Tubulointerstitial Infiltration of M2 Macrophages in Henoch-Schönlein Purpura Nephritis Indicates the Presence of Glomerular Crescents and Bad Clinical Parameters

The association between fractalkine/CX3CR1 axis with IgA vasculitis and nephritis

BACKGROUND

The study investigated whether the fractalkine/CX3CR1 axis is associated with the presence and severity of IgA vasculitis (IgAV) and IgA vasculitis nephritis (IgAVN) in children.

METHODS

We included 59 children with IgAV, 42 children with IgAVN (including 18 children with kidney biopsy), 26 plasma controls and 8 kidney controls. Clinical pathological data were collected, and the fractalkine/CX3CR1 axis and macrophage expression in the circulation and kidneys were detected.

RESULTS

Circulating fractalkine/CX3CR1 axis expression was significantly upregulated in children with IgAV and IgAVN compared to healthy controls. Plasma fractalkine levels and the proportion of CX3CR1+ monocytes were significantly higher in children with IgAVN than in those with IgAV, and the kidney expression of fractalkine/CX3CR1 axis and CD68 were significantly increased in the IgAVN group relative to normal controls, especially in children with IgAVN with more severe ISKDC pathological grading. Additionally, kidney levels of fractalkine, CX3CR1, and CD68 exhibited significant positive correlations with tubulointerstitial grading and serum creatinine levels.

CONCLUSION

The expression of fractalkine/CX3CR1 axis is associated with the presence and severity of IgAV and IgAVN. Our findings support further investigation of fractalkine/CX3CR1 as a target for future therapies in IgAV and IgAN.

IMPACT

The expression of plasma fractalkine/CX3CR1 axis is associated with the presence and severity of IgAV and IgAVN. The expression of kidney fractalkine/CX3CR1 axis and macrophage are upregulated in IgAVN, which is closely associated with poorer kidney function and more severe kidney pathology. Our findings support further investigation of fractalkine/CX3CR1 as a target for future therapies in IgAV and IgAVN.

TLR4 Inhibitor TAK-242 Protected Henoch-Schonlein Purpura Nephritis in Rats by Regulating Inflammatory Response and Immune Competence via NF- κB/NLRP3 Signalling

This study aimed to explore the effect of toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB)/NOD-like receptor thermal protein domain-associated protein 3 (NLRP3) signalling on Henoch-Schonlein purpura nephritis (HSPN). We established a HSPN rat model in a high-altitude hypoxic (HH) environment. Renal tissue lesions were observed by haematoxylin and Eosin (H&E) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL), CD20-postive B cells and CD68-postive macrophage cells were detected by immunohistochemistry, T-cell activation was detected by flow cytometry and toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB)/NOD-like receptor thermal protein domain associated protein 3 (NLRP3) signalling was detected by western blot. TAK-242 inhibited the expression of TLR4/NF-κB/NLRP3 signalling related-proteins, decreased the levels of 24 h urinary protein, serum creatinine, circular immune complex (CIC) and kidney immunoglobulin A (IgA), and improved renal histopathological damage in HH-HSPN rats. Furthermore, TAK-242 attenuated the infiltration of CD20 and CD68 into the kidney and increased the percentage of CD3+, CD4+ and CD4+/CD8+ cells in the blood of HH-HSPN rats. The study revealed that suppressing TLR4/NF-κB/NLRP3 signalling improved renal function and histopathological damage, and this improvement was related to inhibiting the inflammatory response and enhancing immune competence.

High Macrophage Densities in Native Kidney Biopsies Correlate With Renal Dysfunction and Promote ESRD

Introduction

Macrophages and monocytes are main players in innate immunity. The relevance of mononuclear phagocyte infiltrates on clinical outcomes remains to be determined in native kidney diseases.

Methods

Our cross-sectional study included 324 patients with diagnostic renal biopsies comprising 17 disease entities and normal renal tissues for comparison. All samples were stained for CD68⁺ macrophages. Selected groups were further subtyped for CD14⁺ monocytes and CD163⁺ alternatively activated macrophages. Using precise pixel-based digital measurements, we quantified cell densities as positively stained areas in renal cortex and medulla as well as whole renal tissue. Laboratory and clinical data of all cases at the time of biopsy and additional follow-up data in 158 cases were accessible.

Results

Biopsies with renal disease consistently revealed higher CD68⁺-macrophage densities and CD163⁺-macrophage densities in cortex and medulla compared to controls. High macrophage densities correlated with impaired renal function at biopsy and at follow-up in all diseases and in diseases analyzed separately. High cortical CD68⁺-macrophage densities preceded shorter renal survival, defined as requirement of permanent dialysis. CD14⁺ monocyte densities showed no difference compared to controls and did not correlate with renal function.

Conclusion

Precise quantification of macrophage densities in renal biopsies may contribute to risk stratification to identify patients with high risk for end-stage renal disease (ESRD) and might be a promising therapeutic target in renal disease.

Predictive Value of Laboratory Indexes on Renal Involvement in Children with Henoch-Schönlein Purpura

Objective

Henoch-Schönlein purpura (HSP) is the most common vasculitis in children. Renal involvement is the main long-term complication of HSP, and presently there is no way to predict which children may have irreversible renal damage from the outset. This study aimed to explore the prediction value of laboratory indexes on renal involvement in children with HSP, which could help the early identification and intervention.

Methods

Children with HSP hospitalized at the First Affiliated Hospital of Henan University of Chinese Medicine from June 2019 to December 2020 were included. The demographic findings, clinical features, laboratory findings including blood routine examination, serum immunoglobulin, complement, T cell subsets levels, liver and kidney function, coagulation function were recorded. Laboratory indexes were analyzed, logistic regression analysis was performed to identify the independent predictors in HSP patients with renal involvement, and receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes, as well as the efficacy of combined diagnosis.

Results

The study included 146 HSP patients, among them, 50 patients (34.2%) had renal involvement. Age, platelet distribution width (PDW), CD3⁺ and fibrinogen (FIB) were positively correlated with renal involvement, while the levels of Immunoglobulin G (IgG), C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) were negatively correlated with renal involvement. The area under the ROC Curve (AUC) of these biomarkers ranged from 0.6284 to 0.7009, and among the combinations, a combination of NLR, CRP, CD3⁺, FIB, PDW, IgG and age had the best AUC value (0.9774).

Conclusion

Age, PDW, CD3⁺, FIB, CRP, NLR and IgG were prediction indexes for renal involvement in HSP patients, and these indexes can be combined appropriately to improve the diagnostic efficacy.

Associations between clinical features and therapy with macrophage subpopulations and T cells in inflammatory lesions in the aorta from patients with Takayasu arteritis

Takayasu arteritis (TAK) is a large-vessel granulomatous vasculitis; the inflammatory infiltration in arteries comprises macrophages, multi-nucleated giant cells, CD4⁺ and CD8⁺ T cells, γδ T cells, natural killer (NK) cells and neutrophils. However, it is unknown which subtype of macrophages predominates. This study aims to evaluate macrophages subpopulations in the aorta in TAK. Immunohistochemistry was performed in the aorta from TAK patients (n = 22), patients with atherosclerotic disease (n = 9) and heart transplant donors (n = 8) using the markers CD68, CD86, CD206, CD3, CD20 and CD56. Active disease was observed in 54·5% of patients and active histological lesions were found in 40·9%. TAK patients presented atherosclerotic lesions in 27·3% of cases. The frequency of macrophages, M1 macrophages, T, B and NK cells was higher in the aorta from TAK and atherosclerotic patients compared to heart transplant donors. In TAK, macrophages and T cells were the most abundant cells in the aorta, and the expression of CD206 was higher than CD86 (P = 0·0007). No associations were found between the expression of cell markers and active disease or with atherosclerotic lesions. In TAK patients, histological disease activity led to higher T cell counts than chronic fibrotic lesions (P = 0.030), whereas prednisone use was associated with lower T cell counts (P = 0·035). In conclusion, M1 macrophages were more frequent in TAK and atherosclerotic patients compared to heart transplant donors, while M2 macrophages dominated M1 macrophages in TAK. T cells were associated with histological disease activity and with prednisone use in TAK.

Association of Nuclear Receptor Coactivators with Hypoxia-Inducible Factor-1α in the Serum of Patients with Chronic Kidney Disease

Nuclear receptor coactivators (NCOAs), consisting of coactivators and corepressors, dramatically enhance the transcriptional activity of nuclear receptors. Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor that plays a major role under hypoxic conditions. This study was performed with the focus on the association of NCOAs with HIF-1α in the serum of chronic kidney disease (CKD) patients. Sixty patients with stage 5 CKD and 30 healthy controls from The Second Affiliated Hospital of Shantou University Medical College, between March 21, 2019, and October 30, 2019, were recruited in this prospective cohort study. We analyzed the serum levels of NCOAs (NCOA1, NCOA2, and NCOA3), HIF-1α, vascular endothelial growth factor (VEGF), etc. and assessed whether there was any relationship between these parameters and CKD disease. We found that circulating NCOA1 was positively associated with circulating NCOA2, NCOA3, and HIF-1α. A positive correlation was also observed between NCOA2 and NCOA1, NCOA3, HIF-1α, and VEGF. Furthermore, statistically significant correlations between NCOA3 and NCOA1, NCOA2, and HIF-1α were observed. The serum levels of VEGF in the CKD group were higher than those of the healthy control group. Circulating NCOA1 and circulating NCOA2 were negatively associated with procalcitonin. In conclusion, there was an association between circulating NCOA1, NCOA2, NCOA3, and circulating HIF-1α, and circulating VEGF was a risk factor for CKD disease. However, more studies should be performed to confirm this hypothesis.