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Chen X, Wang T, Chen L, Zhao Y, Deng Y, Shen W, Li L, Yin Z, Zhang C, Cai G, Zhang M, Chen X. Cross-species single-cell analysis uncovers the immunopathological mechanisms associated with IgA nephropathy progression. JCI Insight 2024; 9:e173651. [PMID: 38716725 PMCID: PMC11141938 DOI: 10.1172/jci.insight.173651] [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] [Accepted: 03/19/2024] [Indexed: 05/12/2024] Open
Abstract
IgA nephropathy (IgAN) represents the main cause of renal failure, while the precise pathogenetic mechanisms have not been fully determined. Herein, we conducted a cross-species single-cell survey on human IgAN and mouse and rat IgAN models to explore the pathogenic programs. Cross-species single-cell RNA sequencing (scRNA-Seq) revealed that the IgAN mesangial cells (MCs) expressed high levels of inflammatory signatures CXCL12, CCL2, CSF1, and IL-34 and specifically interacted with IgAN macrophages via the CXCL12/CXCR4, CSF1/IL-34/CSF1 receptor, and integrin subunit alpha X/integrin subunit alpha M/complement C3 (C3) axes. IgAN macrophages expressed high levels of CXCR4, PDGFB, triggering receptor expressed on myeloid cells 2, TNF, and C3, and the trajectory analysis suggested that these cells derived from the differentiation of infiltrating blood monocytes. Additionally, protein profiling of 21 progression and 28 nonprogression IgAN samples revealed that proteins CXCL12, C3, mannose receptor C-type 1, and CD163 were negatively correlated with estimated glomerular filtration rate (eGFR) value and poor prognosis (30% eGFR as composite end point). Last, a functional experiment revealed that specific blockade of the Cxcl12/Cxcr4 pathway substantially attenuated the glomerulus and tubule inflammatory injury, fibrosis, and renal function decline in the mouse IgAN model. This study provides insights into IgAN progression and may aid in the refinement of IgAN diagnosis and the optimization of treatment strategies.
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Affiliation(s)
- Xizhao Chen
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Tiantian Wang
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Lei Chen
- Department of Critical Care Nephrology and Blood Purification, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yinghua Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yiyao Deng
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Wanjun Shen
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Lin Li
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Zhong Yin
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Chaoran Zhang
- Department of Stomatology, The First Medical Center of People’s Liberation Army General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Min Zhang
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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El Karoui K, Fervenza FC, De Vriese AS. Treatment of IgA Nephropathy: A Rapidly Evolving Field. J Am Soc Nephrol 2024; 35:103-116. [PMID: 37772889 PMCID: PMC10786616 DOI: 10.1681/asn.0000000000000242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
The pivotal event in the pathophysiology of IgA nephropathy is the binding of circulating IgA-containing immune complexes to mesangial cells, with secondary glomerular and tubulointerstitial inflammation and fibrosis. The paramount difficulty in the management of IgA nephropathy is the heterogeneity in its clinical presentation and prognosis, requiring an individualized treatment approach. Goal-directed supportive care remains the bedrock of therapy for all patients, regardless of risk of progression. Sodium-glucose transporter 2 inhibitors and sparsentan should be integral to contemporary supportive care, particularly in patients with chronic kidney damage. Pending the development of reliable biomarkers, it remains a challenge to identify patients prone to progression due to active disease and most likely to derive a net benefit from immunosuppression. The use of clinical parameters, including the degree of proteinuria, the presence of persistent microscopic hematuria, and the rate of eGFR loss, combined with the mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis, crescents score, is currently the best approach. Systemic glucocorticoids are indicated in high-risk patients, but the beneficial effects wane after withdrawal and come at the price of substantial treatment-associated toxicity. Therapies with direct effect on disease pathogenesis are increasingly becoming available. While targeted-release budesonide has garnered the most attention, anti-B-cell strategies and selective complement inhibition will most likely prove their added value. We propose a comprehensive approach that tackles the different targets in the pathophysiology of IgA nephropathy according to their relevance in the individual patient.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology, Hôpital Tenon, Sorbonne Université, Paris, France
| | | | - An S. De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
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Li H, Chen Z, Chen W, Li J, Liu Y, Ma H, Shi M, Sun X, Yao X, Li Z, Pawluczyk IZ, Zhang S, Barratt J, Lv J, Wang K, Zhao B. MicroRNA-23b-3p Deletion Induces an IgA Nephropathy-like Disease Associated with Dysregulated Mucosal IgA Synthesis. J Am Soc Nephrol 2021; 32:2561-2578. [PMID: 34479967 PMCID: PMC8722801 DOI: 10.1681/asn.2021010133] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/16/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND IgA nephropathy (IgAN) is the most common primary GN worldwide. Circulating immune complexes form that are prone to deposition in the mesangium, where they trigger glomerular inflammation. A growing body of evidence suggests that dysregulated expression of microRNAs in IgAN may play a significant role in establishing the disease phenotype. METHODS We generated single miR-23b-3p(miR-23b) knockout mice using CRISPR-Cas9. RESULTS In humans, miR-23b levels are downregulated in kidney biopsies and sera of patients with IgAN, and serum miR-23b levels are negatively correlated with serum IgA1 levels. We show that miR-23b-/- mice develop an IgAN-like phenotype of mesangial IgA and C3 deposition associated with development of albuminuria, hypertension, an elevated serum creatinine, and dysregulated mucosal IgA synthesis. Dysregulation of IgA production is likely mediated by the loss of miR-23b-mediated suppression of activation-induced cytidine deaminase in mucosal B cells. In addition, we show that loss of miR-23b increases the susceptibility of the kidney to progressive fibrosis through loss of regulation of expression of gremlin 2 and IgA accumulation through downregulation of the transferrin receptor. CONCLUSIONS Our findings suggest an indispensable role for miR-23b in kidney disease, and in particular, IgAN. miR-23b may in the future offer a novel therapeutic target for the treatment of IgAN.
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Affiliation(s)
- Hongzhi Li
- Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, Jilin, China
| | - Zhichao Chen
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Weitian Chen
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jingyi Li
- Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China,Correspondence: Dr. Binghai Zhao, Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, 3999 Binjiang Dong Road, Jilin, Jilin 132011, China; or Dr. Kai Wang, Molecular Imaging Research Center (MIRC), Harbin Medical University, 766 North Xiang'an Street, Harbin, Heilongjiang 150028, China. or
| | - Yunshuang Liu
- Department of Ultrasound, Affiliated Hong Qi Hospital, Mudanjiang Medical University, Mudanjiang 157011, China
| | - Hongchuang Ma
- Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, Jilin, China,Correspondence: Dr. Binghai Zhao, Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, 3999 Binjiang Dong Road, Jilin, Jilin 132011, China; or Dr. Kai Wang, Molecular Imaging Research Center (MIRC), Harbin Medical University, 766 North Xiang'an Street, Harbin, Heilongjiang 150028, China. or
| | - Mingming Shi
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xuelian Sun
- Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, Jilin, China
| | - Xiusong Yao
- Nephrology Department of Jinlin Central Hospital, Jinlin 132011, Jilin, China
| | - Zhijun Li
- Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, Jilin, China
| | | | - Shuchen Zhang
- Electron Microscopy Center, Basic Medical Science College, Harbin Medical University, Harbin, 150081, China
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Jicheng Lv
- Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Kai Wang
- Molecular Imaging Research Center, Harbin Medical University (MIRC), Harbin, Heilongjiang 150028, China
| | - Binghai Zhao
- Nephrosis Precision Medicine Innovation Center, University of Beihua School of Medicine, Beihua University, Jilin 132011, Jilin, China
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Wehbi B, Pascal V, Zawil L, Cogné M, Aldigier JC. History of IgA Nephropathy Mouse Models. J Clin Med 2021; 10:jcm10143142. [PMID: 34300307 PMCID: PMC8306110 DOI: 10.3390/jcm10143142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 01/05/2023] Open
Abstract
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world. It was first described in 1968 by Jean Berger and Nicole Hinglais as the presence of intercapillary deposits of IgA. Despite this simple description, patients with IgAN may present very broad clinical features ranging from the isolated presence of IgA in the mesangium without clinical or biological manifestations to rapidly progressive kidney failure. These features are associated with a variety of histological lesions, from the discrete thickening of the mesangial matrix to diffuse cell proliferation. Immunofluorescence on IgAN kidney specimens shows the isolated presence of IgA or its inconsistent association with IgG and complement components. This clinical heterogeneity of IgAN clearly echoes its complex and multifactorial pathophysiology in humans, inviting further analyses of its various aspects through the use of experimental models. Small-animal models of IgAN provide the most pertinent strategies for studying the multifactorial aspects of IgAN pathogenesis and progression. Although only primates have the IgA1 subclass, several murine models have been developed in which various aspects of immune responses are deregulated and which are useful in the understanding of IgAN physiopathology as well as in the assessment of IgAN therapeutic approaches. In this manuscript, we review all murine IgAN models developed since 1968 and discuss their remarkable contribution to understanding the disease.
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Affiliation(s)
- Batoul Wehbi
- Immunology Department, UMR CNRS 7276 INSERM 1262, Limoges University, 87032 Limoges, France; (B.W.); (V.P.); (L.Z.)
| | - Virginie Pascal
- Immunology Department, UMR CNRS 7276 INSERM 1262, Limoges University, 87032 Limoges, France; (B.W.); (V.P.); (L.Z.)
| | - Lina Zawil
- Immunology Department, UMR CNRS 7276 INSERM 1262, Limoges University, 87032 Limoges, France; (B.W.); (V.P.); (L.Z.)
| | - Michel Cogné
- Immunology Department, EFS Bretagne, INSERM 1236, Rennes 1 University, 35000 Rennes, France;
| | - Jean-Claude Aldigier
- Immunology Department, UMR CNRS 7276 INSERM 1262, Limoges University, 87032 Limoges, France; (B.W.); (V.P.); (L.Z.)
- Correspondence:
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Are there animal models of IgA nephropathy? Semin Immunopathol 2021; 43:639-648. [PMID: 34230994 DOI: 10.1007/s00281-021-00878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022]
Abstract
Immunoglobulin A (IgA) nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Up to 40% of IgAN patients develop end-stage kidney disease after 15-20 years. Despite the poor prognosis associated with this multifactorial disease, no clear treatment strategy has been identified, primarily due to the lack of understanding of its pathogenesis. Clinical observations indicate that aberrant IgAN immune systems, rather than intrinsic renal abnormalities, may be involved in its pathogenesis. Moreover, nephritogenic IgA and its related immune complexes are considered to be produced not only in the mucosa, but also in systemic immune sites, such as the bone marrow; however, there are numerous challenges to understanding this dynamic and complex immune axis in humans. Thus, several investigators have used experimental animal models. Although there are inter-strain differences in IgA molecules and immune responses between humans and rodents, animal models remain a powerful tool for investigating IgAN's pathogenesis, and the subsequent development of effective treatments. Here, we introduced some classical models of IgAN with or without genetic manipulation and recent translational approaches with some promising models. This includes humanized mouse models expressing human IgA1 and human IgA Fc receptor (CD89) that develops spontaneously the disease. Pre-clinical studies targeting IgA1 are discussed. Together, animal models are very useful tools to study pathophysiology and to validate new therapeutic approaches for IgAN.
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Pascal V, Hiblot M, Wehbi B, Aldigier JC, Cogné M. [Microbiota and IgA response homeostasis]. Med Sci (Paris) 2021; 37:35-40. [PMID: 33492216 DOI: 10.1051/medsci/2020258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mucosal immunity has to deal with a patchy mix of commensal but also eventually pathogenic bugs. Immunoglobulins of the A class (IgA) are opposing to this duality a functional balance going from tolerance to protective response or even to hyper-inflammation. Recent reports have shown the binding of polyreactive natural IgA, but also of affinity maturated protective IgA to the commensal microbiota, to superantigens and also to vaccinal antigens. Diverse types of humoral responses thus altogether contribute to the homeostasis of mucosal immunity. Their knowledge has to be taken into consideration for defining strategies of immuno-intervention, for mucosal vaccination as much as for immunotherapy of chronic inflammatory bowel disease.
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Affiliation(s)
- Virginie Pascal
- CNRS UMR 7276, Inserm U1262, Contrôle de la réponse immune B et lymphoproliférations, Université de Limoges, Rue du Docteur Marcland, 87000 Limoges, France
| | - Margaux Hiblot
- CNRS UMR 7276, Inserm U1262, Contrôle de la réponse immune B et lymphoproliférations, Université de Limoges, Rue du Docteur Marcland, 87000 Limoges, France
| | - Batoul Wehbi
- CNRS UMR 7276, Inserm U1262, Contrôle de la réponse immune B et lymphoproliférations, Université de Limoges, Rue du Docteur Marcland, 87000 Limoges, France
| | - Jean-Claude Aldigier
- CNRS UMR 7276, Inserm U1262, Contrôle de la réponse immune B et lymphoproliférations, Université de Limoges, Rue du Docteur Marcland, 87000 Limoges, France
| | - Michel Cogné
- CNRS UMR 7276, Inserm U1262, Contrôle de la réponse immune B et lymphoproliférations, Université de Limoges, Rue du Docteur Marcland, 87000 Limoges, France - EFS Bretagne, Inserm U1236, Université de Rennes 1, Rue Pierre-Jean-Gineste, 35000 Rennes, France
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He JW, Zhou XJ, Lv JC, Zhang H. Perspectives on how mucosal immune responses, infections and gut microbiome shape IgA nephropathy and future therapies. Am J Cancer Res 2020; 10:11462-11478. [PMID: 33052226 PMCID: PMC7545987 DOI: 10.7150/thno.49778] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023] Open
Abstract
Infections have been considered to play a critical role in the pathogenesis of IgA nephropathy (IgAN) because synpharyngitic hematuria is a common feature in IgAN. However, how infections participate in this process is still debated. More recent studies have also revealed that the alteration of the gut microbiome exerts a profound effect on host immune responses, contributing to the etiology or progression of autoimmunity. Considering IgA as the first line of defense against bacterial and viral antigens, this review evaluates the relationships among intestinal infections, gut microbiome, and IgA for a better understanding of the pathogenesis of IgAN. Moreover, as a prototype of IgA immunity, we provide detailed clarification of IgAN pathogenesis to shed light on other diseases in which IgA plays a role. Finally, we discuss potential therapies focusing on microbes and mucosal immune responses in IgAN.
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Chang S, Li XK. The Role of Immune Modulation in Pathogenesis of IgA Nephropathy. Front Med (Lausanne) 2020; 7:92. [PMID: 32266276 PMCID: PMC7105732 DOI: 10.3389/fmed.2020.00092] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/03/2020] [Indexed: 01/10/2023] Open
Abstract
IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide, with diverse clinical manifestations characterized by recurrent gross hematuria or microscopic hematuria, and pathological changes featuring poorly O-galactosylated IgA1 deposition in the glomerular mesangium. Pathogenesis has always been the focus of IgAN studies. After 50 years of research, most scholars agree that IgAN is a group of clinicopathological syndromes with certain common immunopathological characteristics, and multiple mechanisms are involved in its pathogenesis, including immunology, genetics, and environmental or nutritional factors. However, the precise pathogenetic mechanisms have not been fully determined. One hypothesis about the pathogenesis of IgAN suggests that immunological factors are engaged in all aspects of IgAN development and play a critical role. A variety of immune cells (e.g., dendritic cells, NK cells, macrophages, T-lymphocyte subsets, and B-lymphocytes, etc.) and molecules (e.g., IgA receptors, Toll-like receptors, complements, etc.) in innate and adaptive immunity are involved in the pathogenesis of IgAN. Moreover, the abnormality of mucosal immune regulation is the core of IgAN immunopathogenesis. The roles of tonsil immunity or intestinal mucosal immunity, which have received more attention in recent years, are supported by mounting evidence. In this review, we will explore the latest research insights on the role of immune modulation in the pathogenesis of IgAN. With a better understanding of immunopathogenesis of IgAN, emerging therapies will soon become realized.
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Affiliation(s)
- Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.,Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Xiao-Kang Li
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Floege J. Fatal Attraction: Immunoglobulin A and the Glomerular Mesangium. J Am Soc Nephrol 2019; 30:1139-1141. [PMID: 31227635 DOI: 10.1681/asn.2019040373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jürgen Floege
- Division of Nephrology, Medizinische Klinik II, Rheinisch Westfälische Technische Hochschule University Hospital Aachen, Aachen, Germany
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