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Zhu Q, Luo J, Li HP, Ye W, Pan R, Shi KQ, Yang R, Xu H, Li H, Lee LP, Liu F. Robust Acute Pancreatitis Identification and Diagnosis: RAPIDx. ACS NANO 2023; 17:8564-8574. [PMID: 36988967 DOI: 10.1021/acsnano.3c00922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The occurrence of acute pancreatitis (AP) is increasing significantly worldwide. However, current diagnostic methods of AP do not provide a clear clinical stratification of severity, and the prediction of complications in AP is still limited. Here, we present a robust AP identification and diagnosis (RAPIDx) method by the proteomic fingerprinting of intact nanoscale extracellular vesicles (EVs) from clinical samples. By tracking analysis of circulating biological nanoparticles released by cells (i.e., EVs) via bottom-up proteomics, we obtain close phenotype connections between EVs, cell types, and multiple tissues based on their specific proteomes and identify the serum amyloid A (SAA) proteins on EVs as potential biomarkers that are differentially expressed from AP patients significantly. We accomplish the quantitative analysis of EVs fingerprints using MALDI-TOF MS and find the SAA proteins (SAA1-1, desR-SAA1-2, SAA2, SAA1-2) with areas under the curve (AUCs) from 0.92 to 0.97, which allows us to detect AP within 30 min. We further realize that SAA1-1 and SAA2, combined with two protein peaks (5290.19, 14032.33 m/z), can achieve an AUC of 0.83 for classifying the severity of AP. The RAPIDx platform will facilitate timely diagnosis and treatment of AP before severity development and persistent organ failure and promote precision diagnostics and the early diagnosis of pancreatic cancer.
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Affiliation(s)
- Qingfu Zhu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Jiaxin Luo
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hui-Ping Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Wen Ye
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Reguang Pan
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Ke-Qing Shi
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Rui Yang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hao Xu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hengrui Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Luke P Lee
- Harvard Medical School, Department of Medicine, Brigham Women's Hospital, Boston, Massachusetts 02115, United States
- Department of Bioengineering, Department of Electrical Engineering and Computer Science, University of California at Berkeley, Berkeley, California 94720, United States
- Department of Biophysics, Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
| | - Fei Liu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
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Liu S, Szatmary P, Lin JW, Wang Q, Sutton R, Chen L, Liu T, Huang W, Xia Q. Circulating monocytes in acute pancreatitis. Front Immunol 2022; 13:1062849. [PMID: 36578487 PMCID: PMC9791207 DOI: 10.3389/fimmu.2022.1062849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal pain. It is frequently associated with organ failure, pancreatic necrosis, and death. Mounting evidence describes monocytes - phagocytic, antigen presenting, and regulatory cells of the innate immune system - as key contributors and regulators of the inflammatory response and subsequent organ failure in acute pancreatitis. This review highlights the recent advances of dynamic change of numbers, phenotypes, and functions of circulating monocytes as well as their underling regulatory mechanisms with a special focus on the role of lipid modulation during acute pancreatitis.
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Affiliation(s)
- Shiyu Liu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Peter Szatmary
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jing-wen Lin
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Qiqi Wang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Lu Chen
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Tingting Liu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Tingting Liu, ; Wei Huang, ; Qing Xia,
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,Institutes for Systems Genetics & Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Tingting Liu, ; Wei Huang, ; Qing Xia,
| | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Tingting Liu, ; Wei Huang, ; Qing Xia,
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Firsova TI, Alekhin SA, Nazarenko DP, Danilenko LM, Chub AG, Malyutina ES, Lazareva TY, Druzhikin LV. Combined anti-mediator therapy for severe destructive forms of acute necrotizing pancreatitis in rats. RESEARCH RESULTS IN PHARMACOLOGY 2022. [DOI: 10.3897/rrpharmacology.8.79939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Inflammatory mediators play a major role in pathogenesis of acute pancreatitis with TNF (tumor necrosis factor) as the most important one. Development of effective combined therapy could help to decrease tissue damage, improve results and, finally, diminish the mortality rate in this severe pathology.
Materials and methods: All the studies were performed on 120 female white Wistar rats, weighing 250±25g. Acute pancreatitis reproduced by an intracanalicular injection of bile salts compound.
Results and discussion: The data obtained in the course of the study on the pronounced pancreatoprotective effect of infliximab are explained by its key role in the onset of the systemic inflammatory response, and, therefore, with the blockade of tumor necrosis factor alpha in the early stages, there is no pronounced secondary damage to the pancreas, which is reflected in a significant decrease in edema from 4.87±0.03 in the model up to 2.75±0.04, and as a consequence, an improvement in the blood supply of the acinar tissue from 182.38±15.92 PU up to 287.92±14.64 PU, which is expressed in a decrease in the zones of necrosis and in a decrease in mortality and, finally, efficiency coefficient from 13480.000 to 4283.348. A selective blocker of cysteinyl leukotrienes has a less pronounced protective reaction against damage to pancreatocytes, but to a much greater extent than octreotide. That is expressed by changes in the efficiency coefficient to the level of 8621.18 in montelukast group and 12767.30 in octreotide group, respectively. On the other hand, the effect of the use of infliximab does not surpass that of montelukast, and their combined use has a pronounced additive effect, which is proved by the efficiency coefficient at the level of 2390.33. This reaction is explained by the fact that TNF alpha-mediated pathway of activation of leukotriene biosynthesis is the main, but not the only one.
Conclusion: The combined anti-mediator therapy provides a great opportunity to improve the standard therapy of acute pancreatitis.
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Zhou L, Chen J, Mu G, Lu Z, Li W, Deng Y. Heparin-binding protein (HBP) worsens the severity of pancreatic necrosis via up-regulated M1 macrophages activation in acute pancreatitis mouse models. Bioengineered 2021; 12:11978-11986. [PMID: 34895060 PMCID: PMC8810113 DOI: 10.1080/21655979.2021.2011018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Acute pancreatitis (AP) is one of the most widespread clinical emergencies. Macrophages are the most common immune cells in AP pancreatic tissue and are closely associated with pancreatic necrosis and recovery. The level of heparin-binding protein (HBP) is closely linked to inflammation. In this study, we assessed the effect of HBP on AP tissue necrosis severity and whether HBP is associated with M1 macrophages in pancreatic necrosis. We observed the dynamic changes of HBP levels in the pancreas during acute inflammation in the caerulein-induced AP mice model. We used hematoxylin-eosin staining to evaluate pancreatic edema and necrosis, and to detect infiltration of macrophages by immunohistochemistry. Moreover, expressions of the maker and cytokines of macrophages, including inducible nitric oxide synthase (iNOS), and arginase 1 (Arg-1), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) mRNA, were detected by real-time polymerase-chain reaction (RT-PCR). High levels of HBP in the pancreas were detected at 48 h, and heparin inhibited HBP expression in AP pancreatic tissue. Inhibiting HBP expression by injecting heparin before AP can alleviate pancreatic necrosis and inhibit F4/80 labeled M1 macrophage infiltration and IL-6, TNF-α, and iNOS mRNA expression. Clodronate liposome (CLDL) intraperitoneally treated mice showed no change in pancreatic HBP levels, but pancreatic macrophage-specific antigen F4/80 and TNF-α, IL-1β, and IL-6 mRNA levels decreased after CLDL treatment. HBP is critical for pancreatic necrosis response in acute pancreatitis by increasing the infiltration of M1 macrophages and promoting the secretion of inflammatory factors, such as TNF-α, IL-6, IL-1β, which can be reduced by heparin.
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Affiliation(s)
- Liangliang Zhou
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Jianjun Chen
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Genhua Mu
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Zhongqian Lu
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Weiqin Li
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Yijun Deng
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
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Krane GA, O'Dea CA, Malarkey DE, Miller AD, Miller CR, Tokarz DA, Jensen HL, Janardhan KS, Shockley KR, Flagler N, Rainess BA, Mariani CL. Immunohistochemical evaluation of immune cell infiltration in canine gliomas. Vet Pathol 2021; 58:952-963. [PMID: 34196247 DOI: 10.1177/03009858211023946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Evasion of the immune response is an integral part of the pathogenesis of glioma. In humans, important mechanisms of immune evasion include recruitment of regulatory T cells (Tregs) and polarization of macrophages toward an M2 phenotype. Canine glioma has a robust immune cell infiltrate that has not been extensively characterized. The purpose of this study was to determine the distribution of immune cells infiltrating spontaneous intracranial canine gliomas. Seventy-three formalin-fixed, paraffin-embedded tumor samples were evaluated using immunohistochemistry for CD3, forkhead box 3 (FOXP3), CD20, Iba1, calprotectin (Mac387), CD163, and indoleamine 2,3-dioxygenase (IDO). Immune cell infiltration was present in all tumors. Low-grade and high-grade gliomas significantly differed in the numbers of FoxP3+ cells, Mac387+ cells, and CD163+ cells (P = .006, .01, and .01, respectively). Considering all tumors, there was a significant increase in tumor area fraction of CD163 compared to Mac387 (P < .0001), and this ratio was greater in high-grade tumors than in low-grade tumors (P = .005). These data warrant further exploration into the roles of macrophage repolarization or Treg interference therapy in canine glioma.
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Affiliation(s)
- Gregory A Krane
- 6857National Institute of Environmental Health Sciences, National Toxicology Program, Cellular and Molecular Pathology Branch, Research Triangle Park, NC, USA.,Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA.,Comparative Neuroimmunology and Neuro-Oncology Laboratory, North Carolina State University, Raleigh, NC, USA
| | | | - David E Malarkey
- 6857National Institute of Environmental Health Sciences, National Toxicology Program, Cellular and Molecular Pathology Branch, Research Triangle Park, NC, USA
| | | | | | - Debra A Tokarz
- Experimental Pathology Laboratories Inc, Research Triangle Park, NC, USA
| | - Heather L Jensen
- 6857National Institute of Environmental Health Sciences, National Toxicology Program, Cellular and Molecular Pathology Branch, Research Triangle Park, NC, USA
| | | | - Keith R Shockley
- Division of Intramural Research, Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Norris Flagler
- 6857National Institute of Environmental Health Sciences, National Toxicology Program, Cellular and Molecular Pathology Branch, Research Triangle Park, NC, USA
| | - Brittani A Rainess
- Comparative Neuroimmunology and Neuro-Oncology Laboratory, North Carolina State University, Raleigh, NC, USA
| | - Christopher L Mariani
- Comparative Neuroimmunology and Neuro-Oncology Laboratory, North Carolina State University, Raleigh, NC, USA
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The Use of Values WNR and GNR to Distinguish between and Diagnose Different Types of Pancreatitis. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:7-14. [PMID: 32548210 PMCID: PMC7287189 DOI: 10.1016/j.omtm.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
There is no effective serologic parameter to distinguish different types of pancreatitis now. To distinguish between acute pancreatitis (AP) and acute exacerbations of chronic pancreatitis (CP) and to determine whether fibrosis occurs in CP, we evaluated the ability to produce white blood cells (WBCs), the neutrophil-to-retinol-binding protein (RBP) ratio (called the WNR), the product of the gamma-glutamyl transpeptidase (GGT) level, and the 5′-nucleotide-to-RBP ratio (called the GNR). We evaluated the newly proposed difference index RBP and analyzed the effectiveness of the WNR and GNR in 691 patients with pancreatic diseases. We performed univariate and multivariate analyses of serological indices and their correlations with RBP and performed receiver operating characteristic (ROC) curve analyses of the WNR and GNR. The serum RBP level decreased markedly in AP compared with that in the acute stage of CP (p < 0.05). The GGT, alkaline phosphatase (ALP), total protein (TP), albumin (ALB), prealbumin (PA), 5′-nucleotide, and uric acid (UC) serum levels were significantly higher for fibrotic CP than for the acute stage of CP without fibrosis (p < 0.05). With progressing to pancreatic fibrosis, the liver injury-related indicators, prothrombin time (PT), activated partial thromboplastin time (APTT), D-Dimer, aspartate aminotransferase (AST), and GGT, gradually increased (p < 0.05). ROC curve analysis suggests that both the WNR (area under the curve [AUC] = 0.821) and GNR (AUC = 0.778) can be used to differentiate pancreatitis types.
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Abstract
OBJECTIVE We clarified clinicopathological characteristics of acute pancreatitis in terminal patients. METHODS Pathological changes in the entire pancreas from serial autopsies (N = 183) classified lesions into the following 3 categories: focal neutrophil infiltration, focal necrotizing pancreatitis, and diffuse necrotizing pancreatitis. The former two are possible precursors of diffuse necrotizing pancreatitis. Immunohistochemical staining was performed to analyze pancreatic stellate cells and inflammatory cells. RESULTS There were pathologically acute pancreatitis in 45 patients (24.6%), and no patients were diagnosed with it before autopsy. Focal neutrophil infiltration was present in 22 cases, focal necrotizing pancreatitis in 18 cases, and diffuse necrotizing pancreatitis in 5 cases. Severe inflammatory disease and surgery were associated with acute pancreatitis. Sepsis due to viral or bacterial infection was the most common cause of acute pancreatitis. Patients with diffuse necrotizing pancreatitis showed low white blood cell counts, while amylase levels were not increased. Increase in α-smooth muscle actin and nestin-positive stellate cell numbers in acute pancreatitis was correlated to increase in numbers of CD34-positive vascular endothelium, CD68- or CD163-positive macrophages, CD138-positive plasmacytes, CD3-positive T lymphocytes, and myeloperoxidase-positive leucocytes. CONCLUSIONS Necrotizing pancreatitis without typical clinical signs was frequently detected in autopsy samples. Clinicians must be mindful of necrotizing pancreatitis in terminal patients.
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Dynamic Detection of Monocyte Subsets in Peripheral Blood of Patients with Acute Hypertriglyceridemic Pancreatitis. Gastroenterol Res Pract 2019; 2019:5705782. [PMID: 31281350 PMCID: PMC6590588 DOI: 10.1155/2019/5705782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022] Open
Abstract
Aim Monocytes play an important role in acute pancreatitis (AP). Hypertriglyceridemic pancreatitis (HTGP) is always more severe than normal lipid-AP, whether the mechanism of aggravation involves monocyte subsets remains unknown though. The present study was aimed to analyze changes of peripheral blood M1 and M2 monocytes in HTGP patients. Methods A total of 90 subjects were enrolled, among which 16 diagnosed with HTGP, 34 with acute biliary pancreatitis (ABP), 20 with hypertriglyceridemia (HTG), and 20 healthy controls (HC). Peripheral blood CD14+CD86+ M1 and CD14+CD206+ M2 monocytes were examined by flow cytometry on days 1, 3, and 7 after admission. Results We found a marked increase in total and M1 monocyte count in AP patients (P < 0.05). In HTGP, the percentage of M1 monocytes in white blood cells was significantly higher on days 1, 3, and 7, while M2 monocyte percentage was decreased on day 3, compared with ABP (P < 0.05). In mild HTGP, M1 monocyte count and percentage gradually decreased, while M2 monocyte percentage gradually increased from day 1 to 7. In severe HTGP, M1 monocyte count and percentage rose to the highest point while M2 were the lowest on day 3. Additionally, the level of M1 monocytes showed a positive correlation with plasma triglyceride and Ranson score of HTGP patients. Conclusions Peripheral blood M1 and M2 monocytes showed different dynamic changes in mild and severe HTGP. A more dominant role of CD14+CD86+ M1 monocytes may be involved in the pathogenesis of HTGP.
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Circulating CD14 +CD163 +CD206 + M2 Monocytes Are Increased in Patients with Early Stage of Idiopathic Membranous Nephropathy. Mediators Inflamm 2018; 2018:5270657. [PMID: 30034290 PMCID: PMC6032654 DOI: 10.1155/2018/5270657] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
Aim To analyze changes in peripheral blood monocytes and their clinical significance in patients with early stage of idiopathic membranous nephropathy (IMN). Methods A total of 27 patients with early stage of IMN and 16 age- and sex-matched healthy controls (HCs) were recruited for the study. The monocyte subset counts in circulation were measured by flow cytometry, and serum interleukin- (IL-) 10 and IL-12 concentrations were tested by enzyme-linked immunosorbent assay. The potential association between clinical signs and monocyte subset counts was analyzed statistically. Results Compared with the HCs, the patients with early stage of IMN had higher counts of CD14+CD163+, CD14+CD163+CD206+, and CD14+CD163+CD206+CD115+ M2-like monocytes. The CD14+CD163+CD206+ M2-like cell counts and intracellular IL-10 concentrations in the monocytes were positively correlated with progression in proteinuria. The levels of serum IL-10 were significantly higher in early IMN patients than in the HCs. Furthermore, CD14+CD163+CD206+ M2-like cell counts in the patients with incipient IMN were also positively related with 24 h urinary albumin levels and the values of serum M-type phospholipase A2 receptor (PLA2R). Conclusion CD14+CD163+CD206+ M2-like monocytes may contribute to the pathologic process in early-stage IMN and could serve as potential markers for evaluating the disease severity.
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