trials in order to positively modulate microbiota result in improvement of gastrointestinal disorders and inflammation in patients suffering with kidney diseases. SUMMARY The investigation of gut alterations in kidney diseases open new therapeutic strategies. In IgAN, targeted treatments for intestinal inflammation and modifications of gut microbiota seem promising.
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Affiliation(s)
- Renato C Monteiro
- INSERM UMR1149, Center of Research on Inflammation CRI, CNRS ERL8252
- Inflamex Laboratory of Excellence, Paris University
- Immunology Department, Bichat Hospital, AP-HP, DHU Apollo, Paris
| | - Laureline Berthelot
- Center of Research in Transplantation and Immunology CRTI, UMR1064, INSERM, Nantes University, Nantes, France
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Chen XQ, Tu L, Zou JS, Zhu SQ, Zhao YJ, Qin YH. The Involvement of Neutrophil Extracellular Traps in Disease Activity Associated With IgA Vasculitis. Front Immunol 2021; 12:668974. [PMID: 34539623 PMCID: PMC8446352 DOI: 10.3389/fimmu.2021.668974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives This aim of this study was to determine whether neutrophil extracellular traps (NETs) are involved in the pathogenesis of IgA vasculitis (IgAV) and investigate whether the circulating NETs levels are associated with disease activity in children. Methods We performed a case-control study and collected blood samples from 193 children with different stages of IgAV (61 were at the onset stage, 64 at the remission stage, 43 at the active stage, and 25 were undergoing drug withdrawal). A total of 192 healthy children were recruited as controls. Circulating cell free DNA (cf-DNA) was obtained from the plasma and quantified by using the Quant-iT PicoGreen DNA quantification kit. NETs-associated myeloperoxidase-DNA (MPO-DNA), citrullinated-histone H3 (cit-H3), neutrophil elastase (NE), and the deoxyribonuclease I (DNase I) concentrations were measured using enzyme-linked immunosorbent assays. The presence of NETs in the kidney and gastrointestinal tissues of onset and active IgAV patients was determined by multiple immunofluorescence staining in 15 IgAV nephritis patients and 9 IgAV patients without IgAV nephritis, respectively. NETs degradation potency of collected sera samples from IgAV patients were checked in vitro. Relationships between circulating levels of cf-DNA with MPO-DNA, NE, and DNase I and the patients were analyzed. Results Circulating levels of cf-DNA in onset and active IgAV patients were significantly higher than those in remission and drug withdrawal patients as well as healthy controls. The results were similar for MPO-DNA and NE. The levels of circulating cf-DNA correlated significantly with MPO-DNA, NE and DNase I. A significantly decreased degradation of NETs from the onset and active IgAV patients was observed, but was normal in healthy controls. Furthermore, presence of NETs was also confirmed in all renal and gastrointestinal tissues obtained from the onset and active IgAV patients but not control samples. Conclusions Our data showed that NETs were released into the circulation of IgAV patients and are involved in the disease activity. The circulating levels of NETs maybe used to assess disease severity in children with IgAV.
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Affiliation(s)
- Xiu-Qi Chen
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Li Tu
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jia-Sen Zou
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Shi-Qun Zhu
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yan-Jun Zhao
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yuan-Han Qin
- Department of Pediatrics, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
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IgA Vasculitis and IgA Nephropathy: Same Disease? J Clin Med 2021; 10:jcm10112310. [PMID: 34070665 PMCID: PMC8197792 DOI: 10.3390/jcm10112310] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
Many authors suggested that IgA Vasculitis (IgAV) and IgA Nephropathy (IgAN) would be two clinical manifestations of the same disease; in particular, that IgAV would be the systemic form of the IgAN. A limited number of studies have included sufficient children or adults with IgAN or IgAV (with or without nephropathy) and followed long enough to conclude on differences or similarities in terms of clinical, biological or histological presentation, physiopathology, genetics or prognosis. All therapeutic trials available on IgAN excluded patients with vasculitis. IgAV and IgAN could represent different extremities of a continuous spectrum of the same disease. Due to skin rash, patients with IgAV are diagnosed precociously. Conversely, because of the absence of any clinical signs, a renal biopsy is practiced for patients with an IgAN to confirm nephropathy at any time of the evolution of the disease, which could explain the frequent chronic lesions at diagnosis. Nevertheless, the question that remains unsolved is why do patients with IgAN not have skin lesions and some patients with IgAV not have nephropathy? Larger clinical studies are needed, including both diseases, with a common histological classification, and stratified on age and genetic background to assess renal prognosis and therapeutic strategies.
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Sestito C, Leurs CE, Steenwijk MD, Brevé JJP, Twisk JWR, Wilhelmus MMM, Drukarch B, Teunissen CE, van Dam AM, Killestein J. Tissue Transglutaminase Expression Associates With Progression of Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e998. [PMID: 33906937 PMCID: PMC8105890 DOI: 10.1212/nxi.0000000000000998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Objective The clinical course of multiple sclerosis (MS) is variable and largely unpredictable pointing to an urgent need for markers to monitor disease activity and progression. Recent evidence revealed that tissue transglutaminase (TG2) is altered in patient-derived monocytes. We hypothesize that blood cell–derived TG2 messenger RNA (mRNA) can potentially be used as biomarker in patients with MS. Methods In peripheral blood mononuclear cells (PBMCs) from 151 healthy controls and 161 patients with MS, TG2 mRNA was measured and correlated with clinical and MRI parameters of disease activity (annualized relapse rate, gadolinium-enhanced lesions, and T2 lesion volume) and disease progression (Expanded Disability Status Scale [EDSS], normalized brain volume, and hypointense T1 lesion volume). Results PBMC-derived TG2 mRNA levels were significantly associated with disease progression, i.e., worsening of the EDSS over 2 years of follow-up, normalized brain volume, and normalized gray and white matter volume in the total MS patient group at baseline. Of these, in patients with relapsing-remitting MS, TG2 expression was significantly associated with worsening of the EDSS scores over 2 years of follow-up. In the patients with primary progressive (PP) MS, TG2 mRNA levels were significantly associated with EDSS, normalized brain volume, and normalized gray and white matter volume at baseline. In addition, TG2 mRNA associated with T1 hypointense lesion volume in the patients with PP MS at baseline. Conclusion PBMC-derived TG2 mRNA levels hold promise as biomarker for disease progression in patients with MS. Classification of Evidence This study provides Class II evidence that in patients with MS, PBMC-derived TG2 mRNA levels are associated with disease progression.
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Affiliation(s)
- Claudia Sestito
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Cyra E Leurs
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Martijn D Steenwijk
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - John J P Brevé
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Jos W R Twisk
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Micha M M Wilhelmus
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Benjamin Drukarch
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Anne-Marie van Dam
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands.
| | - Joep Killestein
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
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Prat-Duran J, Pinilla E, Nørregaard R, Simonsen U, Buus NH. Transglutaminase 2 as a novel target in chronic kidney disease - Methods, mechanisms and pharmacological inhibition. Pharmacol Ther 2020; 222:107787. [PMID: 33307141 DOI: 10.1016/j.pharmthera.2020.107787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/02/2020] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease (CKD) is a global health problem with a prevalence of 10-15%. Progressive fibrosis of the renal tissue is a main feature of CKD, but current treatment strategies are relatively unspecific and delay, but do not prevent, CKD. Exploration of novel pharmacological targets to inhibit fibrosis development are therefore important. Transglutaminase 2 (TG2) is known to be central for extracellular collagenous matrix formation, but TG2 is a multifunctional enzyme and novel research has broadened our view on its extra- and intracellular actions. TG2 exists in two conformational states with different catalytic properties as determined by substrate availability and local calcium concentrations. The open conformation of TG2 depends on calcium and has transamidase activity, central for protein modification and cross-linking of extracellular protein components, while the closed conformation is a GTPase involved in transmembrane signaling processes. We first describe different methodologies to assess TG2 activity in renal tissue and cell cultures such as biotin cadaverine incorporation. Then we systematically review animal CKD models and preliminary studies in humans (with diabetic, IgA- and chronic allograft nephropathy) to reveal the role of TG2 in renal fibrosis. Mechanisms behind TG2 activation, TG2 externalization dependent on Syndecan-4 and interactions between TG and profibrotic molecules including transforming growth factor β and the angiotensin II receptor are discussed. Pharmacological TG2 inhibition shows antifibrotic effects in CKD. However, the translation of TG2 inhibition to treat CKD in patients is a challenge as clinical information is limited, and further studies on pharmacokinetics and efficacy of the individual compounds are required.
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Affiliation(s)
| | | | | | - Ulf Simonsen
- Institute of Biomedicine, Health, Aarhus University, Denmark
| | - Niels Henrik Buus
- Institute of Biomedicine, Health, Aarhus University, Denmark; Department of Renal Medicine, Aarhus University Hospital, Denmark.
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Selvaskandan H, Shi S, Twaij S, Cheung CK, Barratt J. Monitoring Immune Responses in IgA Nephropathy: Biomarkers to Guide Management. Front Immunol 2020; 11:572754. [PMID: 33123151 PMCID: PMC7572847 DOI: 10.3389/fimmu.2020.572754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
IgA nephropathy (IgAN) is the commonest biopsy-reported primary glomerulonephritis worldwide. It has an incidence which peaks among young adults, and 30 to 40% of patients' progress to end stage kidney disease within twenty years of diagnosis. Ten-year kidney survival rates have been reported to be as low as 35% in some parts of the world. The successful management of IgAN is limited by an incomplete understanding of the pathophysiology of IgAN and a poor understanding of how pathophysiology may vary both from patient to patient and between patient groups, particularly across races. This is compounded by a lack of rigorously designed and delivered clinical trials in IgAN. This is slowly changing, with a number of Phase 2 and 3 clinical trials of novel therapies targeting a number of different putative pathogenic pathways in IgAN due to report in the next 5 years. From our current, albeit limited, understanding of the pathophysiology of IgAN it is unlikely a single therapy will be effective in all patients with IgAN. The successful management of IgAN in the future is, therefore, likely to be reliant on targeted therapies, carefully selected based on an individualized understanding of a patient's risk of progression and underlying pathophysiology. The potential role of biomarkers to facilitate personalization of prognostication and treatment of IgAN is immense. Here we review the progress made over the past decade in identifying and validating new biomarkers, with a particular focus on those that reflect immunological responses in IgAN.
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Affiliation(s)
- Haresh Selvaskandan
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sufang Shi
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sara Twaij
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Chee Kay Cheung
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jonathan Barratt
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
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12
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Guo N, Zhou Q, Huang X, Yu J, Han Q, Nong B, Xiong Y, Liang P, Li J, Feng M, Lv J, Yang Q. Identification of differentially expressed circulating exosomal lncRNAs in IgA nephropathy patients. BMC Immunol 2020; 21:16. [PMID: 32234013 PMCID: PMC7110735 DOI: 10.1186/s12865-020-00344-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Although immunoglobulin A nephropathy (IgAN) is one of the foremost primary glomerular disease, treatment of IgAN is still in infancy. Non-invasive biomarkers are urgently needed for IgAN diagnosis. We investigate the difference in expression profiles of exosomal long non-coding-RNAs (lncRNAs) in plasma from IgAN patients compared with their healthy first-degree relatives, which may reveal novel non-invasive IgAN biomarkers. Methods We isolated exosomes from the plasma of both IgAN patients and their healthy first-degree relatives. High-throughput RNA sequencing and real-time quantitative polymerase chain reaction (qRT-PCR) was used to validate lncRNA expression profiles. Pathway enrichment analysis was used to predict their nearest protein-coding genes. Results lncRNA-G21551 was significantly down-regulated in IgAN patients. Interestingly, the nearest protein-coding gene of lncRNA-G21551 was found to be encoding the low affinity receptor of the Fc segment of immunoglobulin G (FCGR3B). Conclusions Exosomal lncRNA-G21551, with FCGR3B as the nearest protein-coding gene, was down-regulated in IgAN patients, indicating its potential to serve as a non-invasive biomarker for IgAN.
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Affiliation(s)
- Na Guo
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Qin Zhou
- Department of Nephrology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Xiang Huang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Jianwen Yu
- Department of Nephrology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Qianqian Han
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Baoting Nong
- Key Laboratory of Gene Engineering of the Ministry of Education and State, Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Yuanyan Xiong
- Key Laboratory of Gene Engineering of the Ministry of Education and State, Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Peifen Liang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Jiajia Li
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Min Feng
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Jun Lv
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China
| | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, P.R. China.
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13
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Abbad L, Monteiro RC, Berthelot L. Food antigens and Transglutaminase 2 in IgA nephropathy: Molecular links between gut and kidney. Mol Immunol 2020; 121:1-6. [PMID: 32135400 DOI: 10.1016/j.molimm.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 01/27/2023]
Abstract
The transglutaminase 2 (TG2) is one of the enigmatic enzymes with important functional diversity. It plays an important role in several pathologies such as celiac disease (CD). In patients with active CD, the abnormal retrotranscytosis of IgA/gliadin complexes is mediated by Transferrin Receptor 1 (TfR1). This triad association takes also place in IgA nephropathy (IgA-N). IgA-N is characterized by the formation of nephrotoxic complexes of IgA1 and soluble CD89 (sCD89). These complexes are abnormally deposited in the kidney. Using a humanized mouse model of IgA-N (α1KI-CD89Tg), we showed that IgA1-sCD89 complexes engender mesangial cell activation and proliferation with TfR1 and TG2 up-regulation, associated with IgA-N features. This TG2-TfR1 interaction enhances mesangial IgA1 deposition promoting inflammation. Humanized α1KI-CD89Tg mice deficient for TG2 show a decrease in TfR1 expression in kidney leading to reduced IgA1-sCD89 deposits and an improvement in IgA-N features. Moreover, TG2 is active and overexpressed in the intestine of IgA-N mice and gliadin participates to this renal pathology. In kidney as in intestine, the TG2 has a crucial role in the cooperation between TfR1-IgA and a central role in the pathogenic amplification.
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Affiliation(s)
- Lilia Abbad
- INSERM UMR1149, Center of Research on Inflammation CRI, CNRS ERL8252, Paris, France; Inflamex Laboratory of Excellence, Paris Diderot University, Sorbonne Paris City, Paris, France
| | - Renato C Monteiro
- INSERM UMR1149, Center of Research on Inflammation CRI, CNRS ERL8252, Paris, France; Inflamex Laboratory of Excellence, Paris Diderot University, Sorbonne Paris City, Paris, France; Immunology Department, AP-HP, DHU Fire, Paris, France
| | - Laureline Berthelot
- Centre de Recherche en Transplantation et Immunologie, Nantes, UMR1064, INSERM, Université de Nantes, France; Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; LabEx IGO, "Immunotherapy, Graft, Oncology", Nantes, France.
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14
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Serum Soluble CD89-IgA Complexes Are Elevated in IgA Nephropathy without Immunosuppressant History. DISEASE MARKERS 2020; 2020:8393075. [PMID: 32076466 PMCID: PMC7017530 DOI: 10.1155/2020/8393075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
Purpose CD89 (FcαRI), the receptor of IgA, can shed from cells to form complexes with IgA in serum and is supposed to participate in the pathogenesis of IgA nephropathy (IgAN). There are contradictory results on their utility in clinical practice. This study is aimed at investigating whether sCD89-IgA complexes can help in the diagnosis or evaluation of the disease. Methods A sandwich ELISA was established using anti-CD89 as a capture antibody and HRP-conjugated anti-IgA as a detection antibody. This method was used to measure serum levels of sCD89-IgA complexes in IgAN patients without immunosuppressant history and healthy subjects. Correlations between serum levels of sCD89-IgA complexes and disease severity were analyzed. Results Serum sCD89-IgA complexes increased with age (P < 0.001). IgAN patients had higher sCD89-IgA complex levels compared with age- and gender-matched normal healthy individuals (P < 0.001). IgAN patients had higher sCD89-IgA complex levels compared with age- and gender-matched normal healthy individuals (P < 0.001). IgAN patients had higher sCD89-IgA complex levels compared with age- and gender-matched normal healthy individuals ( Conclusions Serum sCD89-IgA complexes can guide diagnosis of IgAN in patients without immunosuppressant history, but provide limited help in clinicopathologic prediction.
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15
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Berthelot L, Jamin A, Viglietti D, Chemouny JM, Ayari H, Pierre M, Housset P, Sauvaget V, Hurtado-Nedelec M, Vrtovsnik F, Daugas E, Monteiro RC, Pillebout E. Value of biomarkers for predicting immunoglobulin A vasculitis nephritis outcome in an adult prospective cohort. Nephrol Dial Transplant 2019; 33:1579-1590. [PMID: 29126311 DOI: 10.1093/ndt/gfx300] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background Henoch-Schönlein purpura, more recently renamed immunoglobulin A vasculitis (IgAV), is a systemic vasculitis characterized by IgA deposits. The current markers used to assess IgAV inaccurately evaluate the risk of nephritis occurrence and its long-term outcomes. The current study assessed biomarkers of nephritis outcomes. Methods This French multicentre prospective study enrolled 85 adult patients at the time of disease onset. Patients were assessed for clinical and biological parameters and re-examined after 1 year. Immunoglobulins, cytokines, IgA glycosylation, IgA complexes and neutrophil gelatinase-associated lipocalin (NGAL) concentrations were assessed in blood and urine. Results We identified 60 patients with IgAV-related nephritis (IgAV-N) and 25 patients without nephritis (IgAV-woN). At the time of inclusion (Day 1), the serum levels of galactose-deficient IgA1 (Gd-IgA1) and urinary concentrations of IgA, IgG, IgM, NGAL, interleukin (IL)-1β, IL-6, IL-8, IL-10, IgA-IgG and IgA-sCD89 complexes were higher in the IgAV-N patients than in the IgAV-woN patients (P < 0.005 for all comparisons). After follow-up (1 year), 22 patients showed a poor outcome. Among the tested markers, urine IgA at disease onset adequately reclassified the risk of poor outcome over conventional clinical factors, including estimated glomerular filtration rate, proteinuria and age (continuous net reclassification improvement = 0.72, P = 0.001; integrated discrimination improvement = 0.13, P = 0.009) in IgAV patients. Conclusions Taken together, these results showed that serum Gd-IgA1 and urinary IgA, IgG, IgM, NGAL, IL-1β, IL-6, IL-8, IL-10, IgA-IgG and IgA-sCD89 complexes were associated with nephritis in IgAV patients. Urinary IgA level may improve patient risk stratification for poor outcome.
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Affiliation(s)
- Laureline Berthelot
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Agnès Jamin
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Denis Viglietti
- Department of Nephrology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Jonathan M Chemouny
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | - Hamza Ayari
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Melissa Pierre
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Pierre Housset
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Virginia Sauvaget
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Margarita Hurtado-Nedelec
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Immunology, Bichat Hospital, AP-HP, Paris, France
| | - François Vrtovsnik
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | - Eric Daugas
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | | | - Renato C Monteiro
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Immunology, Bichat Hospital, AP-HP, Paris, France
| | - Evangeline Pillebout
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Saint-Louis Hospital, AP-HP, Paris, France
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16
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Abstract
The field of biomarker research in IgA nephropathy has experienced a major boost in recent years with the publication of a large number of scientific reports. Candidate biomarkers from blood, urine, and renal tissue obtained through the use of clinical chemistry, molecular biology, and omics have been proposed for translation in clinical practice. Nevertheless, individual biomarkers often lack sensitivity and specificity with the consequent impairment of disease specificity. This review, moving on from the analysis of the four-hit hypothesis, illustrates the biomarkers linked to the abnormal glycosylation process of IgA1 and the immune complex formation. It also describes other serum and urinary biomarkers. Given the profound insights into the pleiotropic function of a single biomarker that is specific for a pathophysiological mechanism, this review suggests a novel approach based on a panel of biomarkers that covers the entire pathogenic process of the disease. Clinical bioinformatics that integrate genetic, clinical, and bioinformatics data sets could optimize the specific value of each biomarker in a multimarker panel. This is a promising approach for precision medicine and personalized therapy in IgA nephropathy.
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Affiliation(s)
- Francesco Paolo Schena
- Policlinic, University of Bari, Bari, Italy; Laboratory Research, Schena Foundation, Valenzano, Bari, Italy.
| | - Sharon Natasha Cox
- Policlinic, University of Bari, Bari, Italy; Laboratory Research, Schena Foundation, Valenzano, Bari, Italy
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17
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Pillebout É. Adult IgA vasculitis (Henoch-Schönlein purpura). Nephrol Ther 2019; 15 Suppl 1:S13-S20. [PMID: 30981390 DOI: 10.1016/j.nephro.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
IgA vasculitis is a systemic vasculitis affecting small vessels. IgA vasculitis usually affect children whereas it is rare in adults (150 to 200 for 1) in which the disease is often more serious with more frequent and severe nephritis. Prevalence of adult IgA vasculitis is unknown and its annual incidence is 1 in 1 million. The dominant clinical features include cutaneous purpura, arthritis and gastrointestinal symptoms. Sometimes nephritis can add, typically as glomerulonephritis with IgA mesangial deposits. Pulmonary, cardiac, genital and neurological symptoms have also been observed. Although the cause is unknown, it is clear that IgA plays a pivotal role in the immunopathogenesis of IgA vasculitis. Only symptomatic treatment is advised in case of self-limited disease. Treatment of severe IgA vasculitis, nephritis or gastrointestinal manifestations, is not established but some studies, which need to be confirmed, reported the benefit of corticosteroids combined with immunosuppressive drugs. Short-term outcome depends of the severity of the gastro-intestinal manifestations. The long-term prognosis is heavily dependent on the presence and severity of nephritis. Studies with prolonged follow-up show up to one third of adult patients reaching end stage renal failure, as for IgA nephropathy. Some authors even suggest that IgA nephropathy and IgA vasculitis would be the same disease.
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Affiliation(s)
- Évangéline Pillebout
- Service de néphrologie et de transplantation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Inserm U1149, CRI, faculté de médecine Xavier-Bichat, 16, rue Henri-Huchard, 75018 Paris, France.
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18
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Breedveld A, van Egmond M. IgA and FcαRI: Pathological Roles and Therapeutic Opportunities. Front Immunol 2019; 10:553. [PMID: 30984170 PMCID: PMC6448004 DOI: 10.3389/fimmu.2019.00553] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Immunoglobulin A (IgA) is the most abundant antibody class present at mucosal surfaces. The production of IgA exceeds the production of all other antibodies combined, supporting its prominent role in host-pathogen defense. IgA closely interacts with the intestinal microbiota to enhance its diversity, and IgA has a passive protective role via immune exclusion. Additionally, inhibitory ITAMi signaling via the IgA Fc receptor (FcαRI; CD89) by monomeric IgA may play a role in maintaining homeostatic conditions. By contrast, IgA immune complexes (e.g., opsonized pathogens) potently activate immune cells via cross-linking FcαRI, thereby inducing pro-inflammatory responses resulting in elimination of pathogens. The importance of IgA in removal of pathogens is emphasized by the fact that several pathogens developed mechanisms to break down IgA or evade FcαRI-mediated activation of immune cells. Augmented or aberrant presence of IgA immune complexes can result in excessive neutrophil activation, potentially leading to severe tissue damage in multiple inflammatory, or autoimmune diseases. Influencing IgA or FcαRI-mediated functions therefore provides several therapeutic possibilities. On the one hand (passive) IgA vaccination strategies can be developed for protection against infections. Furthermore, IgA monoclonal antibodies that are directed against tumor antigens may be effective as cancer treatment. On the other hand, induction of ITAMi signaling via FcαRI may reduce allergy or inflammation, whereas blocking FcαRI with monoclonal antibodies, or peptides may resolve IgA-induced tissue damage. In this review both (patho)physiological roles as well as therapeutic possibilities of the IgA-FcαRI axis are addressed.
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Affiliation(s)
- Annelot Breedveld
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Marjolein van Egmond
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam, Netherlands
- Department of Surgery, Amsterdam UMC, Amsterdam, Netherlands
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19
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Chowdhury W, Saleem TS, Lodhi MU, Syed IA, Iqbal HI, Rahim M. Adult-onset Minimal Change Disease with IgA Nephropathy and Hepatitis C. Cureus 2018; 10:e2207. [PMID: 29682437 PMCID: PMC5908716 DOI: 10.7759/cureus.2207] [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] [Indexed: 11/05/2022] Open
Abstract
Minimal change disease (MCD) is one of the most common causes of nephrotic syndrome in children, leading to heavy proteinuria and edema. However, it is not as common in adults. Adult-onset minimal change disease with IgA nephropathy is rare. The initial presentation of heavy proteinuria and edema with effacement of podocytes on electron microscopy (EM) should lead the physician to suspect minimal change disease regardless of age. We present a 44-year-old male patient with a history of hepatitis C virus (HCV) who presented with sudden onset of lower extremity edema and 6.6 grams (g) of proteinuria per day.
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Affiliation(s)
- Waliul Chowdhury
- Medical Student, Department of Medicine, Raleigh General Hospital, Beckley, Wv
| | | | | | | | - Hafiz Imran Iqbal
- Nephrologist, Department of Medicine, Raleigh General Hospital, Beckley, Wv
| | - Mustafa Rahim
- Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine
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20
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Jhee JH, Kang HY, Wu M, Nam BY, Chang TI, Jung SY, Park S, Kim H, Yun HR, Kee YK, Yoon CY, Park JT, Yoo TH, Kang SW, Han SH. Circulating CD89-IgA complex does not predict deterioration of kidney function in Korean patients with IgA nephropathy. ACTA ACUST UNITED AC 2017; 56:75-85. [DOI: 10.1515/cclm-2017-0090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022]
Abstract
Abstract
Background:
Soluble CD89 (sCD89)-IgA complex plays a key role in the pathogenesis of IgA nephropathy (IgAN). However, there is a lack of evidence supporting this complex as a good biomarker for disease progression. This study aimed to evaluate the usefulness of sCD89-IgA complex for risk stratification of IgAN.
Methods:
A total of 326 patients with biopsy-proven IgAN were included. sCD89-IgA complex was measured by sandwich-enzyme-linked immunosorbent assay. The study endpoints were a 30% decline in estimated glomerular filtration rate (eGFR).
Results:
sCD89-IgA complex levels were inversely and weakly associated with eGFR at the time of biopsy (r=−0.12, p=0.03). However, the significance between the two factors was lost in the multivariate linear regression after adjustment of clinical factors (β=0.35, p=0.75). In a multivariate Cox model, the highest (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.35–1.61; p=0.45) and middle (HR, 0.93; 95% CI, 0.46–1.89; p=0.84) tertiles of sCD89-IgA complex levels were not associated with an increased risk of developing a 30% decrease in eGFR. Furthermore, the decline rates in eGFR did not differ between groups and C-statistics revealed that the sCD89-IgA complex were not superior to clinical factors in predicting disease progression.
Conclusions:
This study found no association between sCD89-IgA complex levels and disease progression in IgAN. Although sCD89 can contribute to the formation of immune complexes, our findings suggest that the sCD89-IgA level is not a good predictor of adverse outcomes and has limited clinical utility as a biomarker for risk stratification in IgAN.
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Affiliation(s)
- Jong Hyun Jhee
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Hye-Young Kang
- Severance Biomedical Science Institute, Brain Korea 21 PLUS , Yonsei University , Seoul , Republic of Korea
| | - Meiyan Wu
- Severance Biomedical Science Institute, Brain Korea 21 PLUS , Yonsei University , Seoul , Republic of Korea
- Department of Nephrology , The First Hospital of Jilin University , Changchun , P.R. China
| | - Bo Young Nam
- Severance Biomedical Science Institute, Brain Korea 21 PLUS , Yonsei University , Seoul , Republic of Korea
| | - Tae-Ik Chang
- Department of Internal Medicine , National Health Insurance Service Medical Center, Ilsan Hospital , Gyeonggi-do , Republic of Korea
| | - Su-Young Jung
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Seohyun Park
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Hyoungnae Kim
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Youn Kyung Kee
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Chang-Yun Yoon
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research , Yonsei University , Seoul , Republic of Korea
- Severance Biomedical Science Institute, Brain Korea 21 PLUS , Yonsei University , Seoul , Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine , Severance Hospital , Yonsei University College of Medicine , 50-1 Yonsei-ro, Seodaemun-gu , Seoul , 120-752, Korea
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21
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Rasche FM, Keller F, Rasche WG, Schiekofer S, Boldt A, Sack U, Fahnert J. Why, when and how should immunosuppressive therapy considered in patients with immunoglobulin A nephropathy? Clin Exp Immunol 2016; 186:115-133. [PMID: 27283488 PMCID: PMC5054563 DOI: 10.1111/cei.12823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 12/13/2022] Open
Abstract
IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Lifelong mesangial deposition of IgA1 complexes subsist inflammation and nephron loss, but the complex pathogenesis in detail remains unclear. In regard to the heterogeneous course, classical immunosuppressive and specific therapeutic regimens adapted to the loss of renal function will here be discussed in addition to the essential common renal supportive therapy. Renal supportive therapy alleviates secondary, surrogate effects or sequelae on renal function and proteinuria of high intraglomerular pressure and subsequent nephrosclerosis by inhibition of the renin angiotensin system (RAASB). In patients with physiological (ΔGFR < 1·5 ml/min/year) or mild (ΔGFR 1·5-5 ml/min/year) decrease of renal function and proteinuric forms (> 1 g/day after RAASB), corticosteroids have shown a reduction of proteinuria and might protect further loss of renal function. In patients with progressive loss of renal function (ΔGFR > 3 ml/min within 3 months) or a rapidly progressive course with or without crescents in renal biopsy, cyclophosphamide with high-dose corticosteroids as induction therapy and azathioprine maintenance has proved effective in one randomized controlled study of a homogeneous cohort in loss of renal function (ΔGFR). Mycophenolic acid provided further maintenance in non-randomized trials. Differentiated, precise, larger, randomized, placebo-controlled studies focused on the loss of renal function in the heterogeneous forms of IgAN are still lacking. Prospectively, fewer toxic agents will be necessary in the treatment of IgAN.
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Affiliation(s)
- F M Rasche
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - F Keller
- Department of Internal Medicine I, Division of Nephrology, University Hospital of Ulm, Ulm, Germany.
| | - W G Rasche
- Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
| | - S Schiekofer
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - A Boldt
- Institute of Clinical Immunology, Medical Faculty, Leipzig, Germany
| | - U Sack
- Institute of Clinical Immunology, Medical Faculty, Leipzig, Germany
| | - J Fahnert
- Department of Diagnostic and Interventional Radiology, University Leipzig, Leipzig, Germany
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