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Gu QH, Xu H, Cao X, Cheng X, Jia JY, Yan TK. The protease inhibitor E64d might attenuate the development of experimental anti-glomerular basement membrane disease through regulating the activation of Th1 cells. Int Immunopharmacol 2024; 129:111594. [PMID: 38295547 DOI: 10.1016/j.intimp.2024.111594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Cathepsins have been recently identified as a regulator in the activation of Th1 and Th17 cells, which play an important role in the pathogenesis of anti-glomerular basement membrane (GBM) disease. Whether cathepsins contribute to the development of anti-GBM disease through regulating the activation of CD4+ T cell is still unclear. METHODS Rats with experimental anti-GBM disease was established by immunization with the nephritogenic T cell epitope α3127-148. E64d, a cysteine cathepsin inhibitor, was administered in vitro and vivo to evaluate the effect of cathepsins on regulating the activation of antigen specific T cells and the development of anti-GBM disease. RESULTS In rats with experimental anti-GBM diseases, E64d treatment not only reduced the levels of proteinuria, serum creatinine and anti-GBM antibody, but also ameliorated the kidney injury with less glomerular IgG deposition, a lower percentage of crescents and less infiltration of CD4+ T cells, CD8+ T cells and macrophages, as well as a lower percentage of splenic Th1 cells. In vitro, E64d treatment could significantly reduce the production of IFN-γ in the supernatant which might be produced by the activation of Th1 cells after being recalled with the autoantigen α3127-148. We also found the CD4+ T cells of rats with anti-GBM disease had an increased expression of cathepsin L (Cts-L), and the percentage of CD4+ T cells with extracellular expression of Cts-L was obviously higher, indicating it as a potential key regulator. CONCLUSIONS E64d might attenuate the development of anti-GBM disease by participating in the activation of Th1 cells, indicating it as a potential drug for anti-GBM disease in the future.
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Affiliation(s)
- Qiu-Hua Gu
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hao Xu
- Department of Urology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300192, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300192, China
| | - Xin Cao
- Department of Nephrology, Tianjin Medical University General Hospital Airport Hospital, Tianjin 300308, China
| | - Xi Cheng
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jun-Ya Jia
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tie-Kun Yan
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Okabayashi Y, Nagasaka S, Kanzaki G, Tsuboi N, Yokoo T, Shimizu A. Group 1 innate lymphoid cells are involved in the progression of experimental anti-glomerular basement membrane glomerulonephritis and are regulated by peroxisome proliferator-activated receptor α. Kidney Int 2019; 96:942-956. [PMID: 31402171 DOI: 10.1016/j.kint.2019.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023]
Abstract
Innate lymphoid cells play an important role in the early effector cytokine-mediated response. In Wistar Kyoto rats, CD8+ non-T lymphocytes (CD8+Lym) infiltrate into glomeruli during the development of anti-glomerular basement membrane (anti-GBM) glomerulonephritis. Here, we examined the profiles and roles of CD8+Lym in anti-GBM glomerulonephritis. The regulation of CD8+Lym by peroxisome proliferator-activated receptor (PPAR)-α in anti-GBM glomerulonephritis was also evaluated. Glomerular infiltrating CD8+Lym were lineage-negative cells that showed markedly high expression of IFN-γ and T-bet mRNAs but not Eomes, indicating these cells are group 1 innate lymphoid cells. In anti-GBM glomerulonephritis, the glomerular mRNAs of innate lymphoid cell-related cytokines (IFN-γ and TNF-α) and chemokines (CXCL9, CXCL10, and CXCL11) are significantly increased. Treatment with a PPARα agonist ameliorated renal injury, with reduced expression of these mRNAs. In vitro, enhanced IFN-γ production from innate lymphoid cells upon IL-12 and IL-18 stimulation was reduced by the PPARα agonist. Moreover, CXCL9 mRNA in glomerular endothelial cells and CXCL9, CXCL10, and CXCL11 mRNAs in podocytes and macrophages were upregulated by IFN-γ, whereas the PPARα agonist downregulated their expression. We also detected the infiltration of innate lymphoid cells into glomeruli in human anti-GBM glomerulonephritis. Thus, innate lymphoid cells are involved in the progression of anti-GBM glomerulonephritis and regulated directly or indirectly by PPARα. Our findings suggest that innate lymphoid cells could serve as novel therapeutic targets for anti-GBM glomerulonephritis.
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Affiliation(s)
- Yusuke Okabayashi
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Nagasaka
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
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Falk RJ, Husseini JS, Fenves AZ, Rosales IA. Case 24-2018: A 71-Year-Old Man with Acute Renal Failure and Hematuria. N Engl J Med 2018; 379:568-578. [PMID: 30089061 DOI: 10.1056/nejmcpc1802829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ronald J Falk
- From the Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (R.J.F.); and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Jad S Husseini
- From the Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (R.J.F.); and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Andrew Z Fenves
- From the Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (R.J.F.); and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Ivy A Rosales
- From the Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (R.J.F.); and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (J.S.H.), Medicine (A.Z.F.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
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Talash V, Bevzenko T, Yarmola T, Tkachenko L, Pustovoyt H. GOODPASCHER'S SYNDROME - THE CHALLENGES IN A TIMELY DIAGNOSIS AND TREATMENT IN MEDICAL PRACTICE (CLINICAL CASE). Georgian Med News 2018:107-114. [PMID: 29905555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The article presents a clinical case with intravital diagnosis of Goodpascher's syndrome in a 22 years old patient. In this work we analyze clinical, laboratory-instrumental, pathologoanatomic and pathomorphological aspects of the disease, which was accompanied by glomerulonephritis with rapidly progressive renal insufficiency, anemia, arterial hypertension and symptoms of lung injury. Article emphasizes on the necessity of timely diagnosis of Goodpascher's syndrome and following administration of immunosuppressive therapy.
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Affiliation(s)
- V Talash
- 1Higher state educational establishment of Ukraine "Ukrainian medical stomatological academy", Poltava; 2State scientific establishment "Scientific-practical centre of prophylactic and clinical medicine" of State affairs management, Kyiv
| | - T Bevzenko
- 1Higher state educational establishment of Ukraine "Ukrainian medical stomatological academy", Poltava; 2State scientific establishment "Scientific-practical centre of prophylactic and clinical medicine" of State affairs management, Kyiv
| | - T Yarmola
- 1Higher state educational establishment of Ukraine "Ukrainian medical stomatological academy", Poltava; 2State scientific establishment "Scientific-practical centre of prophylactic and clinical medicine" of State affairs management, Kyiv
| | - L Tkachenko
- 1Higher state educational establishment of Ukraine "Ukrainian medical stomatological academy", Poltava; 2State scientific establishment "Scientific-practical centre of prophylactic and clinical medicine" of State affairs management, Kyiv
| | - H Pustovoyt
- 1Higher state educational establishment of Ukraine "Ukrainian medical stomatological academy", Poltava; 2State scientific establishment "Scientific-practical centre of prophylactic and clinical medicine" of State affairs management, Kyiv
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Usui T, Kai H, Noguchi K, Morito N, Usui J, Saito C, Uesugi N, Nagata M, Yamagata K. Effectiveness of Plasmapheresis in a Patient with Anti-glomerular Basement Membrane Antibody Glomerulonephritis with Advanced Kidney Dysfunction. Intern Med 2017; 56:2475-2479. [PMID: 28824070 PMCID: PMC5643177 DOI: 10.2169/internalmedicine.8571-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Patients with anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN) have severe kidney dysfunction, leading to end-stage renal disease. The effect of plasmapheresis and immunosuppressive treatment in patients with severe glomerular changes is controversial. A 62-year-old man was admitted with rapidly progressive glomerulonephritis and diagnosed with anti-GBM GN. He required hemodialysis. All glomeruli in the kidney biopsy specimen had cellular crescents without fibrotic changes, suggesting reversible damage. He was treated with plasmapheresis until the anti-glomerular basement membrane antibodies disappeared. His kidney function recovered, and dialysis was able to be discontinued. Frequent plasmapheresis in patients with dialysis-dependent anti-GBM GN may improve the kidney prognosis.
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Affiliation(s)
- Toshiaki Usui
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirayasu Kai
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazuyuki Noguchi
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Naoki Morito
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Joichi Usui
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Chie Saito
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Noriko Uesugi
- Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Michio Nagata
- Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
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Wu X, Zhang M, Huang X, Zhang L, Zeng C, Zhang J, Liu Z, Tang Z. Therapeutic Mechanism of Glucocorticoids on Cellular Crescent Formation in Patients With Antiglomerular Basement Membrane Disease. Am J Med Sci 2017; 354:145-151. [PMID: 28864372 DOI: 10.1016/j.amjms.2017.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study aimed to explore the therapeutic mechanism of glucocorticoids (GCs) in antiglomerular basement membrane disease. MATERIALS AND METHODS Thirty-four patients with biopsy-proven antiglomerular basement membrane nephritis were divided into the following 2 groups: group 1 (patients treated with GCs, n = 22) and group 2 (patients who were not treated with GCs, n = 12). The expression of parietal epithelial cells (PECs), activated PECs and glucocorticoid receptors (GRs) was examined quantitatively and compared between the 2 groups. Correlations between GR expression in glomeruli and patients' clinicopathological indices were also analyzed. RESULTS Compared with patients in group 2, patients in group 1 showed lower levels of serum creatinine (SCr) (P = 0.03), average cellular crescent percentage (P = 0.005) and macrophages infiltrating in renal interstitium (P = 0.03). PECs (P = 0.007) and activated PECs (P = 0.03) were strongly detected in the cellular components of classic crescents, and both were significantly reduced in group 1 compared to group 2. GR expression either in glomeruli (P = 0.01) or interstitium (P = 0.009) was lower in group 1 after GCs treatment than in group 2. Additionally, GR expression in glomeruli was strongly correlated with renal function (SCr: r = 0.45, P = 0.009; eGFR: r = -0.35, P = 0.046), the proportion of cellular crescents (r = 0.67, P < 0.001), PECs (r = 0.64, P < 0.001) and activated PECs (r = 0.72, P < 0.001), and the degree of interstitial (r = 0.50, P = 0.004) and glomerular (r = 0.49, P = 0.007) macrophage infiltration. CONCLUSIONS GCs might exert their therapeutic effects via inhibiting the activation and proliferation of PECs, as well as macrophage infiltration, which could contribute to crescent formation and determine renal survival. GRs are involved in this process as well.
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Affiliation(s)
- Xiaomei Wu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mingchao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Lihua Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jiong Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zheng Tang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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Li JN, Jia X, Wang Y, Xie C, Jiang T, Cui Z, Zhao MH. Plasma from patients with anti-glomerular basement membrane disease could recognize microbial peptides. PLoS One 2017; 12:e0174553. [PMID: 28410377 PMCID: PMC5391914 DOI: 10.1371/journal.pone.0174553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/10/2017] [Indexed: 12/04/2022] Open
Abstract
Infection has long been suspected as a trigger of autoimmune diseases, and molecular mimicry mechanism was hypothesized in this study. Microbe originated peptides were searched from the Uniprot database based on a previous defined critical amino acid motif within α3129−150, isoleucine137, tryptophan140, glycine142, phenylalanine 143 and phenylalanine 145. 23826 microbial peptides were identified using our searching strategy, among which seven were related with human infections. Circulating IgG and IgM antibodies against the seven microbial peptides were detected using ELISA in 76 patients with anti-GBM disease. Four peptides were recognized by both IgG and IgM antibodies, and one peptide was recognized by IgG antibodies only. Peptides from Bacteroides, Saccharomyces cerevisiae, and Bifidobacterium thermophilum possessed the highest recognition frequency with the prevalence of 73.7%, 61.8% and 67.1% for IgG, 56.6%, 44.7% and 67.1% for IgM in anti-GBM patients. Patients with antibodies against these microbial peptides showed more severe kidney injury, including higher serum creatinine and higher percentage of crescent formation. In conclusion, antibodies against microbial peptides were identified in the circulation of anti-GBM patients, implying its etiological role in eliciting autoimmune response against α3(IV)NC1 through molecular mimicry.
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Affiliation(s)
- Jian-nan Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Xiaoyu Jia
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Yongqiang Wang
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Can Xie
- State Key Laboratory of Membrane Biology, Laboratory of Molecular Biophysics, School of Life Sciences, Peking University, Beijing, China
| | - Taijiao Jiang
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
- * E-mail:
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
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Zhou C, Lou K, Tatum K, Funk J, Wu J, Bartkowiak T, Kagan D, Lou Y. Differentiating Glomerular Inflammation from Fibrosis in a Bone Marrow Chimera for Rat Anti-Glomerular Basement Membrane Glomerulonephritis. Am J Nephrol 2016; 42:42-53. [PMID: 26337665 DOI: 10.1159/000438929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many types of glomerulonephritis (GN) undergo tandem connected phases: inflammation and fibrosis. Fibrosis in human GNs leads to irreversible end-stage disease. This study investigated how these 2 phases were controlled. METHODS Using a rat anti-glomerular basement membrane GN model, we established bone marrow (BM) chimeras between GN-resistant Lewis (LEW) and GN-susceptible Wistar Kyoto (WKY) rats. Glomerular inflammation and fibrosis were compared between chimeras. RESULTS LEW's BM to WKY chimeras with or without co-transfer of host WKY's T cells were GN-resistant. On the other hand, WKY's BM to LEW (LEW(WKY)) chimeras developed glomerular inflammation and albuminuria upon immunization. Quantitative analysis showed that the number and composition of inflammatory cells in glomeruli of immunized LEW(WKY) chimeras were similar to those in immunized WKY rats at their inflammatory peak. Thus, glomerular inflammation was controlled by BM-derived non-T cell populations. However, unlike WKY rats, LEW(WKY) rats did not develop fibrosis until the end of experiments (84 days) in spite of persistent inflammation and albuminuria. CONCLUSION Inflammation alone was not sufficient to trigger fibrosis, suggesting a critical role of glomerular cells in the fibrotic process. As LEW(WKY) chimera allows us to separate glomerular inflammation from fibrosis, this model provides a useful tool to study how fibrosis is initiated following inflammation.
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Touzot M, Poisson J, Faguer S, Ribes D, Cohen P, Geffray L, Anguel N, François H, Karras A, Cacoub P, Durrbach A, Saadoun D. Rituximab in anti-GBM disease: A retrospective study of 8 patients. J Autoimmun 2015; 60:74-9. [PMID: 25953709 DOI: 10.1016/j.jaut.2015.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Anti-glomerular basement membrane (GBM) disease is a rare autoantibody-mediated disorder presenting as rapidly progressive glomerulonephritis, and often with pulmonary hemorrhage. Antibody removal with plasmapheresis and immunosuppressive drugs are the cornerstones of the treatment. Data regarding the use of specific B-cell depleting therapy such as rituximab are lacking. METHODS We conducted a retrospective observational study of 8 patients with severe and/or refractory GBM disease that received rituximab therapy. RESULTS Eight patients (2 men, 6 women) with a mean age of 26 ± 13.1 years old were included. Seven had severe renal involvement [median creatinin level was 282 μmol/l, range (65-423)] requiring high immunosuppressive or plasmapheresis dependent, and two had relapse of pulmonary hemorrhage including one with renal failure. Patients received an initial immunosuppressive treatment including steroid and cyclosphosphamide (n = 8) and plasmapheresis (n = 5). Except one late relapse, rituximab therapy was started within two months after diagnosis. All patients except one received 4 weekly dose of rituximab (375 mg(2)). Anti-GBM antibodies were still present in 6/8 patients, at rituximab initiation. Complete remission was observed in 7 out of 8 patients, mostly 3 months after rituximab therapy. After a mean follow-up of 25.6 months (range 4-93), patient and renal survival were 100% and 75% respectively, but rituximab use did not improve GFR. Anti-GBM antibodies remained negative for all patients during follow-up. Only one patient developed a severe bacterial infection but no opportunistic or viral infections were reported. CONCLUSION Rituximab may represent an additional and/or alternative therapy in the induction treatment of anti-GBM disease.
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Affiliation(s)
- Maxime Touzot
- Service de néphrologie, IFRNT, Le Kremlin-Bicêtre, France.
| | - Johanne Poisson
- Département de Médecine Interne et d'Immunologie clinique, Groupe Hospitalier Pitié-Salpêtrière, 84, boulevard de l'Hôpital, Paris 75013, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre Hospitalo-Universitaire de Rangueil, Toulouse, France
| | - David Ribes
- Département de Néphrologie et Transplantation d'Organes, Centre Hospitalo-Universitaire de Rangueil, Toulouse, France
| | - Pascal Cohen
- Service de Médecine interne, groupe hospitalier Cochin, Paris, France
| | | | - Nadia Anguel
- Service de réanimation médicale, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Helene François
- Service de néphrologie, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014 Villejuif, France
| | - Alexandre Karras
- Service de néphrologie, hôpital européen Georges-Pompidou, Paris, France
| | - Patrice Cacoub
- Département de Médecine Interne et d'Immunologie clinique, Groupe Hospitalier Pitié-Salpêtrière, 84, boulevard de l'Hôpital, Paris 75013, France; Centre national de référence maladies systémiques et autoimmunes rares, DHU Inflammation, Immunopathologie, Biothérapie, Université Paris VI-Pierre et Marie Curie, Paris, France
| | - Antoine Durrbach
- Service de néphrologie, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014 Villejuif, France
| | - David Saadoun
- Département de Médecine Interne et d'Immunologie clinique, Groupe Hospitalier Pitié-Salpêtrière, 84, boulevard de l'Hôpital, Paris 75013, France; Centre national de référence maladies systémiques et autoimmunes rares, DHU Inflammation, Immunopathologie, Biothérapie, Université Paris VI-Pierre et Marie Curie, Paris, France.
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10
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Hunt JS, McGiven AR, Lynn KL. Anti-glomerular basement membrane antibodies: significance and estimation by solid phase radioimmunoassay. Contrib Nephrol 2015; 35:61-85. [PMID: 6831883 DOI: 10.1159/000407453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Plessl A, Buser PJ, Daikeler T, Steveling E, Halter J, Holbro A. [Alveolar hemorrhage und cocaine: cause or coincidence?]. Praxis (Bern 1994) 2014; 103:1331-1334. [PMID: 25351696 DOI: 10.1024/1661-8157/a001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the case of a previously healthy young man who presented to the hospital with hemoptysis and dyspnea. Hemoptysis is a frequently encountered symptom in daily routine and investigations can easily be deferred to a longer time frame. Our case illustrates the importance of a prompt investigation and treatment of underlying causes. Furthermore one should not hesitate to include rare, yet life threatening conditions in differential diagnosis.
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Affiliation(s)
| | | | | | | | - Jörg Halter
- Abteilung Hämatologie, Universitätsspital Basel
| | - Andreas Holbro
- Abteilung Hämatologie, Universitätsspital Basel und Blutspendezentrum beider Basel, Schweizerisches Rotes Kreuz
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Usui J, Yamagata K. [The Cutting-edge of Medicine; Rapidly progressive glomerulonephritis]. ACTA ACUST UNITED AC 2014; 103:2587-93. [PMID: 27514210 DOI: 10.2169/naika.103.2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ma R, Cui Z, Hu SY, Jia XY, Yang R, Zheng X, Ao J, Liu G, Liao YH, Zhao MH. The alternative pathway of complement activation may be involved in the renal damage of human anti-glomerular basement membrane disease. PLoS One 2014; 9:e91250. [PMID: 24658070 PMCID: PMC3962356 DOI: 10.1371/journal.pone.0091250] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/10/2014] [Indexed: 11/18/2022] Open
Abstract
Linear deposition of IgG and complement 3 (C3) along glomerular basement membrane (GBM) is generally revealed in the kidneys of human anti-GBM disease. Our recent studies demonstrated the pathogenic role of complement activation in renal damage of this disease. However, the pathways of complement activation were still paradoxical. In this study, renal biopsy tissues from 10 patients with anti-GBM disease were used to investigate the pathways of complement activation by detecting the deposition of various complement components, including C1q, factor B, factor P (properdin), mannose-binding lectin (MBL), C3d, C4d and C5b-9, using immunohistochemistry and immunofluorescence. We found that C1q, factor B, properdin, C3d, C4d and C5b-9 were detected in all the glomeruli of our patients, along GBM with a linear and/or granular staining pattern. Furthermore, C1q, factor B and properdin co-localized well with C5b-9. The properdin also co-localized well with C3d. However, the deposition of MBL was diffusive in mesangium, GBM, Bowman's capsule and within crescents and was not co-localized with C5b-9 but partially co-localized with C4d. The intensity of factor B deposition (3.3 vs. 1.2, P<0.001) and C5b-9 deposition (3.2 vs. 1.6, P<0.001) was significantly stronger in the glomeruli with crescent formation, compared with the glomeruli without crescents. The complement system is overall activated via both the alternative pathway and classical pathway in the kidneys of human anti-GBM disease. The alternative pathway might play an important role in complement activation induced renal damage.
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Affiliation(s)
- Rui Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
- * E-mail:
| | - Shui-Yi Hu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Xiao-Yu Jia
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Rui Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Xin Zheng
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Jie Ao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
| | - Yun-Hua Liao
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education of China, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
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Hou W, Huang G, Cao X, Zhang Y, Zhang J, Li Y. Suppression of experimental autoimmune glomerulonephritis by tryptophan. J Nephrol 2014; 27:19-28. [PMID: 24519862 DOI: 10.1007/s40620-013-0020-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indoleamine 2, 3-dioxygenase (IDO), a heme-containing dioxygenase, can catalyze tryptophan degradation and produce a local microenvironment with tryptophan depletion and tryptophan metabolites accumulation, which may suppress T cell-mediated immunity and play an important immunosuppressive role in many diseases. Previous studies suggested that tryptophan depletion is an important immunosuppressive mechanism of IDO, while recent evidence shows that tryptophan metabolites may also be useful for inducing the T cell immune tolerance. However, it remains unclear whether tryptophan catabolites play a protective role in anti-glomerular basement membrane (anti-GBM) glomerulonephritis (GN), which is a type 1 T-helper (Th1)-mediated autoimmune disease. METHODS We examined the effect of tryptophan catabolites, 3-hydroxykynurenine acid and 3-hydroxyanthranilic acid, on renal injury in experimental autoimmune glomerulonephritis (EAG) of Wistar-Kyoto rats and explored their protective mechanism. RESULTS Treatment by either 3-hydroxyanthranilic acid or 3-hydroxykynurenic acid attenuated the kidney disease of EAG rats, with decreased glomerular histological injury and inflammatory cell infiltration, lightened urinary protein, and improved renal function compared to phosphate buffered saline-treated EAG rats. This was associated with significantly increased apoptosis and decreased proliferation of splenic activated T cells in vivo, inducing the deviation of cytokines of antigen-special T cells from Th1 to Th2. CONCLUSIONS Tryptophan metabolites play an important immunosuppressive role in the development of anti-GBM GN and might offer a new strategy for treating this disease.
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Affiliation(s)
- Weiping Hou
- Department of Nephrology, Xinqiao Hospital, PLA, Third Military Medical University Chongqing, Chongqing, China,
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Li Y, Raman I, Du Y, Yan M, Min S, Yang J, Fang X, Li W, Lu J, Zhou XJ, Mohan C, Li QZ. Kallikrein transduced mesenchymal stem cells protect against anti-GBM disease and lupus nephritis by ameliorating inflammation and oxidative stress. PLoS One 2013; 8:e67790. [PMID: 23935844 PMCID: PMC3720854 DOI: 10.1371/journal.pone.0067790] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/26/2013] [Indexed: 12/20/2022] Open
Abstract
Previously we have shown that kallikreins (klks) play a renoprotective role in nephrotoxic serum induced nephritis. In this study, we have used mesenchymal stem cells (MSCs) as vehicles to deliver klks into the injured kidneys and have measured their therapeutic effect on experimental antibody induced nephritis and lupus nephritis. Human KLK-1 (hKLK1) gene was transduced into murine MSCs using a retroviral vector to generate a stable cell line, hKLK1-MSC, expressing high levels of hKLK1. 129/svj mice subjected to anti-GBM induced nephritis were transplanted with 106 hKLK1-MSCs and hKLK1 expression was confirmed in the kidneys. Compared with vector-MSCs injected mice, the hKLK1-MSCs treated mice showed significantly reduced proteinuria, blood urea nitrogen (BUN) and ameliorated renal pathology. Using the same strategy, we treated lupus-prone B6.Sle1.Sle3 bicongenic mice with hKLK1-MSCs and demonstrated that hKLK1-MSCs delivery also attenuated lupus nephritis. Mechanistically, hKLK1-MSCs reduced macrophage and T-lymphocyte infiltration into the kidney by suppressing the expression of inflammation cytokines. Moreover, hKLK1 transduced MSCs were more resistant to oxidative stress-induced apoptosis. These findings advance genetically modified MSCs as potential gene delivery tools for targeting therapeutic agents to the kidneys in order to modulate inflammation and oxidative stress in lupus nephritis.
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Affiliation(s)
- Yajuan Li
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Laboratory of Disease Genomics and Individualized Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Indu Raman
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yong Du
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Mei Yan
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Soyoun Min
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jichen Yang
- Quantitative Biomedical Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Xiangdong Fang
- Laboratory of Disease Genomics and Individualized Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Wei Li
- Key Laboratory of Medical Genetics, Wenzhou Medical College School of Laboratory Medicine & Life Science, Wenzhou, China
| | - Jianxin Lu
- Key Laboratory of Medical Genetics, Wenzhou Medical College School of Laboratory Medicine & Life Science, Wenzhou, China
| | - Xin J. Zhou
- Renal Path Diagnostics, Pathologist BioMedical Laboratories, Lewisville, Texas, United States of America
| | - Chandra Mohan
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- BME Departments, University of Houston, Houston, Texas, United States of America
- * E-mail: (CM); (QL)
| | - Quan-Zhen Li
- Department of Immunology and Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Key Laboratory of Medical Genetics, Wenzhou Medical College School of Laboratory Medicine & Life Science, Wenzhou, China
- * E-mail: (CM); (QL)
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Xin G, Cui Z, Su Y, Xu LX, Zhao MH, Li KS. Serum BAFF and APRIL might be associated with disease activity and kidney damage in patients with anti-glomerular basement membrane disease. Nephrology (Carlton) 2013; 18:209-14. [PMID: 23317407 DOI: 10.1111/nep.12032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 02/05/2023]
Abstract
AIM B cell activating factor belonging to the tumour necrosis factor family (BAFF) and a proliferation inducing ligand (APRIL) are two tumour necrosis factor (TNF)-like cytokines that were found to be elevated in many autoimmune diseases. Anti-glomerular basement membrane (GBM) disease is a typical severe autoimmune disease characterized by raised serum anti-GBM antibodies. In this study we aimed to detect the serum levels of BAFF and APRIL in patients with anti-GBM disease, and their clinical significance was further analyzed. METHODS Forty-seven patients with anti-GBM disease were enrolled in this study. Forty-eight healthy individuals were used as normal controls. The levels of serum BAFF and APRIL were assessed using commercially available enzyme linked immunosorbent assay kits. The association between the levels of serum BAFF and APRIL, and the clinical and pathological parameters were further evaluated. RESULTS The serum levels of BAFF and APRIL in patients with anti-GBM disease were significantly higher than that in normal controls (12.3 ± 14.1 ng/mL vs. 0.9 ± 0.3 ng/mL, P < 0.001; 19.1 ± 22.9 ng/mL vs. 1.6 ± 4.6 ng/mL, P < 0.001), respectively. The levels of serum APRIL were correlated with the titres of anti-GBM antibodies (r = 0.347, P = 0.041), and the levels of serum BAFF were associated with the percentage of glomeruli with crescents (r = 0.482, P = 0.015) in patients with anti-GBM disease. CONCLUSION The levels of serum BAFF and APRIL were raised in patients with anti-GBM disease and might be associated with disease activity and kidney damage.
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Affiliation(s)
- Gang Xin
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
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Bazari H, Guimaraes AR, Kushner YB. Case records of the Massachusetts General Hospital. Case 20-2012. A 77-year-old man with leg edema, hematuria, and acute renal failure. N Engl J Med 2012; 366:2503-15. [PMID: 22738101 DOI: 10.1056/nejmcpc1111577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hasan Bazari
- Department of Medicine, Massachusetts General Hospital, Boston, USA
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18
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Zieg J, Hacek J. Surprisingly favorable outcome in a patient with Goodpasture's disease. Hemodial Int 2012; 17:135-7. [PMID: 22621249 DOI: 10.1111/j.1542-4758.2012.00708.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kinoshita Y, Kondo S, Urushihara M, Suga K, Matsuura S, Takamatsu M, Shimizu M, Nishiyama A, Kawachi H, Kagami S. Angiotensin II type I receptor blockade suppresses glomerular renin-angiotensin system activation, oxidative stress, and progressive glomerular injury in rat anti-glomerular basement membrane glomerulonephritis. Transl Res 2011; 158:235-48. [PMID: 21925120 DOI: 10.1016/j.trsl.2011.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 05/11/2011] [Accepted: 05/13/2011] [Indexed: 01/13/2023]
Abstract
Excessive renin-angiotensin system (RAS) activation within the kidney induces not only renal oxidative stress but also renal scarring and dysfunction. This study examined the effects of an angiotensin II (Ang II) type I receptor (AT1R) blocker (ARB) on the progression of renal injury in rat anti-glomerular basement membrane glomerulonephritis (GN), with a particular focus on the participation of glomerular RAS activation in glomerular structural alterations, inflammation, and oxidative stress. Nephritic rats were divided into 2 groups and treated with vehicle or ARB until day 28. Treatment with ARB improved proteinuria significantly in nephritic rats. Vehicle-treated nephritic rats developed crescentic GN accompanied by marked macrophage infiltration and the enhanced expression of glomerular α-smooth muscle actin (α-SMA), angiotensinogen (AGT), Ang II, AT1R, and NADPH oxidase (Nox2) on days 7 and 28 of GN. ARB improved pathologic alterations such as crescent formation and glomerulosclerosis, and it had a significant inhibitory effect on the levels of these parameters on day 28 of GN. Enhanced superoxide production in nephritic glomeruli was decreased also by ARB. Moreover, Ang II and transforming growth factor beta (TGF-β) in the supernatant of cultured glomeruli was increased significantly in vehicle-treated nephritic rats whereas ARB inhibited the production of these compounds significantly on day 28. These results indicate that increased glomerular RAS activity and the resulting Ang II play important roles in progressive glomerular injury-the induction of oxidative stress and TGF-β expression, and they suggest that AT1R blockade attenuates proteinuria and progressive glomerular remodeling via the suppression of glomerular RAS activation in GN.
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Affiliation(s)
- Yukiko Kinoshita
- Department of Pediatrics, Institute of Health Bioscience, the University of Tokushima Graduate School, Tokushima, Japan
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Affiliation(s)
- Ming Y. Lim
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Eddie L. Greene
- Adviser to resident and Consultant in Nephrology, Mayo Clinic, Rochester, MN
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Zitt E, Eller K, Huber JM, Kirsch AH, Tagwerker A, Mayer G, Rosenkranz AR. The selective mineralocorticoid receptor antagonist eplerenone is protective in mild anti-GBM glomeru-lonephritis. Int J Clin Exp Pathol 2011; 4:606-15. [PMID: 21904636 PMCID: PMC3160612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/02/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Growing evidence suggests that blockade of the aldosterone-receptor may preserve kidney function by anti-inflammatory effects independent of the blood pressure. We hypothesized that the selective aldosterone-receptor antagonist eplerenone has a profound anti-inflammatory effect in the autologous phase of anti-glomerular basement membrane (GBM) glomerulonephritis (GN). METHODS Mice received ≈200mg/kg body wt/day eplerenone via supplemented chow diet or standard chow starting at the day of immunization with rabbit IgG. Three days later the anti-GBM antibody was injected and the experiments were stopped at day 7 and 14. RESULTS Mice receiving eplerenone showed significantly decreased albuminuria and glomerular sclerosis at day 7 and 14 after induction of anti-GBM GN. Eplerenone treatment significantly inhibited the infiltration of CD4+, CD8+ T cells and macrophages into the kidneys. Circulating levels and glomerular deposition of autologous IgG were comparable in both groups. At day 7 the pro-inflammatory cytokines MCP-1 and IL-6 were found to be significantly decreased in regional draining lymph nodes of eplerenone-treated mice, whereas the anti-inflammatory cytokine IL-10 was significantly upregulated. In line, splenocytes from eplerenone-treated nephritic mice produced significantly increased IL-10. CONCLUSION Aldosterone-receptor blockade by eplerenone effectively attenuated proteinuria, kidney damage and the inflammatory response in anti-GBM GN by significantly decreasing pro-inflammatory cytokines in the regional draining lymph nodes of the kidney. Our results suggest that this selective aldosterone receptor antagonist is a possible additional tool in the treatment of GN.
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Affiliation(s)
- Emanuel Zitt
- Department of Nephrology and Dialysis, Academic Teaching Hospital FeldkirchFeldkirch, Austria
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Kathrin Eller
- Department of Internal Medicine, Clinical Division of Nephrology, Medical University of GrazGraz, Austria
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Julia M Huber
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Alexander H Kirsch
- Department of Internal Medicine, Clinical Division of Nephrology, Medical University of GrazGraz, Austria
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Andrea Tagwerker
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Clinical Division of Nephrology, Medical University of GrazGraz, Austria
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical UniversityInnsbruck, Austria
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Sui M, Zhou J, Xie R, Liu X, Mu S, Jia X, Ma J, Wu H. The sphingosine-1-phosphate receptor agonist FTY720 prevents the development of anti-glomerular basement membrane glomerulonephritis. Mol Biol Rep 2011; 39:389-97. [PMID: 21833515 DOI: 10.1007/s11033-011-0750-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 04/27/2011] [Indexed: 11/26/2022]
Abstract
The sphingosine-1-phosphate (S1P) agonist FTY720 prolongs the survival of organ allograft and attenuates autoimmune-mediated injury in experimental models. Most cases of glomerulonephritis (GN) in human appear to be immunologically initiated. In this study, we evaluated the potential therapeutic role of FTY720 in GN via a mouse anti-glomerular basement membrane (GBM) model. Mice were immunized with rabbit IgG in complete Freund's adjuvant (CFA) followed by an intravenous injection of a rabbit anti-mouse GBM serum. Disease and immune responses were assessed on day 14. Mice were treated with FTY720 (0.3 or 3 mg/kg) and prednisone (10 mg/kg) from days 0 to 14. The S1P modulator reduced proteinuria, serum creatinine, crescent formation and serum IgG level. The expressions of splenic S1P receptor and renal Th-1 cytokine were also inhibited at the transcription stage. Treatment with FTY720 increased splenocyte production of protective Th2 cytokine IL-4 and promoted the apoptosis of splenic CD4+ T cells in the animal models, which suggests that FTY720 played a protective role at the induction stage of GN by inhibiting mRNA expressions of splenic S1P receptor 1, S1P receptor 2, and S1P receptor 5.
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Affiliation(s)
- Manshu Sui
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, People's Republic of China
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Yadla M, Krishnakishore C, Reddy S, Naveen PS, Sainaresh VV, Reddy MK, Sivakumar V. An unusual association of anti-GBM diseases and lupus nephritis presenting as pulmonary renal syndrome. Saudi J Kidney Dis Transpl 2011; 22:349-351. [PMID: 21422643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Williamson SR, Phillips CL, Andreoli SP, Nailescu C. A 25-year experience with pediatric anti-glomerular basement membrane disease. Pediatr Nephrol 2011; 26:85-91. [PMID: 20963446 DOI: 10.1007/s00467-010-1663-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 07/29/2010] [Accepted: 09/10/2010] [Indexed: 11/29/2022]
Abstract
Anti-glomerular basement membrane (anti-GBM) disease, which is extremely uncommon in children, is characterized by rapidly progressive glomerulonephritis (RPGN) and autoantibodies against GBM collagen. Pulmonary hemorrhage is the third component in Goodpasture Syndrome. Cigarette smoking and exposure to hydrocarbons have been linked to anti-GBM disease in adults, but such an association has not been established in children. We reviewed renal biopsy and autopsy specimens over 25 years from a major tertiary care U.S. children's hospital, diagnosing anti-GBM by clinical RPGN, crescentic glomerulonephritis, and linear immunofluorescence (IF) immunoglobulin G staining in patients under 18 years of age. We identified four patients, with and without pulmonary manifestations. The sole autopsy case showed diagnostic IF despite undetectable serum anti-GBM antibodies and positive testing for serum anti-neutrophil cytoplasmic antibodies (ANCA). Three patients have survived 1-18 years following diagnosis, one of whom is recovering renal function. One adolescent had a history of smoking cigarettes and one had a probable hydrocarbon exposure. Anti-GBM disease is unusual in children, and the relationship to inhaled agents is incompletely understood. Serum anti-GBM antibodies are typically present, but cases with undetectable levels can occur. Some patients are anti-GBM and ANCA positive, with a small subset ANCA-positive, anti-GBM-negative. Ours is the first such described pediatric case.
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Affiliation(s)
- Sean R Williamson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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25
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Wang C, Zou WZ, Zheng X, E J, Wang SX, Zhao MH, Liu G. [Cellular components of crescents in four common types of crescentic glomerulonephritis]. Zhonghua Bing Li Xue Za Zhi 2011; 40:37-41. [PMID: 21429357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine the cellular components at different stages of the crescent formation in four most common types of human crescentic glomerulonephritis (CGN), including anti-GBM disease (GBM-CGN), crescentic IgA nephropathy (IgA-CGN), ANCA associated pauci-immune CGN (ANCA-CGN) and crescentic lupus glomerulonephritis (LN-CGN). METHODS Renal biopsy specimens of patients with GBM-CGN (n = 10), IgA-CGN (n = 12), ANCA-CGN (n = 12), and LN-CGN (n = 11) were selected. Immunohistochemistry was adopted to identify the cellular components using different cell markers including cytokeratin (PEC), CD68 (macrophage), nestin (podocyte), podocalyxin (podocyte), CD3 (lymphocyte), CD15 (neutrophil) and PCNA. RESULTS There were different subtypes of cell components identified during the formation of a cellular crescent in 4 different types of human CGN. Mainly of PEC 11.4 (0.0, 95.0)%, macrophage 8.0 (0.0, 35.0)% and podocyte 5.5 (0.0, 22.0)% and their constitutive percentages were different among various CGNs (P < 0.01). In all the CGNs studied, there were 50% of cells were negative to all the cell markers adopted for this expeiment. Podocalyxin positive cells 0.5 (0.0, 9.6)% were significantly less than nestin positive cells 5.5 (0.0, 22.0)% in all CGNs. PCNA positive cells were 44.7 (16.7, 83.3)% in the cellular crescent of all CGNs and co-localized with nestin (38/45 cases), CK (42/45 cases) or CD68 (24/45 cases). CONCLUSIONS PEC, macrophage and podocyte might play important roles in the formation of crescents. The staining disparity of nestin and podocalyxin indicates that podocyte dedifferentiation may occur during the crescent formation. PEC, podocytes and macrophages may participate in the formation of crescent in common CGNs through active cellular proliferation.
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Affiliation(s)
- Chen Wang
- Department of Nephrology, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China
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26
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Zhou C, Wu J, Torres L, Hicks JM, Bartkowiak T, Parker K, Lou YH. Blockade of osteopontin inhibits glomerular fibrosis in a model of anti-glomerular basement membrane glomerulonephritis. Am J Nephrol 2010; 32:324-31. [PMID: 20720406 PMCID: PMC2969149 DOI: 10.1159/000319490] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 07/20/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND In our rat model for anti-GBM GN, severe fibrosis follows glomerular inflammation. A potential role of extracellular matrix protein osteopontin (OPN) in glomerular fibrosis was investigated. METHODS Neutralizing OPN antiserum or control normal serum was injected into the experimental rats at late inflammatory/early fibrotic stage. Glomerular inflammation and fibrosis were determined. RESULTS OPN antiserum treatment had little effect on glomerular inflammation. However, the antiserum treatment resulted in a significant reduction in number of fibrotic glomeruli (50% of the controls). Histology observation showed that fibrotic tissue in glomeruli of the antiserum treated rats was mild and poorly developed. OPN antiserum treatment resulted in downregulated glomerular expression of collagen 1α1; collagen deposition in the antiserum treated rats reduced to <30% of that for normal serum controls. CONCLUSION Neutralization of OPN inhibited progression of fibrosis in vivo when given at early fibrotic stage. Thus, OPN may be a therapeutic target for glomerular fibrosis.
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Affiliation(s)
- Cindy Zhou
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Jean Wu
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Lisa Torres
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | | | - Todd Bartkowiak
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Kiana Parker
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Ya-Huan Lou
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Houston, Tex., USA
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Merszei J, Wu J, Torres L, Hicks JM, Bartkowiak T, Tan F, Lou YH. Osteopontin overproduction is associated with progression of glomerular fibrosis in a rat model of anti-glomerular basement membrane glomerulonephritis. Am J Nephrol 2010; 32:262-271. [PMID: 20714131 PMCID: PMC2980521 DOI: 10.1159/000319238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/12/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Glomerular fibrosis is the common end result of glomerulonephritis (GN) regardless of etiology. In our rat model for anti-glomerular basement membrane GN, severe fibrosis follows glomerular inflammation. We investigated the association between expression of extracellular matrix (ECM) proteins and progression of glomerular fibrosis. METHODS Expression of ECM genes in glomeruli was determined at RNA and protein levels. Immunofluorescence was applied to identify cell sources for the molecules. RESULTS DNA microarray for ECM genes, quantitative RT-PCR and Western blot revealed significant upregulation of osteopontin (OPN), a multifunctional molecule, in the glomeruli only after onset of glomerular fibrosis. Two-dimensional electrophoresis showed that the expressed OPN was in three major isoforms. Immunofluorescence showed that fibrotic tissues in glomeruli accumulated massive deposits of extracellular OPN. Both in vivo and in vitro experiments showed that a novel population of multinucleated α-smooth muscle actin(+)CD90(-) myofibroblast-like cells, which surrounded fibrotic tissue, was the main source of OPN during progression of fibrosis. Since senescence-associated β-galactosidase activity was detected in those cells both in vitro and in vivo, these cells probably were terminally differentiated senescent myofibroblasts. CONCLUSION OPN has been implicated in fibrosis in several organs. Our results suggest potential roles of OPN and its main source, the senescent myofibroblasts, in glomerular fibrosis.
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Affiliation(s)
- Justin Merszei
- Department of Medicine, Baylor College of Medicine, Tex., USA
| | - Jean Wu
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Tex., USA
| | - Lisa Torres
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Tex., USA
| | - John M. Hicks
- Texas Children's Hospital, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Todd Bartkowiak
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Tex., USA
| | - Filemon Tan
- Department of Internal Medicine, Medical School, University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Ya-Huan Lou
- Department of Diagnostic Sciences DB, University of Texas Health Science Center at Houston, Tex., USA
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28
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Liu C, Qu Z, Yang R, Zhao J, Jia XY, Zheng X, Liu ZS, Cui Z, Zhao MH. [The heterogeneity of anti-GBM autoantibodies in sera from patients with anti-GBM disease and its clinical correlation]. Beijing Da Xue Xue Bao Yi Xue Ban 2009; 41:625-629. [PMID: 20019770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the heterogeneity of epitopes recognized by anti-GBM autoantibodies in sera from a large cohort of Chinese patients with anti-GBM disease and its clinical significance. METHODS The present study included 108 patients with anti-GBM disease who were diagnosed in our hospital, between Jan 1991 and May 2009, with complete clinical and renal pathological data. Sera or plasma exchange of the patients were used to incubate with cryostat section of normal human renal tissue for indirect immunofluorescence (IIF) assay. The cryostat sections of normal renal tissue were pre-treated by 6 mol/L urea to unmask cryptic epitopes, and untreated cryostat sections were used to detect natural exposed epitopes. The sera were diluted from 1:2 to 1:512 to determine titers of anti-GBM autoantibodies Patients with anti-GBM autoantibodies against cryptic or exposed epitopes were further stratified; their clinical and pathological associations were analyzed. RESULTS Sera from all the 108 patients could recognize cryptic epitopes on normal renal tissue (urea treated section). IIF showed IgG linear staining along GBM. However, sera from 56/108 patients (group A) could also recognize exposed epitopes on normal renal tissue (untreated section); sera from the rest 52/108 patients (group B) could not recognize exposed epitopes. In urea treated condition, the average titer of anti-GBM autoantibodies from sera of patients in group A was significantly higher than that in group B (P<0.01), ANCA-positive patients in group A were significant less than that in group B (P<0.01). There was no significant difference between the two groups in regard to other clinical data (including serum creatinine) and renal histopathologic data. CONCLUSION Anti-GBM autoantibodies from some patients with anti-GBM disease could recognize natural exposed epitopes, however, their anti-GBM titer for cryptic epitopes was higher than that of those recognizing cryptic epitopes only and the prevalence of serum ANCA was significantly less.
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Affiliation(s)
- Chang Liu
- Renal Division and Institute of Nephrology, Peking University First Hospital, Beijing 100034, China
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29
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Wenderfer SE, Dubinsky WP, Hernandez-Sanabria M, Braun MC. Urine proteome analysis in murine nephrotoxic serum nephritis. Am J Nephrol 2009; 30:450-8. [PMID: 19776558 DOI: 10.1159/000242430] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/14/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urine contains serum proteins filtered by the glomerulus or secreted by the renal tubules and proteins produced locally by the urinary tract. Proteomic analysis of urine holds the potential as a noninvasive means of studying or monitoring disease activity. In mice, large concentrations of albumin and lipocalins have complicated the ability to identify urinary biomarkers in disease models. METHODS Passive nephrotoxic serum nephritis was induced in mice. Urine proteins were identified and quantified by iTRAQ and MALDI-TOF mass spectrometry. Results were compared to Western blotting and multiplex immunoassays. RESULTS Large concentrations of major urinary proteins dominate the urine proteome of mice even in the context of acute nephritis. Increased proteinuria caused by nephrotoxic serum nephritis is transient and includes increased albumin excretion. There were no alterations in chemokine excretion. Altered hepcidin excretion was identified, most likely reflecting local production and renal retention. CONCLUSION Proteomic analysis of mouse urine remains challenging due to the abundance of a limited subset of proteins. iTRAQ analysis does not circumvent these challenges, but can provide information on post-translational processing of some proteins. Hepcidin is identified as a potential urinary marker of nephritis and its role in disease pathogenesis warrants further study.
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Affiliation(s)
- Scott E Wenderfer
- The Brown Foundation Institute of Molecular Medicine, Houston, TX, USA
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30
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Yang R, Cui Z, Zhao J, Zhao MH. The role of HLA-DRB1 alleles on susceptibility of Chinese patients with anti-GBM disease. Clin Immunol 2009; 133:245-50. [PMID: 19654074 DOI: 10.1016/j.clim.2009.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 06/22/2009] [Accepted: 07/06/2009] [Indexed: 11/18/2022]
Abstract
Anti-glomerular basement membrane (GBM) disease, a rare autoimmune disorder, is associated with HLA-DR15 genotype in Caucasian and Japanese populations. But the distribution of HLA-DRB1 alleles in Chinese patients with anti-GBM disease and their association with clinical characteristics of anti-GBM disease are to be determined. The present study analyzed the HLA-DRB1 alleles by sequence based typing in 44 Chinese patients with anti-GBM disease and 200 healthy controls. The effects of DRB1 alleles on susceptibility to anti-GBM disease were examined by a relative predispositional effects (RPEs) method. The clinical and pathological data of the patients were collected and analyzed. The DRB1*1501 allele was significantly associated with anti-GBM disease (p=1.597 x 10(-7)). The RPEs test also showed a significant increased frequency of DRB1*0404 in anti-GBM disease (p=0.037). Interestingly, the patients with DRB1*1501 or 0404 had more crescent formation in glomeruli than those without the two alleles (p=0.021). But the DRB1*0404 was rare in both patients and control groups, which indicates that the importance of the *0404 allele is limited in anti-GBM disease. We conclude that the HLA-DRB1*1501 allele is a genetic marker for susceptibility to anti-GBM disease.
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Affiliation(s)
- Rui Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
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31
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Abstract
Antiglomerular basement membrane (GBM) disease is characteristically described with linear deposition of IgG along GBM. However, the concurrent glomerular immune complex deposition was not rare and might be contributed to the development of anti-GBM disease. In the current series, glomerular immune complexes were identified in 10 of 47 patients who presented with renal-biopsy-proven anti-GBM disease. Six of the 10 patients complicated with a well-documented glomerulonephritis, including two patients with membranous nephropathy, one patient with IgA nephropathy, one patient with membranoproliferative glomerulonephritis, one patient with Schonlein-Henoch nephritis, and one patient with hepatitis B virus associated membranous nephritis. The other four patients had immune complexes with IgG or IgM predominance deposited in glomerular mesangium without a well-documented glomerulonephritis. Clinical and pathological data of patients with immune complex deposition (n = 10) were compared with those of patients with anti-GBM disease alone (n = 37). There was no significant difference in age, gender, clinical and pathological manifestations, and renal outcome between the two groups. In general, the association of glomerular immune complexes did not lead to a benign prognosis. Plasma exchange and extensive immunosuppressive therapy should be carried out as soon as possible. The immune complexes deposited in glomeruli might participate in the initiation of anti-GBM disease.
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Affiliation(s)
- Zhao Cui
- Renal Division and Institute of Nephrology, Peking University First Hospital, Beijing 100034, P.R. China.
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32
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Abstract
There are several known causes for the clinical syndrome of pulmonary hemorrhage and acute renal failure. Here, we report a unique case of a 50-year-old man presenting in this manner. The initial diagnosis was one of antiglomerular basement membrane (anti-GBM) disease that responded well to steroids, cyclophosphamide, and plasma exchange (PE). The pulmonary hemorrhage resolved, but he remained dialysis dependent. However, despite falling anti-GBM titers, the symptoms relapsed and standard therapy was reinitiated with limited success. The anti-GBM antibody titer fell to zero despite clinical deterioration, prompting a search for an alternative diagnosis. He was found to be IgM anti-proteinase-3 antineutrophil cytoplasmic antibody (C-ANCA) positive. The pulmonary hemorrhage responded successfully to the use of intravenous immunoglobulin and the antilymphocyte monoclonal antibody CD52. To our knowledge, this is the first known case of IgM C-ANCA in association with anti-GBM disease. As such, it highlights the predominance of pulmonary hemorrhage in this condition, as well as the need to consider alternative therapies in refractory cases.
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34
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Dai YZ, Chen ML, Yu ZX, Hu XA, Zhang R, Lu J, Pan TQ. [Goodpasture's syndrome: report of a case]. Zhonghua Bing Li Xue Za Zhi 2009; 38:278-279. [PMID: 19575905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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35
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Reynolds J, Haxby J, Juggapah JK, Evans DJ, Pusey CD. Identification of a nephritogenic immunodominant B and T cell epitope in experimental autoimmune glomerulonephritis. Clin Exp Immunol 2009; 155:311-9. [PMID: 19040602 PMCID: PMC2675263 DOI: 10.1111/j.1365-2249.2008.03833.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2008] [Indexed: 11/29/2022] Open
Abstract
Experimental autoimmune glomerulonephritis (EAG) can be induced in Wistar Kyoto (WKY) rats by immunization with the non-collagenous domain (NC1) of the alpha 3 chain of type IV collagen, alpha3(IV)NC1. In patients with Goodpasture's disease, the major B cell epitope is located at the N-terminus of alpha3(IV)NC1. In order to investigate whether B and T cell responses in EAG are directed towards immunodominant peptides within the same region of rat alpha3(IV)NC1, we immunized WKY rats with recombinant rat alpha3(IV)NC1 (positive control) and five 15-mer overlapping synthetic peptides from the N-terminus of rat alpha3(IV)NC1: pCol(17-31), pCol(24-38), pCol(31-45), pCol(38-52) and pCol(45-59). Positive control animals immunized with alpha3(IV)NC1 produced an antibody response directed towards alpha3(IV)NC1 and pCol(24-38). Splenic T cells from these animals proliferated in response to alpha3(IV)NC1 and pCol(24-38). No significant antibody or T cell responses were observed to the other peptides examined. Animals immunized with pCol(24-38) developed linear deposits of immunoglobulin G on the glomerular basement membrane, albuminuria and focal necrotizing glomerulonephritis with crescent formation by week 6 after immunization. Circulating antibodies from these animals recognized pCol(24-38) and alpha3(IV)NC1, and their T cells proliferated in response to pCol(24-38) and alpha3(IV)NC1. Animals immunized with the other peptides developed no significant immune response to alpha3(IV)NC1 and no disease. In conclusion, these results demonstrate that a 15-mer peptide from the N-terminus of alpha3(IV)NC1 [pCol(24-38)] is recognized by B and T cells from rats immunized with recombinant alpha3(IV)NC1, and that the same peptide is capable of inducing crescentic glomerulonephritis. Identification of this immunodominant peptide will be of value in designing new therapeutic strategies for inducing mucosal tolerance in EAG, which may be applicable to patients with glomerulonephritis.
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Affiliation(s)
- J Reynolds
- Division of Medicine, Imperial College London, Hammersmith Campus, London, UK.
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36
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Mazzucco G. [The histological picture of CRF in kidney grafts]. G Ital Nefrol 2008; 25 Suppl 44:S33-S37. [PMID: 19048584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The most common immunological causes of delayed renal function failure in kidney grafts are recurrent glomerular disease, de novo glomerulonephritis, and chronic cellular or antibody-mediated rejection. Glomerulonephritis can recur any time in the natural history of renal allografts, with the same morphological features of the disease occurring in the native kidney. It has a frequency varying from 100% to 1% and a generally favorable prognosis with the exception of FSGS, SHU and diabetic glomerulosclerosis. The most frequent glomerular diseases to occur de novo in the kidney graft are membranous glomerulopathy, antiglomerular basement membrane disease in patients with Alport's syndrome, and nephrotic syndrome of the Finnish type with antinephrin antibodies in patients with NPHS1 gene mutations. Chronic rejection, including chronic transplant arteriopathy and chronic transplant glomerulopathy, is the cause of renal failure in up to 20% of kidney grafts and may occur as early as a few months after transplant.
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Affiliation(s)
- G Mazzucco
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi, Torino, Italy. gianna.
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37
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Affiliation(s)
- Zachary D Goldberger
- Department of Medicine, Veterans Affairs Puget Sound Health Care System and the University of Washington School of Medicine, Seattle, USA.
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38
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Yoshimura H, Ito M, Kuwahara Y, Ishii A, Tsuritani K, Nakamura A, Hirasawa Y, Nagamatsu T. Downregulated expression in high IgA (HIGA) mice and the renal protective role of meprinbeta. Life Sci 2008; 82:899-908. [PMID: 18355876 DOI: 10.1016/j.lfs.2008.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/26/2008] [Accepted: 02/14/2008] [Indexed: 12/17/2022]
Abstract
This study discusses the critical role of the metalloproteinase meprinbeta in the progression of glomerulonephritis. Using a microarray technique, the gene expression profiles in glomeruli isolated from high serum IgA (HIGA) mice with a purity of 97% or greater were examined. HIGA mice are a valid model of human IgA nephropathy (IgAN), with the typical pathological features of this condition, including a consistently high serum IgA level as well as dominant mesangial IgA deposition and mesangial enlargement. Among the many upregulated/downregulated genes after the development of IgAN, the downregulation of meprinbeta was intriguing. The expression level of the meprinbeta gene at 40 weeks of age was 52% of that observed at 8 weeks of age (prior to the development of IgAN), although in the control BALB/c mice, a 2.19-fold elevation was seen. These results were also confirmed by semi-quantitative RT-PCR and immunostaining analyses. As meprinbeta is a subunit of metalloproteinase meprins (meprin A, meprin B) and meprins are capable of proteolytically degrading extracellular matrix (ECM) components and proteolytically processing bioactive peptides, the downregulation of meprinbeta may contribute to the progression of glomerulonephritis and the eventual glomerular scarring. This working hypothesis was examined using an in vivo meprinbeta inhibition study. The inhibition of meprins by actinonin exacerbated some parameters of renal injury in mice afflicted with anti-glomerular basement membrane (anti-GBM) antibody-associated nephritis. These in vitro and in vivo results suggest that meprinbeta may play a protective role against the progression of renal injury through the degradation of ECM and bioactive peptides.
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Affiliation(s)
- Hiromitsu Yoshimura
- Molecular Function and Pharmacology Laboratories, Taisho Pharmaceutical Co., Ltd, Saitama, 331-9530, Japan.
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39
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Nayak SG, Satish R. Crescentic transformation in primary membranous glomerulopathy: association with anti-GBM antibody. Saudi J Kidney Dis Transpl 2007; 18:599-602. [PMID: 17951950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Crescentic transformation of primary membranous nephropathy (MN) associated with the development of anti-GBM antibody is a rare cause of acute renal failure in patients with MN. We report a 54-year-old lady, diagnosed to have MN four years earlier, who presented with acute deterioration of renal functions. Renal biopsy revealed circumferential crescents in all glomeruli. Serum anti-GBM antibodies were positive. Despite therapy with plasmapheresis, steroids and oral cyclophosphamide, she did not improve and continues to be dialysis dependent.
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Affiliation(s)
- Shobhana G Nayak
- Department of Nephrology, St. John's Medical College Hospital, Bangalore, India.
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40
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Archer DC, Frkanec JT, Cromwell J, Clopton P, Cunard R. WY14,643, a PPARalpha ligand, attenuates expression of anti-glomerular basement membrane disease. Clin Exp Immunol 2007; 150:386-96. [PMID: 17888025 PMCID: PMC2219353 DOI: 10.1111/j.1365-2249.2007.03505.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Peroxisome proliferator-activated receptor alpha (PPARalpha) ligands are medications used to treat hyperlipidaemia and atherosclerosis. Increasing evidence suggests that these agents are immunosuppressive. In the following studies we demonstrate that WY14,643, a PPARalpha ligand, attenuates expression of anti-glomerular basement membrane disease (AGBMD). C57BL/6 mice were fed 0.05% WY14,643 or control food and immunized with the non-collagenous domain of the alpha3 chain of Type IV collagen [alpha3(IV) NC1] in complete Freund's adjuvant (CFA). WY14,643 reduced proteinuria and greatly improved glomerular and tubulo-interstitial lesions. However, the PPARalpha ligand did not alter the extent of IgG-binding to the GBM. Immunohistochemical studies revealed that the prominent tubulo-interstitial infiltrates in the control-fed mice consisted predominately of F4/80(+) macrophages and WY14,643-feeding decreased significantly the number of renal macrophages. The synthetic PPARalpha ligand also reduced significantly expression of the chemokine, monocyte chemoattractant protein (MCP)-1/CCL2. Sera from mice immunized with AGBMD were also evaluated for antigen-specific IgGs. There was a significant increase in the IgG1 : IgG2c ratio and a decline in the intrarenal and splenocyte interferon (IFN)-gamma mRNA expression in the WY14,643-fed mice, suggesting that the PPARalpha ligand could skew the immune response to a less inflammatory T helper 2-type of response. These studies suggest that PPARalpha ligands may be a novel treatment for inflammatory renal disease.
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Affiliation(s)
- D C Archer
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, CA, USA
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41
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Garcia GE, Truong LD, Li P, Zhang P, Johnson RJ, Wilson CB, Feng L. Inhibition of CXCL16 attenuates inflammatory and progressive phases of anti-glomerular basement membrane antibody-associated glomerulonephritis. Am J Pathol 2007; 170:1485-96. [PMID: 17456756 PMCID: PMC1854945 DOI: 10.2353/ajpath.2007.060065] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chemokines recruit and activate leukocytes during inflammation. CXCL16 is a recently discovered chemokine that is expressed as a transmembrane protein that is cleaved to form the active, soluble chemokine. We analyzed the role of CXCL16 in the development of inflammation and in the progression of the anti-glomerular basement membrane (GBM) antibody-induced experimental glomerulonephritis in Wistar-Kyoto rats. CXCL16 was expressed in glomerular endothelial cells and mediated adhesion of macrophages expressing CXCL16 and its cognate receptor, CXCR6. Glomerular infiltrates displayed a strong migratory response to soluble CXCL16. Soluble CXCL16 and its receptor CXCR6 were induced in nephritic glomeruli throughout the disease, and CXCL16 expression correlated with the up-regulation of ADAM10, suggesting that this disintegrin and metalloproteinase mediates the chemokine activity of CXCL16. Blocking CXCL16 in the acute inflammatory phase or progressive phase of established glomerulonephritis significantly attenuated monocyte/macrophage infiltration and glomerular injury; proteinuria also improved. We conclude that CXCL16/CXCR6 plays a critical role in stimulating leukocyte influx, which causes glomerular damage during anti-GBM glomerulonephritis. Blocking CXCL16 actions limits the progression of anti-GBM glomerulonephritis even when the disease is established.
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Affiliation(s)
- Gabriela E Garcia
- Section of Nephrology, Baylor Collage of Medicine, Alkek N520, One Baylor Plaza, Houston, TX 77030, USA.
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Salam N, Rezki H, Fadili W, Hachim K, Ramdani B. Goodpasture's syndrome - four case reports. Saudi J Kidney Dis Transpl 2007; 18:235-8. [PMID: 17496401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Goodpasture's syndrome (GPS) is a rare but severe immunological disease, which is characterised by rapidly progressive glomerulonephritis and intraalveolar hemorrhage (IAH) with the presence of anti-glomerular basement membrane (GBM) antibodies. We report four cases of GP's syndrome referred to the nephrology unit at Ibn Rochd UHC in Casablanca from January 1995 to December 2003. All patients had rapidly progressive glomerulonephritis (RPGN) with proteinuria and microscopic hematuria. Elevated blood pressure was noted in one case. IAH was manifested as hemoptysis in two cases, radiological signs in three cases and confirmed by broncho-alveolar lavage in all cases. Laboratory assessment revealed anemia in all cases. Renal biopsy showed extracapillary glomerulonephritis with linear deposits of IgG along the GBM. Renal failure was severe and hemodialysis was required in all cases. All patients were treated with prednisone and cyclophosphamide and none recovered renal function. Two patients died due to severe lung hemorrhage.
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Affiliation(s)
- N Salam
- Nephrology Hemodialysis Department, Ibn Rochd Hospital Center, Morocco
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Abstract
Anemia and cough are common problems with adolescent females. We present a case where these common symptoms led to the discovery of an uncommon entity, Goodpasture's Syndrome. The purpose of this report is to review the clinical manifestations, treatment and pathology of Goodpasture's Syndrome.
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Affiliation(s)
- Jana Upshaw
- Division of Pediatric Emergency/Critical Care, Medical University of South Carolina, Charleston, SC 29425, USA.
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44
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Yang R, Hellmark T, Zhao J, Cui Z, Segelmark M, Zhao MH, Wang HY. Antigen and Epitope Specificity of Anti–Glomerular Basement Membrane Antibodies in Patients with Goodpasture Disease with or without Anti-Neutrophil Cytoplasmic Antibodies. J Am Soc Nephrol 2007; 18:1338-43. [PMID: 17329569 DOI: 10.1681/asn.2006111210] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Goodpasture disease (GP) is defined by the presence of anti-glomerular basement membrane (anti-GBM) antibodies and rapidly progressive glomerulonephritis. Besides anti-GBM, many patients with GP produce anti-neutrophil cytoplasmic antibodies (ANCA). For elucidation of the pathophysiologic significance of ANCA in this setting, epitope and antigen specificity of the anti-GBM antibodies and antigen specificity of ANCA were studied. Bovine testis alpha(IV)NC1 (tNC1); recombinant human alpha1, alpha3, alpha4, and alpha5(IV)NC1 (ralpha1 through ralpha5); and three chimeric proteins that contain previously defined epitope regions designated E(A), E(B), and S2 were used to examine the anti-GBM antibodies by ELISA in 205 Chinese patients with GP with or without ANCA. In the 205 anti-GBM antibody-positive sera, 63 (30.7%) were also ANCA positive (61 myeloperoxidase-ANCA and six proteinase 3-ANCA, four being triple positive). All 205 sera recognized tNC1 and ralpha3(IV)NC1. In the double-positive group, 54.0, 66.7, 71.4% of the sera could recognize ralpha1, ralpha4, and ralpha5, respectively, compared with 49.3, 60.6, and 55.6% for patients with anti-GBM antibodies alone. The levels of the antibodies to ralpha3, tNC1, and the alpha3/alpha1 ratio were lower in the double-positive group than that in patients with anti-GBM antibody alone (P < 0.05). Most of the sera could recognize the epitope regions E(A), E(B), and S2, but the absorbance values to E(A), E(B), and S2 were lower in double-positive group (P < 0.05). Double-positive patients had a broader spectrum of anti-GBM antibodies and lower levels of antibodies against alpha3(IV)NC1 compared with that of patients with anti-GBM antibodies alone.
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Affiliation(s)
- Rui Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Beijing 100034, P.R. China
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Fu H, Li J, Li QX, Xia L, Shao L. Protective effect of ligustrazine on accelerated anti-glomerular basement membrane antibody nephritis in rats is based on its antioxidant properties. Eur J Pharmacol 2007; 563:197-202. [PMID: 17362917 DOI: 10.1016/j.ejphar.2007.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 02/02/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
Ligustrazine has a renoprotective effect against nephritis. In this study, we further characterized the renoprotective properties of ligustrazine in an experimental model using accelerated anti-glomerular basement membrane antibody (AGBM-Ab). Ligustrazine was given i.p. once daily at 50, 100 mg/kg for 15 days after singly giving i.v. of rabbit anti-rat glomerular basement membrane serum, and showed dose-dependent inhibition the elevation of urinary protein, serum creatinine and blood urea nitrogen as well as the development of glomerular histological changes. Ligustrazine (50 mg/kg) had no affect on glutathione (GSH) content, glutathione peroxidase and catalase activities, but decreased the malondialdehyde (MDA) content and increased superoxide dismutase (SOD) activity in nephritis induced by AGBM-Ab. Ligustrazine (100 mg/kg) significantly decreased MDA content while significantly increased GSH content and SOD, glutathione peroxidase, catalase activities of kidney tissues in the rats treated with AGBM-Ab alone. In conclusion, our results show that ligustrazine has protective activity against accelerated AGBM-Ab nephritis, and its renoprotective effect may be due to its antioxidant properties and inhibition reactive oxygen species (ROS).
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Affiliation(s)
- Hong Fu
- Department of Pharmacology, Basic Medical School, and Center of Laboratory, Zhongnan Hospital, Wuhan University, Wuhan, 430071, P.R. China
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Sethi S, Lewin M, Lopez L, Lager D. Linear anti-glomerular basement membrane IgG but no glomerular disease: Goodpasture's syndrome restricted to the lung. Nephrol Dial Transplant 2007; 22:1233-5. [PMID: 17277338 DOI: 10.1093/ndt/gfl841] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Desai A, Goldschmidt RA, Kim GC. Sequential development of pulmonary renal syndrome associated with c-ANCA 3 years after development of anti-GBM glomerulonephritis. Nephrol Dial Transplant 2007; 22:926-9. [PMID: 17210587 DOI: 10.1093/ndt/gfl751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amishi Desai
- Department of Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA
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Takahashi M, Otsubo S, Takei T, Sugiura H, Yoshida K, Tamei N, Koike M, Uchida K, Yumura W, Kawamura S, Horita S, Akiba T, Nitta K. Anti-glomerular basement membrane antibody disease with granulomatous lesions on renal biopsy. Intern Med 2007; 46:295-301. [PMID: 17379997 DOI: 10.2169/internalmedicine.46.6160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present the case of a 56-year-old woman with anti-glomerular basement membrane (anti-GBM) antibody disease accompanied by granulomatous reaction in the kidney. Three months prior to admission to our kidney center, she had suffered from interstitial pneumonia and had a slightly elevated level of MPO-ANCA (13 EU). Her serum level of creatinine was normal (0.72 mg/dl) but proteinuria (1+) and hematuria (2+, 1-4/HF) were present. She was admitted to our hospital because of general fatigue, loss of appetite, high fever (over 38.5 degrees C) and a rapid decline in renal function (creatinine 8.50 mg/dl). Hemodialysis therapy was started immediately after admission. The serological study was negative for MPO-ANCA and PR3-ANCA but positive for anti-GBM antibody (139 EU). Renal biopsy demonstrated necrotizing glomeruli, cellular crescents and grauloma formation with multinucleated giant cells. Immunofluorescence microscopy revealed linear staining of IgG and C3. We diagnosed graulomatous, crescentic and necrotizing glomerulonephritis, patho-logically. She was diagnosed as having anti-GBM antibody disease because alveolar hemorrhage was absent. Steroid therapy including methylprednisolone pulse therapy (500 mg/day, 3 days) and 2 courses of plasma exchange were effective in reducing the fever, anti-GBM antibody titer and C-reactive protein level. Her renal function recovered and she was able to quit hemodialysis therapy 68 days after the start of hemodialysis and she has shown no signs of pulmonary alveolar hemorrhage to date. The present case suggests that intensive therapy may restore renal function in anti-GBM disease even though renal function was sufficiently damaged and required hemodialysis therapy and active pathological changes were observed in renal biopsy specimens.
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Affiliation(s)
- Masaki Takahashi
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo
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Okada H, Inoue T, Kikuta T, Watanabe Y, Kanno Y, Ban S, Sugaya T, Horiuchi M, Suzuki H. A possible anti-inflammatory role of angiotensin II type 2 receptor in immune-mediated glomerulonephritis during type 1 receptor blockade. Am J Pathol 2006; 169:1577-89. [PMID: 17071582 PMCID: PMC1780194 DOI: 10.2353/ajpath.2006.060178] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We previously reported that angiotensin II type 1 receptor (AT1R) blockade attenuates renal inflammation/fibrogenesis in immune-mediated glomerulonephritis via angiotensin II type 2 receptor (AT2R). In the present study, further in vivo experiments revealed that AT2R was expressed in tubular epithelial cells of nephritic kidneys in mice, and feedback activation of the renin-angiotensin system during AT1R blockade significantly reduced p-ERK, but not intranuclear nuclear factor-kappaB, levels via AT2R. This led to reduction in mRNA levels of the proinflammatory mediator monocyte chemoattractant protein-1 and overall interstitial inflammation and subsequent fibrogenesis. Specific blockade of ERK expression in tubular epithelium by anti-sense oligodeoxynucleotides also attenuated interstitial inflammation, mimicking the anti-inflammatory action of AT2R in nephritic kidneys. Alternatively, we succeeded in confirming such an AT(2)R function by demonstrating that AT1R blockade did not confer renoprotection in nephritic, AT2R gene-deficient mice. Additional in vitro experiments revealed that AT2R activation did not affect nuclear factor-kappaB activation by tumor necrosis factor-alpha in cultured tubular epithelial cells, although it inhibited ERK phosphorylation, which reduced monocyte chemoattractant protein-1 mRNA levels. These results suggest that feedback activation of AT2Rs in tubular epithelium of nephritic kidneys plays an important role in attenuating interstitial inflammation.
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MESH Headings
- Angiotensin II Type 1 Receptor Blockers/pharmacology
- Animals
- Anti-Glomerular Basement Membrane Disease/immunology
- Anti-Glomerular Basement Membrane Disease/pathology
- Chemokine CCL2/genetics
- Chemokine CCL2/metabolism
- Enzyme Activation/drug effects
- Epithelial Cells/cytology
- Epithelial Cells/drug effects
- Epithelial Cells/pathology
- Epithelium/drug effects
- Epithelium/pathology
- Extracellular Signal-Regulated MAP Kinases/metabolism
- Gene Expression Regulation/drug effects
- Inflammation/immunology
- Kidney Tubules/drug effects
- Male
- Mice
- NF-kappa B/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptor, Angiotensin, Type 1/metabolism
- Receptor, Angiotensin, Type 2/deficiency
- Receptor, Angiotensin, Type 2/genetics
- Receptor, Angiotensin, Type 2/metabolism
- Time Factors
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Affiliation(s)
- Hirokazu Okada
- Department of Nephrology, Saitama Medical School, 38 Morohongo, Irumagun, Saitama 350-0495, Japan
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Szczech LA, Anderson A, Ramers C, Engeman J, Ellis M, Butterly D, Howell DN. The Uncertain Significance of Anti–Glomerular Basement Membrane Antibody Among HIV-Infected Persons With Kidney Disease. Am J Kidney Dis 2006; 48:e55-9. [PMID: 16997046 DOI: 10.1053/j.ajkd.2006.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 06/14/2006] [Indexed: 11/11/2022]
Abstract
Glomerular lesions that complicate patients with human immunodeficiency virus (HIV) infection include HIV-associated nephropathy, membranous glomerulopathy, and immune-complex glomerulonephritides. This case series presents 3 patients with clinically significant renal disease and positive test results for anti-glomerular basement membrane (anti-GBM) antigen. Characteristic histological findings that would suggest anti-GBM antibodies have a significant role in the pathological state of each patient's kidney disease were absent. In addition, each patient recovered without specific treatment for anti-GBM disease. This case series suggests that anti-GBM antibodies likely are related to the B-cell expansion previously described in patients with HIV infection. We propose that clinicians interpret results of anti-GBM antibody tests carefully for patients with HIV infection, considering biopsy before empiric therapy, particularly in a clinical presentation that is atypical for Goodpasture disease.
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Affiliation(s)
- Lynda Anne Szczech
- Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA.
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