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Xie S, Sun M, Zhang X, Kan C, Shi G, Peng W, Guo J, Wu D, Yin Z, Yang Q, Zhang R. T cell responses in immune-mediated IgA nephropathy. J Leukoc Biol 2024; 116:523-535. [PMID: 38713107 DOI: 10.1093/jleuko/qiae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
Immunoglobulin A nephropathy is a complex autoimmune disease with various underlying causes and significant clinical heterogeneity. There are large individual differences in its development, and the etiology and pathogenesis are still poorly understood. While it is known that immunobiological factors play a significant role in the pathophysiology of immunoglobulin A nephropathy, the specific nature of these factors has yet to be fully elucidated. Numerous investigations have verified that CD4+ and CD8+ T lymphocytes are involved in the immunopathogenesis of immunoglobulin A nephropathy. Furthermore, certain data also point to γδT cells' involvement in the pathophysiology of immunoglobulin A nephropathy. By thoroughly examining the mechanisms of action of these T cells in the context of immunoglobulin A nephropathy, this review sheds light on the immunopathogenesis of the disease and its associated factors. The review is intended to provide reference value for the future research in this field and promising treatment clues for clinical patients.
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Affiliation(s)
- Shimin Xie
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Mengying Sun
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Xiaohan Zhang
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Chao Kan
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Guojuan Shi
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Weixiang Peng
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Junli Guo
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Dantong Wu
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Zhinan Yin
- Biomedical Translational Research Institute, Jinan University, Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510632, China
| | - Quanli Yang
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Rui Zhang
- Department of Nephrology, Zhuhai People's Hospital, Zhuhai Clinical Medical College of Jinan University, Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
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Aiello FB, Ranelletti FO, Liberatore M, Felaco P, De Luca G, Lamolinara A, Schena FP, Bonomini M. Independent Prognostic and Predictive Role of Interstitial Macrophages in Kidney Biopsies of IgA Nephropathy Patients. J Pers Med 2023; 13:935. [PMID: 37373924 DOI: 10.3390/jpm13060935] [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: 04/24/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
A relevant percentage of IgAN patients experience a progressive decline in kidney function. According to the KDIGO guidelines, proteinuria and eGFR are the only validated prognostic markers. The role of interstitial macrophages in kidney biopsies of IgAN patients and the outcome of patients treated with renin-angiotensin system inhibitors (RASBs) alone or combined with glucocorticoids were evaluated. Clinical and laboratory records (age, gender, hypertension, hematuria, proteinuria, eGFR, serum creatinine, and therapy), MEST-C parameters of the Oxford classification, C4d deposition, peritubular capillaries, and glomerular and interstitial macrophages in 47 IgAN patients undergoing kidney biopsy consecutively between 2003 and 2016 were examined. A high number of interstitial macrophages significantly correlated with peritubular capillary rarefaction and impairment of kidney function. Cox's multivariable regression analysis revealed that a value > 19.5 macrophages/HPF behaved as an independent marker of an unfavorable outcome. Patients exhibiting > 19.5 macrophages/HPF treated at the time of diagnosis with RASBs combined with methylprednisolone had an estimated probability of a favorable outcome higher than patients treated with RASBs alone. Thus, a value > 19.5 macrophages/HPF in IgAN biopsies can predict an unfavorable outcome and endorse a well-timed administration of glucocorticoids. Studies evaluating urine biomarkers associated with peritubular capillary rarefaction in patients with marked macrophage infiltration may help personalized treatment decisions.
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Affiliation(s)
- Francesca Bianca Aiello
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti-Pescara, 66100 Chieti, Italy
| | | | | | - Paolo Felaco
- UOC Nephrology and Dialysis PO, 64100 Teramo, Italy
| | - Graziano De Luca
- Graziano De Luca UO Clinical Pathology, Val Vibrata Hospital, 64027 Sant'Omero, Italy
| | - Alessia Lamolinara
- Department of Neurosciences, Imaging and Clinical Sciences, University G. D'Annunzio, Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Paolo Schena
- Department of Emergency and Organ Transplantation, University of Bari, 70121 Bari, Italy
- Schena Foundation, Valenzano, 70010 Bari, Italy
| | - Mario Bonomini
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti-Pescara, 66100 Chieti, Italy
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Martinez Valenzuela L, Oliveras L, Gomà M, Quiros E, Antón-Pámpols P, Gómez-Preciado F, Fulladosa X, Cruzado JM, Torras J, Draibe J. Th1 Cytokines Signature in 2 Cases of IgA Nephropathy Flare after mRNA-Based SARS-CoV-2 Vaccine: Exploring the Pathophysiology. Nephron Clin Pract 2022; 146:564-572. [PMID: 35640535 PMCID: PMC9393770 DOI: 10.1159/000524619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
mRNA-based vaccines have dramatically shifted the course of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. IgA nephropathy (IgAN) flare is the most reported renal adverse effect after the administration of these vaccines. Unraveling the mechanistic pathways leading to these flares is necessary to confirm a causal association. Herein, we report 2 cases of IgAN flare after SARS-CoV-2 vaccination in patients previously diagnosed with IgAN. We describe and compare the clinical and analytical features of the disease at the time of the diagnostic with the post-vaccine flare. In addition, we obtained serum and urine of these patients at the moment of the flare and determined the levels of IL-2, TNF-α, and IFNγ using a multiplex bead-based assay. As diseased controls, we included n = 13 patients diagnosed with IgAN who had available serum and urine samples at the moment of the diagnostic stored in our biobank. We also included 6 healthy controls. Compared to the first episode, postvaccination flares were more severe in terms of peak serum creatinine, albuminuria, and urinary erythrocyte count. The histological lesions found at the biopsy performed during the post-vaccine flare were similar to those found at the diagnostic. One of the patients who suffered a post-vaccine flare showed increased serum IL-2 and TNFα compared to the IgAN-diseased controls and the healthy controls. In conclusion, although several cases of post-vaccine IgAN flares have been reported, there are no mechanistic studies on the occurrence of these flares. We here suggest that hyperactivation of the Th1 pathway may be involved, but larger studies with more refined methods for numerical and functional Th1 lymphocytes evaluation are required.
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Affiliation(s)
- Laura Martinez Valenzuela
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Oliveras
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gomà
- Department of Pathology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Eugenia Quiros
- Department of Pathology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Antón-Pámpols
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Gómez-Preciado
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Fulladosa
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Cruzado
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Torras
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Juliana Draibe
- Nephrology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
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Oh TR, Bae EH. Does Th1/Th2 cell imbalance affect immunoglobulin A nephropathy? Kidney Res Clin Pract 2021; 40:9-11. [PMID: 33789381 PMCID: PMC8041628 DOI: 10.23876/j.krcp.21.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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