1
|
Bradyanova S, Manoylov I, Boneva G, Kechidzhieva L, Tchorbanov A, Nikolova-Ganeva K. Methyl-supplemented nutrition delays the development of autoimmune disease in pristane-induced murine lupus. Immunology 2024; 172:269-278. [PMID: 38430118 DOI: 10.1111/imm.13774] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
The aetiology and progression of systemic lupus erythematosus (SLE) resulted from a complex sequence of events generated both from genetic and epigenetic processes. In the current research, the effect of methyl-supplemented nutrition on the development of SLE was studied in the pristane-induced mouse model of the disease. The results clearly demonstrated decreased anti-dsDNA antibody and proteinuria levels, modulation of cytokines and protected renal structures in the group of treated mice. An additional increase in the DNA methylation of mouse B lymphocytes was also observed. The beneficial effect of the diet is due to the methyl-containing micronutrients with possible anti-inflammatory and immunomodulating effects on cell proliferation and gene expression. Since these components are responsible for maintaining the physiological methylation level of DNA, the results point to the central role of methylation processes in environmentally triggered lupus. As nutrition represents one of the major epigenetic factors, these micronutrients may be considered novel agents with significant therapeutic outcomes.
Collapse
Affiliation(s)
- Silviya Bradyanova
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Iliyan Manoylov
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Gabriela Boneva
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Lidiya Kechidzhieva
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Andrey Tchorbanov
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
- National Institute of Immunology, Sofia, Bulgaria
| | - Kalina Nikolova-Ganeva
- Laboratory of Experimental Immunology, Department of Immunology, "The Stephan Angeloff" Institute of Microbiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| |
Collapse
|
2
|
Baranwal G, Creed HA, Black LM, Auger A, Quach AM, Vegiraju R, Eckenrode HE, Agarwal A, Rutkowski JM. Expanded renal lymphatics improve recovery following kidney injury. Physiol Rep 2021; 9:e15094. [PMID: 34806312 PMCID: PMC8606868 DOI: 10.14814/phy2.15094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a major cause of patient mortality and a major risk multiplier for the progression to chronic kidney disease (CKD). The mechanism of the AKI to CKD transition is complex but is likely mediated by the extent and length of the inflammatory response following the initial injury. Lymphatic vessels help to maintain tissue homeostasis through fluid, macromolecule, and immune modulation. Increased lymphatic growth, or lymphangiogenesis, often occurs during inflammation and plays a role in acute and chronic disease processes. What roles renal lymphatics and lymphangiogenesis play in AKI recovery and CKD progression remains largely unknown. To determine if the increased lymphatic density is protective in the response to kidney injury, we utilized a transgenic mouse model with inducible, kidney-specific overexpression of the lymphangiogenic protein vascular endothelial growth factor-D to expand renal lymphatics. "KidVD" mouse kidneys were injured using inducible podocyte apoptosis and proteinuria (POD-ATTAC) or bilateral ischemia reperfusion. In the acute injury phase of both models, KidVD mice demonstrated a similar loss of function measured by serum creatinine and glomerular filtration rate compared to their littermates. While the initial inflammatory response was similar, KidVD mice demonstrated a shift toward more CD4+ and fewer CD8+ T cells in the kidney. Reduced collagen deposition and improved functional recovery over time was also identified in KidVD mice. In KidVD-POD-ATTAC mice, an increased number of podocytes were counted at 28 days post-injury. These data demonstrate that increased lymphatic density prior to injury alters the injury recovery response and affords protection from CKD progression.
Collapse
Affiliation(s)
- Gaurav Baranwal
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| | - Heidi A. Creed
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| | - Laurence M. Black
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Research and Training CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alexa Auger
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| | - Alexander M. Quach
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| | - Rahul Vegiraju
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| | - Han E. Eckenrode
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Research and Training CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Anupam Agarwal
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Research and Training CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Veterans AffairsBirmingham Veterans Administration Medical CenterBirminghamAlabamaUSA
| | - Joseph M. Rutkowski
- Division of Lymphatic BiologyDepartment of Medical PhysiologyTexas A&M University College of MedicineBryanTexasUSA
| |
Collapse
|
3
|
Abstract
To investigate the clinicopathological features and outcomes of primary IgA nephropathy with nephrotic-range proteinuria in Chinese children. Patients with biopsy-proven IgA nephropathy and nephrotic-range proteinuria between January 2011 and December 2017 were included, and their proteinuria and renal function were followed up. A total of 90 patients were enrolled, and 21.1% (19/90) of them had decreased renal function at diagnosis. Complete remission, partial remission, and no response of proteinuria occurred in 88.6% (70/79), 10.1% (8/79), and 1.3% (1/79), respectively, of the 79 patients who were followed up for 6 to 104 months. 73.7% (14/19) of the patients with decreased renal function at diagnosis recovered to normal level while 26.3% (5/19) of them did not recover or progressed to end-stage renal disease. Two patients with normal renal function at diagnosis progressed to renal insufficiency during follow-up period. By multivariate analysis, the risk for renal function deterioration was significantly higher in the partial remission and no response groups than in the complete remission group. Remission of proteinuria was important for improving renal prognosis in children with IgA nephropathy and nephrotic-range proteinuria. The outcomes for pediatric patients appeared to be better than that reported in adults.
Collapse
MESH Headings
- Adolescent
- Biopsy
- Child
- Child, Preschool
- China/epidemiology
- Drug Therapy, Combination/methods
- Female
- Follow-Up Studies
- Glomerular Mesangium/pathology
- Glomerulonephritis, IGA/complications
- Glomerulonephritis, IGA/drug therapy
- Glomerulonephritis, IGA/immunology
- Glomerulonephritis, IGA/pathology
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/immunology
- Kidney Failure, Chronic/urine
- Male
- Proteinuria/diagnosis
- Proteinuria/epidemiology
- Proteinuria/immunology
- Proteinuria/urine
- Remission Induction/methods
- Retrospective Studies
- Treatment Outcome
Collapse
|
4
|
Ahmadian E, Hosseiniyan Khatibi SM, Razi Soofiyani S, Abediazar S, Shoja MM, Ardalan M, Zununi Vahed S. Covid-19 and kidney injury: Pathophysiology and molecular mechanisms. Rev Med Virol 2021; 31:e2176. [PMID: 33022818 PMCID: PMC7646060 DOI: 10.1002/rmv.2176] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
The novel coronavirus (SARS-CoV-2) has turned into a life-threatening pandemic disease (Covid-19). About 5% of patients with Covid-19 have severe symptoms including septic shock, acute respiratory distress syndrome, and the failure of several organs, while most of them have mild symptoms. Frequently, the kidneys are involved through direct or indirect mechanisms. Kidney involvement mainly manifests itself as proteinuria and acute kidney injury (AKI). The SARS-CoV-2-induced kidney damage is expected to be multifactorial; directly it can infect the kidney podocytes and proximal tubular cells and based on an angiotensin-converting enzyme 2 (ACE2) pathway it can lead to acute tubular necrosis, protein leakage in Bowman's capsule, collapsing glomerulopathy and mitochondrial impairment. The SARS-CoV-2-driven dysregulation of the immune responses including cytokine storm, macrophage activation syndrome, and lymphopenia can be other causes of the AKI. Organ interactions, endothelial dysfunction, hypercoagulability, rhabdomyolysis, and sepsis are other potential mechanisms of AKI. Moreover, lower oxygen delivery to kidney may cause an ischaemic injury. Understanding the fundamental molecular pathways and pathophysiology of kidney injury and AKI in Covid-19 is necessary to develop management strategies and design effective therapies.
Collapse
Affiliation(s)
- Elham Ahmadian
- Kidney Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Saiedeh Razi Soofiyani
- Clinical Research Development UnitSina Educational, Research and Treatment CenterTabriz University of Medical SciencesTabrizIran
| | - Sima Abediazar
- Kidney Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mohammadali M. Shoja
- Department of SurgeryUniversity of Illinois at Chicago‐Metropolitan Group Hospitals (UIC‐MGH)ChicagoIllinoisUSA
| | | | | |
Collapse
|
5
|
Guo Q, Zhang L, Yaron JR, Burgin M, Schutz LN, Awo EA, Lucas AR. Preclinical Testing of Viral Therapeutic Efficacy in Pristane-Induced Lupus Nephritis and Diffuse Alveolar Hemorrhage Mouse Models. Methods Mol Biol 2021; 2225:241-255. [PMID: 33108667 DOI: 10.1007/978-1-0716-1012-1_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial and heterogeneous autoimmune disease involving multiple organ systems and tissues. Lupus nephritis occurs in approximately 60% of patients with SLE and is the leading cause of morbidity. Diffuse alveolar hemorrhage (DAH) is a rare but very serious complication of SLE with a greater than 50% associated mortality. The etiology of SLE is unclear but has proposed genetic, hormonal, and environmental aspects. Pristane is a saturated terpenoid alkane and has become the most popular laboratory model for inducing lupus in mice. The pristane model of SLE has the capacity to reproduce many components of the human presentation of the disease. Previous studies have demonstrated that virus-derived immune-modulating proteins have the potential to control inflammatory and autoimmune disorders. Serp-1, a 55 kDa secreted and highly glycosylated immune modulator derived from myxoma virus (MYXV), has potent immunomodulatory activity in models of vasculitis, viral sepsis, collagen-induced arthritis, and transplant rejection. This chapter describes the mouse preclinical pristane lupus model as a method to examine virus-derived protein efficacy for treating autoimmune diseases and specifically lupus nephritis and DAH.
Collapse
Affiliation(s)
- Qiuyun Guo
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiang Zhang
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Jordan R Yaron
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Michelle Burgin
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Lauren N Schutz
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Enkidia A Awo
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Alexandra R Lucas
- Centers for Personalized Diagnostics and for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, USA.
- Division of Cardiology, Saint Joseph's Hospital, Dignity Health, Phoenix, AZ, USA.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Immune dysfunction, including severe combined immunodeficiency, has been described in genetic disorders affecting the metabolism of the vitamins cobalamin (vitamin B12) and folate. We have reviewed reports of clinical findings in patients with a number of inborn errors of cobalamin or folate metabolism, specifically looking for immune problems. RECENT FINDINGS There is little evidence that immune function is affected in most of the disorders. Exceptions are Imerslund-Gräsbeck syndrome and hereditary folate malabsorption (affecting intestinal absorption of cobalamin and folate, respectively), transcobalamin deficiency (affecting transport of cobalamin in blood and cellular cobalamin uptake), and methylenetetrahydrofolate dehydrogenase 1 deficiency (catalyzing cytoplasmic interconversion of reduced folate coenzyme derivatives). SUMMARY Although some inborn errors of cobalamin or folate can be associated with immune dysfunction, the degree and type of immune dysfunction vary with no obvious pattern.
Collapse
Affiliation(s)
- David Watkins
- Department of Human Genetics, McGill University
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - David S Rosenblatt
- Department of Human Genetics, McGill University
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Neupane N, Krishnamurthy S, Jagadisan B, Dhodapkar R. Hepatitis B Seroprotection in Pediatric Nephrotic Syndrome. Indian Pediatr 2019; 56:659-662. [PMID: 31477646] [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: 06/10/2023]
Abstract
OBJECTIVE To study the prevalence of Hepatitis B seroprotection in children (>1 y) with nephrotic syndrome vaccinated against Hepatitis B vaccine as per the Universal Immunization Program schedule (0,6,10,14 wk); to compare the Hepatitis B seroprotection rates and anti-HBs titers among different phenotypes of nephrotic syndrome; to evaluate the association between Hepatitis B seroprotection status and the immunosuppressive agents; and to study the correlation between anti-HBs titres and proteinuria. METHODS Hepatitis B serology and anti-HBs titers were analyzed in 100 children (age-1-18 y) with different clinical phenotypes of nephrotic syndrome (cases) and 100 healthy controls. RESULTS The proportion of seroprotected children among the cases and controls was 37% (n=37) and 61% (n=61), respectively (P<0.04). The median (IQR) anti- HBs antibodies titers among the cases was 75 (62.5, 81) mIU/mL and 112 (56, 367) mIU/mL among the controls (P=0.001). The proportion of seroprotected children among the steroid sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome and controls was 40% (n=28), 30% (n=9) and 61% (n=61), respectively (P<0.01). No differences in the anti-HBs titers between children receiving steroids versus steroids along with other immunosuppressants were found. Weak negative correlation was noted between proteinuria and protective titers (r = -0.155; P=0.039). CONCLUSIONS Children with nephrotic syndrome, in general, and steroid-resistant nephrotic syndrome in particular, show poor seroprotection with Hepatitis B vaccination.
Collapse
Affiliation(s)
- Nischal Neupane
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Correspondence to: Dr. Sriram Krishnamurthy, Additional Professor, Department of Pediatrics, JIPMER, Puducherry 605 006, India.
| | - Barath Jagadisan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
8
|
van de Logt AE, Fresquet M, Wetzels JF, Brenchley P. The anti-PLA2R antibody in membranous nephropathy: what we know and what remains a decade after its discovery. Kidney Int 2019; 96:1292-1302. [PMID: 31611068 DOI: 10.1016/j.kint.2019.07.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/08/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Abstract
The discovery in 2009 of the M-type phospholipase A2 receptor (PLA2R) as the primary target in membranous nephropathy (MN) greatly advanced basic and clinical research. Primary MN is now considered a renal-limited autoimmune disease, with antibodies against PLA2R (aPLA2Rab) identified in 70-80 % of patients of various ethnic groups. Although the use of aPLA2Rab as a diagnostic and prognostic biomarker is now widely accepted, many questions related to the development of the auto-immune response, the role of IgG subclasses and antigenic epitopes, and the pathways to podocyte injury remain unresolved. PLA2R-associated MN most likely develops governed by factors such as genetic susceptibility, loss of tolerance, alterations in antigen expression with a role for environmental factors like air pollution, smoking, and infections. More detailed knowledge of genetic factors, the relevant B- and T-cell epitopes, and the mechanisms of podocyte injury is needed to identify patients at risk for disease progression and to develop optimized, targeted treatment strategies. In this review we highlight unresolved issues, addressing initiation of antibody formation, the timeline of antibody production, the role of IgG subclass, and the pathogenicity of the antibodies in concert with complement to produce glomerular pathology and proteinuria.
Collapse
Affiliation(s)
- Anne-Els van de Logt
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Maryline Fresquet
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jack F Wetzels
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Paul Brenchley
- Institute of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| |
Collapse
|
9
|
van Daalen EE, Neeskens P, Zandbergen M, Harper L, Karras A, Vaglio A, de Zoysa J, Bruijn JA, Bajema IM. Podocytes and Proteinuria in ANCA-Associated Glomerulonephritis: A Case-Control Study. Front Immunol 2019; 10:1405. [PMID: 31297110 PMCID: PMC6607406 DOI: 10.3389/fimmu.2019.01405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
Proteinuria has been identified as prognosticator of renal outcome in patients with ANCA-associated glomerulonephritis, but whether proteinuria is related to podocyte abnormalities in these patients is largely unknown. We here investigate podocyte foot process width and number of podocytes positive for the podocyte marker WT-1 in diagnostic renal biopsies of 25 Caucasian patients with ANCA-associated glomerulonephritis in relation to proteinuria. Control tissue was used from pre-transplantation donor kidney biopsies. Proteinuria at 10 weeks follow-up correlated significantly with foot process width (P = 0.04). Biopsies with foot process width ≥600 nm belonged more often to the crescentic or mixed class, whereas biopsies with a foot process width <600 nm were most often categorized as focal class (P = 0.03). The mean number of podocytes based upon expression of WT-1 was significantly lower in patients compared to controls (15 vs. 34 podocytes per glomerulus; P < 0.0001). The significant decrease in expression of the podocyte WT-1 marker in ANCA-associated glomerulonephritis is considered indicative of actual podocyte loss or at least, of a loss of functionality. Furthermore, our study indicates that podocyte foot process width at baseline could be indicative for proteinuria at short term follow up. For prognostic purposes, we therefore suggest to include a description of the foot process width in the diagnostic report of a biopsy with ANCA-associated glomerulonephritis.
Collapse
Affiliation(s)
- Emma E. van Daalen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Neeskens
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Malu Zandbergen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Lorraine Harper
- School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alexandre Karras
- Nephrology Department, HEGP Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Augusto Vaglio
- Nephrology Unit, Meyer Children's Hospital and Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Firenze, Firenze, Italy
| | - Janak de Zoysa
- Renal Services, North Shore Hospital, Auckland, New Zealand
| | - Jan A. Bruijn
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Ingeborg M. Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
10
|
Abstract
IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world. IgAN is characterized by mesangial deposits of IgA1-containing immune complexes. IgA1 usually co-deposits with complement C3 and variable IgG and/or IgM. Exactly 50 years have passed since IgAN was described, however, the pathogenesis of disease onset and progression have not been fully clarified. Animal models can re-create the complex immunologic microenvironments that foster human autoimmunity and nephritis and provide access to tissue compartments not readily examined in patients. Thus, multiple models that may be helpful in studies of specific aspects of IgAN have been developed. A unique spontaneous animal model of IgAN, the ddY mouse, was reported in 1985. These mice show mild proteinuria and glomerular IgA deposits, with a highly variable incidence and degree of glomerular injury owing to a heterogeneous genetic background. Thus, we intercrossed an early onset group of ddY mice in which the development of IgAN resulted in the establishment of a novel 100% early onset-grouped ddY mouse model with increased levels of aberrantly glycosylated IgA and immune complexes. Although the molecular features of human IgA1 are different from rodent IgA, human IgA1 knock-in (α1KI)-CD89 transgenic mice, which express both human IgA1 and CD89, show circulating and mesangial deposits of IgA1-soluble CD89 complexes that result in kidney inflammation, hematuria, and proteinuria. In this review, we introduce several murine models of IgAN that can be useful tools for the analysis of multiple aspects of the pathogenesis of IgAN, which may aid in the assessment of approaches for the treatment of IgAN.
Collapse
Affiliation(s)
- Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Liao HT, Tung HY, Tsai CY. Anti-RNA polymerase III antibody in lupus patients with proteinuria. J Chin Med Assoc 2019; 82:260-264. [PMID: 30946206 DOI: 10.1097/jcma.0000000000000061] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To investigate the relationship between serum anti-ribonucleic acid polymerase III (anti-RNAP3) autoantibodies (Abs) and proteinuria severity in lupus patients. METHODS Serum antibodies reacting with anti-RNAP3 were measured in 49 systemic lupus erythematosus (SLE) patients (29 cases of SLE with proteinuria and 20 cases of SLE without proteinuria) and 10 healthy controls (HCs). For the patients, we recorded demographic data, daily urinary protein loss, serum anti-double strand deoxyribonucleic acid (anti-ds-DNA) antibodies, serum creatinine (Cr), estimated glomerular filtrating rate (eGFR), complement 3 (C3), and C4. RESULTS Fewer anti-RNAP3 antibodies were found in the SLE patients than in the HCs (p = 0.061). In the SLE with proteinuria group, positive correlations were observed among anti-RNAP3 antibodies and daily urinary protein loss, serum C3, C4, and eGFR, and negative correlations were observed between anti-RNAP3-Abs and anti-ds-DNA-Abs and serum Cr levels. However, these correlations were nonsignificant (p > 0.05). CONCLUSION This study demonstrated the possible role of anti-RNAP3 antibodies in SLE patients with proteinuria, as evidenced by their positive and negative relationships with daily urinary protein loss, eGFR, C3, C4, serum Cr, and anti-ds-DNA-Abs. Although these correlations were nonsignificant, our study builds a foundation for future tailored studies, and more in-depth studies with larger samples are warranted to provide more information.
Collapse
Affiliation(s)
- Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hsiang-Yuen Tung
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| |
Collapse
|
12
|
Muchtar E, Gertz MA, Kyle RA, Lacy MQ, Dingli D, Leung N, Buadi FK, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves W, Kourelis TV, Warsame R, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Rajkumar SV, Kumar SK, Dispenzieri A. A Modern Primer on Light Chain Amyloidosis in 592 Patients With Mass Spectrometry-Verified Typing. Mayo Clin Proc 2019; 94:472-483. [PMID: 30770096 DOI: 10.1016/j.mayocp.2018.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 04/12/2018] [Revised: 06/30/2018] [Accepted: 08/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe the clinical and laboratory characteristics of patients with meticulously typed light chain (AL) amyloidosis. PATIENTS AND METHODS Patients (N=592) with biopsy-proven, mass spectrometry-confirmed AL amyloidosis diagnosed from January 1, 2008, through August 31, 2015, were included. RESULTS The median patient age at diagnosis was 63 years. Thirty-four percent of patients (n=204) had isolated organ involvement, mostly heart (19% [n=115]) followed by kidney (9% [n=53]). In contrast, 25% (n=146) had more than 2 involved organs. Patients with isolated cardiac involvement had similar cardiac dysfunction compared with those with nonisolated cardiac amyloidosis. In contrast, isolated renal involvement was associated with increased proteinuria and higher estimated glomerular filtration rate compared with nonisolated renal amyloidosis. Serum and urine immunofixation electrophoresis results were positive in 80% and 88% of patients, respectively, with 94% of patients having at least 1 positive immunofixation electrophoresis result (serum or urine). The serum free light chain ratio was abnormal in 91% of patients. When all monoclonal protein studies were combined, only 1 patient (0.2%) had normal results. The 1- and 5-year survival rates were 65% and 46%, respectively. Survival of patients with cardiac amyloidosis was not influenced by the number of involved organs (1 vs >1 organ), emphasizing the prognostic significance of cardiac involvement. CONCLUSION When mass spectrometry is used to definitively type amyloid, only a fraction of a percent of patients with AL have negative monoclonal protein studies, unlike historical reports. Patient characteristics and outcomes of accurately typed patients are described.
Collapse
Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | | | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | |
Collapse
|
13
|
Chebotareva N, Bobkova I, Lysenko L, Neprinzeva N, Vinogradov A, Moiseev S. Heat shock protein 70 and anti-heat shock protein 70 antibodies in patients with chronic glomerulonephritis. Cell Stress Chaperones 2018; 23:1229-1235. [PMID: 30062391 PMCID: PMC6237676 DOI: 10.1007/s12192-018-0928-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/14/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022] Open
Abstract
We evaluated the heat shock system 70 (HSP70) in patients with chronic glomerulonephritis (CGN). Seventy-six patients with CGN patients were included in our study. Ten patients with mild proteinuria (median 0.48 [0.16-0.78] g/24 h) and ten healthy subjects served as positive and negative controls, respectively. Urinary levels of HSP70, interleukin-10, and serum levels of anti-HSP70 were measured by ELISA. The immunohistochemical peroxidase method was used to study the expression of HSP70 and Foxp3+ in kidney biopsies. TregFoxP3+ cells in the interstitium were determined morphometrically. Median urinary HSP70 levels in patients with nephrotic syndrome (NS) [6.57 (4.49-8.33) pg/mg] and subnephrotic range proteinuria [5.7 (4.12-6.9) pg/mg] were higher (p < 0.05) than in positive [3.7 (2.5-4.82) pg/mg] and negative [3.78 (2.89-4.84) pg/mg] controls. HSP70 expression index in tubular cells positively correlated with urinary HSP70 (Rs = 0.948, р < 0.05) and proteinuria (Rs = 0.362, p < 0.05). The number of TregFoxp3+ cells in the kidney interstitium and interleukin-10 excretion were lower in patients with NS. Anti-HSP70 antibody serum levels in patients with NS [21.1 (17.47-29.72) pg/ml] and subnephrotic range proteinuria [24.9 (18.86-30.92) pg/ml] were significantly higher than in positive [17.8 (12.95-23.03) pg/ml] and negative [18.9 (13.5-23.9) pg/ml] controls. In patients with CGN, increasing proteinuria was associated with higher HSP70 renal tissue and urinary levels. However, activation of HSP70 in patients with nephrotic syndrome did not lead to an increase in tissue levels of TregFoxp3+ cells or to the release of IL-10.
Collapse
Affiliation(s)
- Natalia Chebotareva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435.
| | - Irina Bobkova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435
| | - Lidia Lysenko
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435
| | - Natalia Neprinzeva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435
| | - Anatoly Vinogradov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Rossolimo 11/5, Moscow, Russia, 119435
| |
Collapse
|
14
|
Rhee RL, Davis JC, Ding L, Fervenza FC, Hoffman GS, Kallenberg CGM, Langford CA, McCune WJ, Monach PA, Seo P, Spiera R, St Clair EW, Specks U, Stone JH, Merkel PA. The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis. Clin J Am Soc Nephrol 2018; 13:251-257. [PMID: 29371340 PMCID: PMC5967421 DOI: 10.2215/cjn.04160417] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 04/14/2017] [Accepted: 10/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The significance of persistent hematuria or proteinuria in patients with ANCA-associated vasculitis who are otherwise in clinical remission is unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A post hoc analysis was conducted using participants enrolled in two randomized, placebo-controlled clinical trials who had active GN due to ANCA-associated vasculitis, had positive ANCA, and achieved remission by month 6. Dipstick and microscopic urinalyses were performed at each visit. Persistent hematuria or proteinuria for at least 6 months and the cumulative duration of hematuria were examined. Renal relapse was defined as new or worsening red blood cell casts and/or worsening kidney function according to the Birmingham Vasculitis Activity Score for Granulomatosis with Polyangiitis. RESULTS There were 149 patients included in this study: 42% had persistent hematuria, and 43% had persistent proteinuria beyond 6 months. Persistent hematuria was associated with a significantly higher risk of relapse, even after adjusting for potential confounders (subdistribution hazard ratio, 3.99; 95% confidence interval, 1.20 to 13.25; P=0.02); persistent proteinuria was not associated with renal relapse (subdistribution hazard ratio, 1.44; 95% confidence interval, 0.47 to 4.42; P=0.53). Furthermore, greater cumulative duration of hematuria was significantly associated with a higher risk of renal relapse (adjusted subdistribution hazard ratio, 1.08 per each month; 95% confidence interval, 1.03 to 1.12; P<0.01). The median time to renal relapse was 22 months. CONCLUSIONS In patients with ANCA-associated vasculitis and kidney involvement who achieve remission after induction therapy, the presence of persistent hematuria, but not proteinuria, is a significant predictor of future renal relapse.
Collapse
Affiliation(s)
- Rennie L Rhee
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Malhotra PS, Jorna T, Bhandari S. Treatment of Immunoglobulin A Nephropathy Recurrence Post-Renal Transplant. Transplant Proc 2018; 50:165-167. [PMID: 29407303 DOI: 10.1016/j.transproceed.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/21/2017] [Accepted: 12/09/2017] [Indexed: 11/16/2022]
Abstract
Immunoglobulin A nephropathy (IgAN) is the most commonly occurring glomerulonephritis. Recurrence of disease in the transplanted kidney can significantly reduce allograft survival rates. Currently, there is no definitive management plan for IgAN recurrence in a transplant that reduces the rate of decline of allograft function and prolongs time to dialysis or re-transplantation. Herein we present a 48-year-old man who had received a renal transplantation in 2006 following his diagnosis of IgAN. In 2015, the patient was noted to have an elevated blood pressure and proteinuria (urinary protein:creatinine ratio [uPCR] 170 mg/mmol). A transplant biopsy confirmed recurrent IgAN. A year later, he presented with dipstick hematuria, nephrotic-range proteinuria (uPCR 820 mg/mmol), and a serum creatinine of 90 to 140 μmol/L. A second biopsy revealed mesangioproliferative glomerulopathy consistent with crescentic IgAN. An optimal management plan is currently unknown for recurrent crescentic IgAN in the transplanted kidney. We decided to treat this patient with oral cyclophosphamide daily and high-dose prednisolone. The treatment has so far yielded a positive response and managed to preserve allograft function without significant adverse effects for our patient. Our case illustrates the importance of timely biopsies to identify recurrence of disease and highlights an effective therapeutic option for recurrent IgAN with crescent formation in a transplant.
Collapse
Affiliation(s)
- P S Malhotra
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom
| | - T Jorna
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom
| | - S Bhandari
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom.
| |
Collapse
|
16
|
Brightbill HD, Suto E, Blaquiere N, Ramamoorthi N, Sujatha-Bhaskar S, Gogol EB, Castanedo GM, Jackson BT, Kwon YC, Haller S, Lesch J, Bents K, Everett C, Kohli PB, Linge S, Christian L, Barrett K, Jaochico A, Berezhkovskiy LM, Fan PW, Modrusan Z, Veliz K, Townsend MJ, DeVoss J, Johnson AR, Godemann R, Lee WP, Austin CD, McKenzie BS, Hackney JA, Crawford JJ, Staben ST, Alaoui Ismaili MH, Wu LC, Ghilardi N. NF-κB inducing kinase is a therapeutic target for systemic lupus erythematosus. Nat Commun 2018; 9:179. [PMID: 29330524 PMCID: PMC5766581 DOI: 10.1038/s41467-017-02672-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [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: 09/11/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
NF-κB-inducing kinase (NIK) mediates non-canonical NF-κB signaling downstream of multiple TNF family members, including BAFF, TWEAK, CD40, and OX40, which are implicated in the pathogenesis of systemic lupus erythematosus (SLE). Here, we show that experimental lupus in NZB/W F1 mice can be treated with a highly selective and potent NIK small molecule inhibitor. Both in vitro as well as in vivo, NIK inhibition recapitulates the pharmacological effects of BAFF blockade, which is clinically efficacious in SLE. Furthermore, NIK inhibition also affects T cell parameters in the spleen and proinflammatory gene expression in the kidney, which may be attributable to inhibition of OX40 and TWEAK signaling, respectively. As a consequence, NIK inhibition results in improved survival, reduced renal pathology, and lower proteinuria scores. Collectively, our data suggest that NIK inhibition is a potential therapeutic approach for SLE.
Collapse
Affiliation(s)
- Hans D Brightbill
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Eric Suto
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Nicole Blaquiere
- Department of Discovery Chemistry, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Nandhini Ramamoorthi
- Department of Biomarker Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Swathi Sujatha-Bhaskar
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Emily B Gogol
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Georgette M Castanedo
- Department of Discovery Chemistry, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Benjamin T Jackson
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Youngsu C Kwon
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Susan Haller
- Department of Pathology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Justin Lesch
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Karin Bents
- Evotec, Inc., Essener Bogen 7, Hamburg, 22419, Germany
| | - Christine Everett
- Department of Biochemical and Cellular Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Pawan Bir Kohli
- Department of Biochemical and Cellular Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Sandra Linge
- Evotec, Inc., Essener Bogen 7, Hamburg, 22419, Germany
| | - Laura Christian
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Kathy Barrett
- Department of Biochemical and Cellular Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Allan Jaochico
- Department of Drug Metabolism and Pharmacokinetics, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Leonid M Berezhkovskiy
- Department of Drug Metabolism and Pharmacokinetics, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Peter W Fan
- Department of Drug Metabolism and Pharmacokinetics, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Zora Modrusan
- Department of Molecular Biology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Kelli Veliz
- Department of Laboratory Animal Resources, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Michael J Townsend
- Department of Biomarker Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Jason DeVoss
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Adam R Johnson
- Department of Biochemical and Cellular Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | | | - Wyne P Lee
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Cary D Austin
- Department of Pathology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Brent S McKenzie
- Department of Translational Immunology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Jason A Hackney
- Department of Bioinformatics and Computational Biology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - James J Crawford
- Department of Discovery Chemistry, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Steven T Staben
- Department of Discovery Chemistry, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Moulay H Alaoui Ismaili
- Department of Biochemical and Cellular Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Lawren C Wu
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA
| | - Nico Ghilardi
- Department of Immunology Discovery, Genentech, 1 DNA Way, South San Francisco, CA-94080, USA.
| |
Collapse
|
17
|
Pourcine F, Dahan K, Mihout F, Cachanado M, Brocheriou I, Debiec H, Ronco P. Prognostic value of PLA2R autoimmunity detected by measurement of anti-PLA2R antibodies combined with detection of PLA2R antigen in membranous nephropathy: A single-centre study over 14 years. PLoS One 2017; 12:e0173201. [PMID: 28257452 PMCID: PMC5336294 DOI: 10.1371/journal.pone.0173201] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 08/03/2016] [Accepted: 02/16/2017] [Indexed: 01/24/2023] Open
Abstract
Introduction Clinical course of membranous nephropathy (MN) is difficult to predict. Measurement of circulating anti-PLA2R autoantibodies (PLA2R-Ab) and detection in immune deposits of PLA2R antigen (PLA2R-Ag) are major advances in disease understanding. We evaluated the clinical significance of these biomarkers. Methods In this 14-year retrospective study, we collected data from 108 MN patients and assessed the relationship between clinical course, PLA2R-Ab and PLA2R-Ag. We also assessed THSD7A status. Results Eighty-five patients suffered from primary MN (PMN) and 23 patients from a secondary form. The median follow-up was 30.4 months [interquartile range, 17.7;56.7]. Among the 77 patients with PMN and available serum and/or biopsy, 69 (89.6%) had PLA2R-related disease as shown by anti-PLA2R-Ab and/or PLA2R-Ag, while 8 patients (8/77, 10.4%) were negative for both. There was no significant difference between these two groups in age at diagnosis and outcome assessed by proteinuria, serum albumin level and eGFR. Two of the 8 negative patients were positive for THSD7A. In patients with PLA2R related PMN, younger age, lower proteinuria, higher eGFR, and lower PLA2R-Ab level at baseline and after 6 months were associated with remission of proteinuria. Initial PLA2R-Ab titer ≤ 97.6 RU/mL and complete depletion of PLA2R-Ab within 6-months were significantly associated with spontaneous remission at the end of follow-up. In rituximab treated patients, lower PLA2R-Ab titer at initiation of treatment, and absence of PLA2R-Ab and higher serum albumin level at 3 months were significantly associated with remission. Noticeably, 81.8% of the patients who achieved remission completely cleared PLA2R-Ab. Depletion of PLA2R-Ab and increase of serum albumin level preceded the decrease of proteinuria. Conclusion Assessment of PLA2R autoimmunity is essential for patient management. Combination of PLA2R-Ab and PLA2R-Ag increases diagnosis sensitivity. PLA2R-Ab titer is a biomarker of disease severity at initial assessment, and the kinetics of the antibody are significantly correlated to disease evolution.
Collapse
Affiliation(s)
- Franck Pourcine
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Department of Nephrology and Transplantation, Créteil, France
| | - Karine Dahan
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Nephrology and Dialysis, Paris, France
| | - Fabrice Mihout
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Nephrology and Dialysis, Paris, France
| | - Marine Cachanado
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique, Paris, France
| | - Isabelle Brocheriou
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Pathology, Paris, France
| | - Hanna Debiec
- Sorbonne Universités, Université Pierre et Marie Curie Univ Paris, Paris, France
- Institut National de la Santé Et la Recheche Médicale, Unit, Paris, France
| | - Pierre Ronco
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Nephrology and Dialysis, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie Univ Paris, Paris, France
- Institut National de la Santé Et la Recheche Médicale, Unit, Paris, France
- * E-mail:
| |
Collapse
|
18
|
Scaglioni V, Scolnik M, Catoggio LJ, Christiansen SB, Varela CF, Greloni G, Rosa-Diez G, Soriano ER. ANCA-associated pauci-immune glomerulonephritis: always pauci-immune? Clin Exp Rheumatol 2017; 35 Suppl 103:55-58. [PMID: 28229825] [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] [Received: 08/19/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) is considered "pauci-immune" with absent or mild glomerular tuft staining for immunoglobulin (Ig) and/or complement. However, it is not unusual to see some immune deposits (ID) within glomeruli on immunofluorescence (IF). We determined to evaluate the prevalence and clinical significance of immune deposits in ANCA-associated GN. METHODS We included all patients with ANCA associated vasculitis with renal biopsies between January 2002 and May 2014: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis and renal limited vasculitis. Patients were divided into Group A: biopsy without ID (≤2+ intensity of immunostaining) and Group B: biopsy with ID (>2+ intensity of immunostaining). Serum creatinine, estimated glomerular filtration rate (eGFR) at time of the biopsy, amount of proteinuria and hematuria, requirement of dialysis and extra renal involvement were recorded. RESULTS Fifty-three patients (75.4% females) were included. Mean age at biopsy was 66.3 years. Typical pauci-immune GN was found in 39 patients (73.5%, group A). In 14 patients (26.4%, group B) examination revealed substantial deposition of Ig or complement in the mesangium and/or along the glomerular capillary wall. The only difference comparing both groups was significantly higher proteinuria in group B (mean 1.6/24 h (SD: 10.7) vs. 0.8/24 h (SD: 7.6), p=0.0036). CONCLUSIONS In ANCA GN at least a quarter of patients were not "pauci-immune" (26.4%). In this subgroup, immune deposits were only associated with a significantly higher proteinuria. Further basic and clinical research is needed to elucidate the significance of immune deposition in ANCA GN.
Collapse
Affiliation(s)
- Valeria Scaglioni
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
| | - Marina Scolnik
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| | - Luis J Catoggio
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| | | | - Carlos F Varela
- Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| | - Gustavo Greloni
- Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| | - Guillermo Rosa-Diez
- Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| | - Enrique R Soriano
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina
| |
Collapse
|
19
|
Williams AL, Gullipalli D, Ueda Y, Sato S, Zhou L, Miwa T, Tung KS, Song WC. C5 inhibition prevents renal failure in a mouse model of lethal C3 glomerulopathy. Kidney Int 2017; 91:1386-1397. [PMID: 28139294 DOI: 10.1016/j.kint.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/15/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 12/23/2022]
Abstract
C3 glomerulopathy is a potentially life-threatening disease of the kidney caused by dysregulated alternative pathway complement activation. The specific complement mediator(s) responsible for kidney injury in C3 glomerulopathy are yet to be defined and no specific therapy is currently available. We previously developed a mouse model of lethal C3 glomerulopathy with factor H and properdin gene double mutations. Therefore, we used this model to examine the role of C5 and C5a receptor (C5aR) in the pathogenesis of the disease. Disease severity in these factor H/properdin double-mutant mice was found to be correlated with plasma C5 levels, and prophylactic anti-C5 mAb therapy was effective in preventing lethal C3 glomerulopathy. When given to these double-mutant mice that had already developed active disease with severe proteinuria, anti-C5 mAb treatment also prevented death in half of the mice. Deficiency of C5aR significantly reduced disease severity, suggesting that C5aR-mediated inflammation contributed to C3 glomerulopathy. Thus, C5 and C5aR have a critical role in C3 glomerulopathy. Hence, early intervention targeting these pathways may be an effective therapeutic strategy for patients with C3 glomerulopathy.
Collapse
Affiliation(s)
- Allison Lesher Williams
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Damodar Gullipalli
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoshiyasu Ueda
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sayaka Sato
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lin Zhou
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Takashi Miwa
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth S Tung
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Wen-Chao Song
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
20
|
Hoshino Y, Moriyama T, Uchida K, Tsuchiya K, Nitta K. Comparison of oral steroids with tonsillectomy plus steroid pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol 2016; 21:617-623. [PMID: 27549901 DOI: 10.1007/s10157-016-1324-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/20/2016] [Accepted: 08/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment of IgA nephropathy (IgAN) in Japan has recently changed, from oral prednisolone (oPSL) to tonsillectomy plus steroid pulse (TSP) therapy. However, a few studies have compared their efficacy and safety. METHODS IgAN patients diagnosed in our institution between 1991 and 2013, treated with TSP or oPSL, aged ≥16 years, with ≥1 g/day proteinuria, and estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m2, and no other renal disease were selected. Baseline clinical and histological findings, clinical outcomes, and adverse events were compared. Clinical remission (CR) was defined as <0.3 g/day proteinuria and <5 urinary red blood cells per high-powered field. RESULTS Sixty-six patients were identified; after propensity score adjustment, 26 patients were selected in each group. CR rates were significantly higher at 12 (30.8 % vs. 3.9 %), 36 (47.3 % vs. 7.9 %), and 72 (57.8 % vs. 20.1 %) months (p < 0.01), and the renal survival rate, defined as the development of a 25 % reduction from baseline eGFR, was significantly higher at 12 (96.2 % vs. 69.2 %), 36 (96.2 % vs. 61.5 %), and 72 (96.2 % vs. 41.0 %) months in the TSP than the oPSL group (p < 0.001). Multivariate analysis showed that TSP was the only independent factor associated with CR (hazard ratio, 3.58; 95 % confidence interval, 1.32-10.91, p = 0.01). The number of patients with adverse events was significant lower in TSP group than in oPSL group (11.5 % vs. 34.6 %, p = 0.04). CONCLUSIONS CR rates are higher; protection of renal function and prevention from adverse events were superior with TSP than with oPSL in patients with IgAN and moderate-to-severe proteinuria.
Collapse
Affiliation(s)
- Yoshie Hoshino
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takahito Moriyama
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Keiko Uchida
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Tsuchiya
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
21
|
Abstract
The diversity of clinical presentations of lupus nephritis parallel the diversity of pathologic lesions seen in the kidneys of patients with SLE. Renal manifestations range from asymptomatic hematuria or proteinuria to overt nephritic and nephrotic syndromes, rapidly progressive glomerulonephritis, and chronic renal failure. Subclinical nephropathy both during presentation and during monitoring of disease activity is frequently missed because of the notorious unreliability of routine screening urinalyses performed in high-throughput clinical pathology laboratories. Requisitions for urine microscopy should be flagged for special attention in patients at risk for lupus nephritis. Depression of classic complement pathway components and high titers of anti-DNA, anti-nucleosome, or anti-C1q antibodies identify patients are increased risk of renal involvement or flares of nephritis. Several disease activity and damage indexes are available, but they are mostly used in clinical research setting and none has achieved wide use for standard clinical practice.
Collapse
Affiliation(s)
- J E Balow
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892-1818, USA.
| |
Collapse
|
22
|
Ozawa M, Komatsuda A, Ohtani H, Nara M, Sato R, Togashi M, Takahashi N, Wakui H. Long-term prognosis of AL and AA renal amyloidosis: a Japanese single-center experience. Clin Exp Nephrol 2016; 21:212-227. [PMID: 27116248 DOI: 10.1007/s10157-016-1271-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/09/2015] [Accepted: 04/12/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Few studies have been conducted on the long-term prognosis of patients with amyloid light chain (AL) and amyloid A (AA) renal amyloidosis in the same cohort. METHODS We retrospectively examined 68 patients with biopsy-proven renal amyloidosis (38 AL and 30 AA). Clinicopathological findings at the diagnosis and follow-up data were evaluated in each patient. We analyzed the relationship between clinicopathological parameters and survival data. RESULTS Significant differences were observed in several clinicopathological features, such as proteinuria levels, between the AL and AA groups. Among all patients, 84.2 % of the AL group and 93.3 % of the AA group received treatments for the underlying diseases of amyloidosis. During the follow-up period (median 18 months in AL and 61 months in AA), 36.8 % of the AL group and 36.7 % of the AA group developed end-stage renal failure requiring dialysis, while 71.1 % of the AL group and 56.7 % of the AA group died. Patient and renal survivals were significantly longer in the AA group than in the AL group. eGFR of >60 mL/min/1.73 m2 at biopsy and an early histological stage of glomerular amyloid deposition were identified as low-risk factors. A multivariate analysis showed that cardiac amyloidosis and steroid therapy significantly influenced patient and renal survivals. CONCLUSIONS Our results showed that heart involvement was the major predictor of poor outcomes in renal amyloidosis, and that the prognosis of AA renal amyloidosis was markedly better than that in previously reported cohorts. Therapeutic advances in inflammatory diseases are expected to improve the prognosis of AA amyloidosis.
Collapse
Affiliation(s)
- Masatoyo Ozawa
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Nephrology, Akita Red Cross Hospital, Akita, Japan
| | - Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
| | - Hiroshi Ohtani
- Department of Nephrology, Akita Kousei Medical Center, Akita, Japan
| | - Mizuho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Ryuta Sato
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Nephrology, Akita Red Cross Hospital, Akita, Japan
| | - Masaru Togashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Hideki Wakui
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Life Science, Akita University Graduate School of Engineering Science, Akita, Japan
| |
Collapse
|
23
|
Topaloglu R, Batu ED, Orhan D, Ozen S, Besbas N. Anti-interleukin 1 treatment in secondary amyloidosis associated with autoinflammatory diseases. Pediatr Nephrol 2016; 31:633-40. [PMID: 26563115 DOI: 10.1007/s00467-015-3249-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amyloidosis may complicate autoinflammatory diseases (AID). We aimed to evaluate the renal biopsy findings, and clinical and laboratory parameters in patients with AID-associated amyloidosis who have responded to anti-interleukin 1(IL1) treatment. METHODS Two children with systemic juvenile idiopathic arthritis and one with cryopyrin-associated periodic syndrome diagnosed as having reactive amyloidosis were treated with anti-IL1 drugs. The renal histopathological findings at the time of diagnosis of amyloidosis and after the onset of anti-IL1 were evaluated according to the amyloid scoring/grading system. RESULTS The median age of disease onset and diagnosis of amyloidosis were 3 and 12 years, respectively. Anakinra was started in all; however, anakinra caused a local cutaneous reaction in one, thus canakinumab was commenced. Proteinuria improved in all. Control renal biopsies were performed a median of 3 years after the first biopsies. The renal amyloid prognostic score did not improve in patient 1, and progressed in patients 2 and 3. The renal amyloid grade progressed in patient 2. CONCLUSIONS This is the first series demonstrating progression of renal tissue damage after the improvement of proteinuria with anti-IL 1 in AID-associated amyloidosis. Anti-IL1 drugs are important to prevent further amyloid accumulation; however, new treatment strategies are needed to target the amyloid deposits.
Collapse
Affiliation(s)
- Rezan Topaloglu
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey.
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatrics, Division of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nesrin Besbas
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| |
Collapse
|
24
|
Wu H, Zhen Y, Ma Z, Li H, Yu J, Xu ZG, Wang XY, Yi H, Yang YG. Arginase-1-dependent promotion of TH17 differentiation and disease progression by MDSCs in systemic lupus erythematosus. Sci Transl Med 2016; 8:331ra40. [PMID: 27009269 PMCID: PMC4895207 DOI: 10.1126/scitranslmed.aae0482] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [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: 12/09/2015] [Accepted: 02/16/2016] [Indexed: 12/22/2022]
Abstract
Expansion of myeloid-derived suppressor cells (MDSCs) has been documented in some murine models and patients with autoimmune diseases, but the exact role of MDSCs in this process remains largely unknown. The current study investigates this question in patients with systemic lupus erythematosus (SLE). Patients with active SLE showed a significant increase in HLA-DR(-)CD11b(+)CD33(+)MDSCs, including both CD14(+)CD66b(-)monocytic and CD14(-)CD66b(+)granulocytic MDSCs, in the peripheral blood compared to healthy controls (HCs). The frequency of MDSCs was positively correlated with the levels of serum arginase-1 (Arg-1) activity, T helper 17 (TH17) responses, and disease severity in SLE patients. Consistently, in comparison with MDSCs from HCs, MDSCs from SLE patients exhibited significantly elevated Arg-1 production and increased potential to promote TH17 differentiation in vitro in an Arg-1-dependent manner. Moreover, in a humanized SLE model, MDSCs were essential for the induction of TH17 responses and the associated renal injuries, and the effect of MDSCs was Arg-1-dependent. Our data provide direct evidence demonstrating a pathogenic role for MDSCs in human SLE. This study also provides a molecular mechanism of the pathogenesis of SLE by demonstrating an Arg-1-dependent effect of MDSCs in the development of TH17 cell-associated autoimmunity, and suggests that targeting MDSCs or Arg-1 may offer potential therapeutic strategies for the treatment of SLE and other TH17 cell-mediated autoimmune diseases.
Collapse
Affiliation(s)
- Hao Wu
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Yu Zhen
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Zhanchuan Ma
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Huimin Li
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Jinyu Yu
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Zhong-Gao Xu
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China
| | - Xiang-Yang Wang
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Huanfa Yi
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China.
| | - Yong-Guang Yang
- The First Hospital and Institute of Immunology, Jilin University, Changchun 130061, China. Department of Medicine, Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| |
Collapse
|
25
|
Ding LH, Liu D, Xu M, Wu M, Liu H, Tang RN, Ma KL, Chen PS, Liu BC. TLR2-MyD88-NF-κB pathway is involved in tubulointerstitial inflammation caused by proteinuria. Int J Biochem Cell Biol 2015; 69:114-20. [PMID: 26485683 DOI: 10.1016/j.biocel.2015.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 03/13/2015] [Revised: 09/23/2015] [Accepted: 10/13/2015] [Indexed: 01/04/2023]
Abstract
Proteinuria is an important risk factor for chronic kidney diseases (CKD). Several studies have suggested that proteinuria initiates tubulointerstitial inflammation, while the mechanisms have not been fully understood. In this study, we hypothesized whether the activation of the TLR2-MyD88-NF-κB pathway is involved in tubulointerstitial inflammation induced by proteinuria. We observed expression of TLR2, MyD88, NF-κB, as well as TNF-α and IL-6 detected by immunohistostaining, Western blotting and real-time PCR in albumin-overloaded (AO) nephropathy rats. In vitro, we observed these markers in HK-2 cells stimulated by albumin. We used TLR2 siRNA or the NF-κB inhibitor BAY 11-7082 to observe the influence of TNF-α and IL-6 expression caused by albumin overload. Finally, we studied these markers in non-IgA mesangioproliferative glomerulonephritis (MsPGN) patients with different levels of proteinuria. It was demonstrated that expression of TLR2, MyD88 and NF-κB were significantly increased in AO rats and in non-IgA MsPGN patients with high levels of proteinuria, and TNF-α and IL-6 expressions were increased after NF-κB activation. Furthermore, TNF-α and IL-6 expression was positively correlated with the level of proteinuria. Albumin-overload induced TNF-α and IL-6 secretions by the TLR2-MyD88-NF-κB pathway activation, which could be attenuated by the TLR2 siRNA or BAY 11-7082 in HK-2 cells. In summary, we demonstrated that proteinuria may exhibit an endogenous danger-associated molecular pattern (DAMP) that induces tubulointerstitial inflammation via the TLR2-MyD88-NF-κB pathway activation.
Collapse
Affiliation(s)
- Li-Hong Ding
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Dan Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Min Xu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Min Wu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Hong Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Ri-Ning Tang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Kun-Ling Ma
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Ping-Sheng Chen
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China.
| |
Collapse
|
26
|
Hünemörder S, Treder J, Ahrens S, Schumacher V, Paust HJ, Menter T, Matthys P, Kamradt T, Meyer-Schwesinger C, Panzer U, Hopfer H, Mittrücker HW. TH1 and TH17 cells promote crescent formation in experimental autoimmune glomerulonephritis. J Pathol 2015; 237:62-71. [PMID: 25965582 DOI: 10.1002/path.4559] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 03/05/2015] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 12/11/2022]
Abstract
Autoimmunity against the Goodpasture antigen α3IV-NC1 results in crescentic glomerulonephritis (GN). Both antibodies and T cells directed against α3IV-NC1 have been implicated in disease development and progression. Using the model of experimental autoimmune glomerulonephritis (EAG) in DBA/1 mice, we aimed to characterize the frequency and function of α3IV-NC1-specific CD4(+) T cells in the kidneys. DBA/1 mice repeatedly immunized with human α3IV-NC1 developed necrotizing/crescentic GN. Kidneys with crescentic GN contained CD4(+) cells responding to α3IV-NC1 with the production of IFN-γ or IL-17A, demonstrating the accumulation of both α3IV-NC1-specific TH1 and TH17 cells. To test the functional relevance of TH1 and TH17 cells, EAG was induced in DBA/1 mice deficient in IFN-γR, IL-17A or IL-23p19. Mice of all knockout groups mounted α3IV-NC1 IgG, developed nephrotic range proteinuria, and IgG deposition to the glomerular basement membranes at levels similar to immunized wild-type mice. However, all knockout groups showed significantly fewer glomerular crescents and attenuated tubulointerstitial damage. Our results suggest that both α3IV-NC1-specific TH1 and TH17 cells accumulate in the kidneys and are crucial for the development of necrotizing/crescentic GN.
Collapse
Affiliation(s)
- Stefanie Hünemörder
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Julia Treder
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stefanie Ahrens
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Valéa Schumacher
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Hans-Joachim Paust
- 3rd Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Thomas Menter
- Institute for Pathology, University Hospital Basel, Switzerland
| | - Patrick Matthys
- Laboratory of Immunobiology, Rega Institute, University of Leuven, Leuven, Belgium
| | - Thomas Kamradt
- Institute for Immunology, University Hospital Jena, Germany
| | | | - Ulf Panzer
- 3rd Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Helmut Hopfer
- Institute for Pathology, University Hospital Basel, Switzerland
| | | |
Collapse
|
27
|
Shi L, Bian Z, Chen CXJ, Guo YN, Lv Z, Zeng C, Liu Z, Zen K, Liu Y. CD47 deficiency ameliorates autoimmune nephritis in Fas(lpr) mice by suppressing IgG autoantibody production. J Pathol 2015; 237:285-95. [PMID: 26095930 DOI: 10.1002/path.4574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 12/10/2014] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 11/07/2022]
Abstract
CD47, a self-recognition marker, plays an important role in both innate and adaptive immune responses. To explore the potential role of CD47 in activation of autoreactive T and B cells and the production of autoantibodies in autoimmune disease, especially systemic lupus erythematosus (SLE), we have generated CD47 knockout Fas(lpr) (CD47(-/-) -Fas(lpr) ) mice and examined histopathological changes in the kidneys, cumulative survival rates, proteinuria, extent of splenomegaly and autoantibodies, serum chemistry and immunological parameters. In comparison with Fas(lpr) mice, CD47(-/-) -Fas(lpr) mice exhibit a prolonged lifespan and delayed autoimmune nephritis, including glomerular cell proliferation, basement membrane thickening, acute tubular atrophy and vacuolization. CD47(-/-) -Fas(lpr) mice have lower levels of proteinuria, associated with reduced deposition of complement C3 and C1q, and IgG but not IgM in the glomeruli, compared to age-matched Fas(lpr) mice. Serum levels of antinuclear antibodies and anti-double-stranded DNA antibodies are significantly lower in CD47(-/-) -Fas(lpr) than in Fas(lpr) mice. CD47(-/-) -Fas(lpr) mice also display less pronounced splenomegaly than Fas(lpr) mice. The mechanistic studies further suggest that CD47 deficiency impairs the antigenic challenge-induced production of IgG but not IgM, and that this effect is associated with reduction of T follicular cells and impairment of germinal centre development in lymphoid tissues. In conclusion, our results demonstrate that CD47 deficiency ameliorates lupus nephritis in Fas(lpr) mice via suppression of IgG autoantibody production.
Collapse
Affiliation(s)
- Lei Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Centre for MicroRNA Biology and Biotechnology, Nanjing University School of Life Sciences, Peoples Republic of China
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Zhen Bian
- State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Centre for MicroRNA Biology and Biotechnology, Nanjing University School of Life Sciences, Peoples Republic of China
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Celia X J Chen
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Ya-Nan Guo
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Zhiyuan Lv
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Caihong Zeng
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China
| | - Zhihong Liu
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China
| | - Ke Zen
- State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Centre for MicroRNA Biology and Biotechnology, Nanjing University School of Life Sciences, Peoples Republic of China
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Yuan Liu
- Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
28
|
|
29
|
Chatterjee P, Chiasson VL, Seerangan G, Tobin RP, Kopriva SE, Newell-Rogers MK, Mitchell BM. Cotreatment with interleukin 4 and interleukin 10 modulates immune cells and prevents hypertension in pregnant mice. Am J Hypertens 2015; 28:135-42. [PMID: 24906486 DOI: 10.1093/ajh/hpu100] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Excessive maternal immune system activation plays a central role in the development of the hypertensive disorder of pregnancy preeclampsia (PE). The immunomodulatory cytokines interleukin 4 (IL-4) and interleukin 10 (IL-10) are dysregulated during PE; therefore we hypothesized that treatment with both recombinant IL-4 and IL-10 during pregnancy could prevent the development of PE in mice. METHODS Using our mouse model of PE in which immune system activation is induced by the double-stranded RNA receptor agonist poly I:C, we gave daily injections of IL-4, IL-10, or both on days 13-17 of pregnancy. Mice were then killed on day 18. RESULTS Poly I:C caused a significant increase in systolic blood pressure in pregnant (P-PIC) mice compared with vehicle-treated pregnant (P) mice. All 3 treatments significantly decreased blood pressure in P-PIC mice to P levels, ameliorated the endothelial dysfunction, and decreased placental TLR3 levels in P-PIC mice. However, only IL-4/IL-10 cotreatment prevented the proteinuria and increased incidence of fetal demise in P-PIC mice; IL-4 or IL-10 alone had no effect. Additionally, only IL-4/IL-10 cotreatment prevented the significant increase in CD3(+)/γδ(+) T cells and CD11c(+) dendritic cells and significant decrease in CD11b(+)/CD14(-) suppressor monocytes, as well as completely prevented placental necrosis, in P-PIC mice. Importantly, IL-4/IL-10 cotreatment in P mice had no detrimental effects. CONCLUSIONS Taken together, these data demonstrate that exogenous IL-4 and IL-10 administration concurrently during pregnancy can normalize immune cell subsets and prevent PE induced by maternal immune system activation.
Collapse
Affiliation(s)
- Piyali Chatterjee
- Department of Internal Medicine, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - Valorie L Chiasson
- Department of Internal Medicine, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - Geetha Seerangan
- Department of Internal Medicine, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - Richard P Tobin
- Department of Surgery, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - Shelley E Kopriva
- Department of Internal Medicine, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - M Karen Newell-Rogers
- Department of Surgery, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas
| | - Brett M Mitchell
- Department of Internal Medicine, Texas A&M Health Science Center/Baylor Scott & White Health, Temple, Texas;
| |
Collapse
|
30
|
Cantaluppi V, Medica D, Mannari C, Stiaccini G, Figliolini F, Dellepiane S, Quercia AD, Migliori M, Panichi V, Giovannini L, Bruno S, Tetta C, Biancone L, Camussi G. Endothelial progenitor cell-derived extracellular vesicles protect from complement-mediated mesangial injury in experimental anti-Thy1.1 glomerulonephritis. Nephrol Dial Transplant 2014; 30:410-22. [PMID: 25488895 DOI: 10.1093/ndt/gfu364] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endothelial progenitor cells (EPCs) are known to induce tissue repair by paracrine mechanisms including the release of growth factors and extracellular vesicles (EVs), nanoparticles able to carry proteins and genetic information to target cells. The aim of this study was to evaluate whether EVs derived from EPCs may protect from complement-mediated mesangial injury in experimental anti-Thy1.1 glomerulonephritis. METHODS EVs were isolated by serial ultracentrifugation from supernatants of cultured human EPCs and characterized for their protein and RNA content. In vivo, EVs were injected i.v. in the experimental rat model of mesangiolytic anti-Thy1.1 glomerulonephritis evaluating renal function, proteinuria, complement activity and histological lesions. In vitro, the biological effects of EPC-derived EVs were studied in cultured rat mesangial cells incubated with anti-Thy1.1 antibody and rat or human serum as complement source. RESULTS After i.v. injection in Thy1.1-treated rats, EVs localized within injured glomeruli and inhibited mesangial cell activation, leucocyte infiltration and apoptosis, decreased proteinuria, increased serum complement haemolytic activity (CH50) and ameliorated renal function. EV treatment decreased intraglomerular deposition of the membrane attack complex (MAC or C5b-9) and expression of smooth muscle cell actin and preserved the endothelial antigen RECA-1 and the podocyte marker synaptopodin. The protective effect of EVs was significantly reduced by pre-treatment with a high dose of RNase (1 U/mL), suggesting a key role for EV-carried RNAs in these mechanisms. Indeed, EPC-derived EVs contained different mRNAs coding for several anti-apoptotic molecules and for the complement inhibitors Factor H, CD55 and CD59 and the related proteins. The in vitro experiments aimed to investigate the mechanisms of EV protection indicated that EVs transferred to mesangial cell mRNAs coding for Factor H, CD55 and CD59 and inhibited anti-Thy1.1 antibody/complement-induced apoptosis and C5b-9/C3 mesangial cell deposition. CONCLUSIONS EVs derived from EPCs exert a protective effect in Thy1.1 glomerulonephritis by inhibition of antibody- and complement-mediated injury of mesangial cells.
Collapse
Affiliation(s)
- Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | - Davide Medica
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Federico Figliolini
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | - Sergio Dellepiane
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessandro Domenico Quercia
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Vincenzo Panichi
- Nephrology and Dialysis Unit, Ospedale Versilia, Camaiore, LU, Italy
| | | | - Stefania Bruno
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | - Ciro Tetta
- EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany
| | - Luigi Biancone
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giovanni Camussi
- Nephrology, Dialysis and Kidney Transplantation Unit and Center for Experimental Medical Research (CeRMS), Department of Medical Sciences, University of Torino, Torino, Italy
| |
Collapse
|
31
|
Yamaji K, Suzuki Y, Suzuki H, Satake K, Horikoshi S, Novak J, Tomino Y. The kinetics of glomerular deposition of nephritogenic IgA. PLoS One 2014; 9:e113005. [PMID: 25409466 PMCID: PMC4237359 DOI: 10.1371/journal.pone.0113005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 07/15/2014] [Accepted: 10/17/2014] [Indexed: 11/18/2022] Open
Abstract
Whether IgA nephropathy is attributable to mesangial IgA is unclear as there is no correlation between intensity of deposits and extent of glomerular injury and no clear mechanism explaining how these mesangial deposits induce hematuria and subsequent proteinuria. This hinders the development of a specific therapy. Thus, precise events during deposition still remain clinical challenge to clarify. Since no study assessed induction of IgA nephropathy by nephritogenic IgA, we analyzed sequential events involving nephritogenic IgA from IgA nephropathy-prone mice by real-time imaging systems. Immunofluorescence and electron microscopy showed that serum IgA from susceptible mice had strong affinity to mesangial, subepithelial, and subendothelial lesions, with effacement/actin aggregation in podocytes and arcade formation in endothelial cells. The deposits disappeared 24-h after single IgA injection. The data were supported by a fluorescence molecular tomography system and real-time and 3D in vivo imaging. In vivo imaging showed that IgA from the susceptible mice began depositing along the glomerular capillary from 1 min and accumulated until 2-h on the first stick in a focal and segmental manner. The findings indicate that glomerular IgA depositions in IgAN may be expressed under the balance between deposition and clearance. Since nephritogenic IgA showed mesangial as well as focal and segmental deposition along the capillary with acute cellular activation, all glomerular cellular elements are a plausible target for injury such as hematuria.
Collapse
Affiliation(s)
- Kenji Yamaji
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hitoshi Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Satake
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Horikoshi
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Jan Novak
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
- * E-mail:
| |
Collapse
|
32
|
Pressler B, Vaden S, Gerber B, Langston C, Polzin D. Consensus guidelines for immunosuppressive treatment of dogs with glomerular disease absent a pathologic diagnosis. J Vet Intern Med 2014; 27 Suppl 1:S55-9. [PMID: 24635381 DOI: 10.1111/jvim.12222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In certain situations, veterinarians must decide whether or not to recommend immunosuppressive therapy for dogs with suspect glomerular disease in the absence of renal biopsy-derived evidence that active immune mechanisms are contributing to glomerular injury. The purpose of this report is to provide guidelines for the use of immunosuppressive drugs under these conditions. ANIMALS Animals were not used in this study. METHODS Recommendations were developed by a formal consensus method. RESULTS Four recommendations were developed and accepted at a high level of consensus (median 92.5% agreement). Renal biopsy should not be performed when contraindications are present or when results will not alter treatment or outcome. Immunosuppressive drugs should not be given when the source of proteinuria is unknown, they are otherwise contraindicated, or a familial nephropathy or amyloidosis is likely. However, they should be considered when dogs are already being given standard therapy and the serum creatinine is >3.0 mg/dL, azotemia is progressive, or hypoalbuminemia is severe. Thorough client communication regarding pros and cons of such treatment as well as close and careful patient monitoring is required. CONCLUSION AND CLINICAL IMPORTANCE These recommendations can help guide the decision about renal biopsy in patients with proteinuria as well as the use of immunosuppressive drugs in those patients where the decision was made not to perform renal biopsy.
Collapse
|
33
|
Lim JH, Yhim HY, Cha EJ, Park MH, Kang KP. Crystals in a patient with asymptomatic proteinuria. Korean J Intern Med 2014; 29:838-9. [PMID: 25378987 PMCID: PMC4219978 DOI: 10.3904/kjim.2014.29.6.838] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jin Han Lim
- Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Eun Jung Cha
- Department of Pathology, Konyang University Hospital, Daejeon, Korea
| | - Moon Hyang Park
- Department of Pathology, Konyang University Hospital, Daejeon, Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| |
Collapse
|
34
|
Yao L, Chen HP, Ma Q. Piperlongumine alleviates lupus nephritis in MRL-Fas(lpr) mice by regulating the frequency of Th17 and regulatory T cells. Immunol Lett 2014; 161:76-80. [PMID: 24837470 DOI: 10.1016/j.imlet.2014.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 03/26/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
Recent data have shown that piperlongumine (PL), an important component of Piper longum fruits, is known to possess anti-inflammatory and vascular-protective activities. This study aimed to examine the therapeutic effects and underlying mechanisms of PL on lupus-prone MRL-Fas(lpr) mice. Female MRL-Fas(lpr) mice were intraperitoneally treated with PL (2.4 mg kg(-1) d(-1)) for 10 weeks, and the proteinuria level was biweekly monitored. After the mice were euthanized, serum biochemical parameters and renal damage were determined. Splenocytes of MRL-Fas(lpr) mice were isolated for in vitro study. Treatment of the mice with PL significantly attenuated the progression of proteinuria and glomerulonephritis. The improvement was accompanied by decreased serum levels of nephritogenic anti-dsDNA antibodies, IL-6, IL-17, IL-23 and TNF-α. Treatment of the mice with PL suppressed the frequency of Th17 cells and increased the regulatory T cells (Tregs). In vitro, the levels of IL-6, IL-17, IL-23 and TNF-α were significantly decreased in the cultures of splenocytes from PL-treated mice compared with those from vehicle-treated mice. In addition, PL treatment impeded activation of the JAK/STAT3 signaling in splenocytes. Of great important, the survival of MRL-Fas(lpr) mice were improved by PL treatment. In summary, PL effectively ameliorates lupus syndrome in MRL-Fas(lpr) mice by suppressing the pathogenic Th17 cells and increasing the Tregs as well as inhibiting activation of the JAK/STAT3 signaling pathway. This study sheds new light on the immune-modulatory role of PL.
Collapse
Affiliation(s)
- Lan Yao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hai-ping Chen
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Qing Ma
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| |
Collapse
|
35
|
Chuan W, Wu-qing W, Zhu-wen Y, Zuo L. Effect of nonmyeloablative unrelated fetal and neonatal murine peripheral blood mononuclear cell infusion on MRL/lpr mice. Lupus 2014; 23:994-1005. [PMID: 24756437 DOI: 10.1177/0961203314532561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 12/29/2022]
Abstract
For patients with refractory systemic lupus erythematosus (SLE), current medications are insufficient to control their condition, and new treatments are necessary. We investigated the effect of fetal and neonatal murine peripheral blood (FNPB) mononuclear cells on MRL/lpr lupus-prone mice. Female MRL/lpr mice were randomized to three groups (control, radiation and infusion groups). The infusion group had significantly better results for survival rate, body weight increase, reduction of spleen index, serum anti-ds-DNA antibody, antinuclear antibodies (ANA) and creatinine (Cr), 24 h urine protein and pathological renal tissue lesions than either the control or radiation group. Graft versus host disease (GVHD) was not observed in MRL/lpr mice in the infusion group. The infusion group also had better hematogenesis reconstruction than the radiation group. Flow cytometry analysis revealed a significant increase in Th1, CD8+ T and T reg cells and a reduction in Th2, CD4+ T and Th17 cells in the peripheral blood of the radiation and infusion groups compared with the control group. Immunocytochemical assay revealed a significant increase in serum transforming growth factor (TGF)-β and a significant reduction in interleukin (IL)-17 in the radiation and infusion groups compared with the control group. Therefore, our study showed that FNPB mononuclear cell infusion has a significant role in regulating CD4+ T cells, Th1/Th2, Th17/T reg balance and their corresponding cytokines in MRL/lpr mice. The FNPB mononuclear cell infusion provided evidence in animals and suggested a potential clinical application for umbilical cord blood transplantation to treat SLE patients.
Collapse
MESH Headings
- Animals
- Animals, Newborn
- Antibodies, Antinuclear/blood
- Biomarkers/blood
- CD4-Positive T-Lymphocytes/immunology
- Creatinine/blood
- Cytokines/blood
- Disease Models, Animal
- Female
- Gestational Age
- Hematopoiesis
- Kidney/immunology
- Kidney/pathology
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/transplantation
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/genetics
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Lupus Erythematosus, Systemic/surgery
- Mice, Inbred C57BL
- Mice, Inbred MRL lpr
- Proteinuria/immunology
- Proteinuria/prevention & control
- Spleen/immunology
- T-Lymphocytes, Regulatory/immunology
- Th1 Cells/immunology
- Th17 Cells/immunology
- Th2 Cells/immunology
- Time Factors
- Whole-Body Irradiation
Collapse
Affiliation(s)
- W Chuan
- Department of Pediatrics, Second Xiangya Hospital of Central South University, Changsha, China
| | - W Wu-qing
- Department of Pediatrics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Y Zhu-wen
- Department of Pediatrics, Second Xiangya Hospital of Central South University, Changsha, China
| | - L Zuo
- Department of Pediatrics, Navy General Hospital of People's Liberation Army, Beijing city, China
| |
Collapse
|
36
|
Tsai YG, Lee CY, Lin TY, Lin CY. CD8⁺ Treg cells associated with decreasing disease activity after intravenous methylprednisolone pulse therapy in lupus nephritis with heavy proteinuria. PLoS One 2014; 9:e81344. [PMID: 24475019 PMCID: PMC3903465 DOI: 10.1371/journal.pone.0081344] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/11/2013] [Indexed: 01/26/2023] Open
Abstract
We focus on the role of CD8+ Treg cell in Intravenous methyl-prednisolone (IVMP) pulse therapy in forty patients with active Class III/IV childhood lupus nephritis (LN) with heavy proteinuria. IVMP therapy for five days. From peripheral blood mononuclear cells (PBMCs) and renal tissues, we saw IVMP therapy definitely restoring both CD4+CD25+FoxP3+ and CD8+CD25+Foxp3+ Treg cell number plus greater expression with intracellular IL-10 and granzyme B in CD8+FoxP3+ Treg from PBMCs. IVMP-treated CD8+CD25+ Treg cells directly suppressed CD4+ T proliferation and induced CD4+CD45RO+ apoptosis. Histologically, CD4+FoxP3+ as well as CD8+FoxP3+ Treg cells appeared in renal tissue of LN patients before IVMP by double immunohistochemical stain. CD8+FoxP3+ Treg cells increased in 10 follow-up renal biopsy specimens after IVMP. Reverse correlation of serum anti-C1q antibody and FoxP3+ Treg cells in PBMNCs (r = −0.714, P<0.01). After IVMP, serum anti-C1q antibody decrease accompanied increase of CD4+FoxP3+ Treg cells. CD8+Treg cells reduced interferon-r response in PBMCs to major peptide autoepitopes from nucleosomes after IVMP therapy; siRNA of FoxP3 suppressed granzyme B expression while decreasing CD8+CD25+Treg-induced CD4+CD45RO+ apoptosis. Renal activity of LN by SLEDAI-2k in childhood LN was significantly higher than two weeks after IVMP (P<0.01). CD8+FoxP3+ Treg cells return in post-IVMP therapy and exert crucial immune modulatory effect to control autoimmune response in LN.
Collapse
Affiliation(s)
- Yi-Giien Tsai
- Departments of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Ying Lee
- Division of Pediatric Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tze-Yi Lin
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Yuang Lin
- Division of Pediatric Nephrology, China Medical University Hospital, Taichung, Taiwan
- Clinical Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
37
|
Hafez SS, Saad WES, Shedid NH. B-cell-attracting chemokine-1 (BCA-1/CXCL13) in systemic lupus erythematosus, its correlation to disease activity and renal involvement. Egypt J Immunol 2014; 21:23-32. [PMID: 25812350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Systemic lupus erythematosus (SLE) is a prototype of systemic autoimmune disease in which cytokines such as B lymphocyte chemoattractant (BLC or CXCL13) may play important roles in pathogenesis. The aim of our study was to investigate the implications of CXCL13 in SLE diagnosis and its correlation with disease activity and renal involvement. The study included 50 adult female patients with SLE and 30 age-matched female healthy individuals serving as a control group. Patients' Group was further subdivided according to disease activity calculated by SLE Disease Activity Index (SLEDAI). All studied individuals were subjected to assessment of serum CXCL13 by ELISA. A highly significant stepwise progressive increase in CXCL 13 level was recorded through controls, inactive SLE and active disease (P < 0.01). Moreover, it correlated positively with SLEDAI and proteinuria (P < 0.01). At a cut- off level 80 pg/mL, CXCL13 could discriminate active SLE from inactive (AUC = 0.989, sensitivity 100% & specificity 96%). In conclusion, an increased level of CXCL13 is a distinctive feature in SLE. CXCL13 correlates with disease activity and renal involvement.
Collapse
|
38
|
Peng ZG, Tian J. Higher Serum Trough Levels of Tacrolimus Increase 5-Year Allograft Survival in Antibody Positive Renal Transplant Patients. Clin Transpl 2014:209-214. [PMID: 26281147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The presence of human leukocyte antigen (HLA) and major histocompatibility complex class I chain-related gene-A (MICA) antibodies after transplantation is correlated with rejection episodes, proteinuria, and renal allografts loss. We assessed the clinical value of high-dose tacrolimus on post-transplant HLA and MICA antibodies and proteinuria after renal transplantation. METHODS Post-transplant sera of 310 renal transplantation patients who were negative for antibodies prior to transplant were tested by Luminex flow cytometry for HLA antibodies and MICA antibodies posttransplant. Once a patient was found to be antibody positive (Ab+), tacrolimus was dosed at two different concentrations: high tacrolimus Ab+ group (11 ± 1.36 ng/mL average tacrolimus trough) or low tacrolimus Ab+ group (7 ± 1.28 ng/mL average tacrolimus trough). Antibody negative (Ab-) patients were also studied and were given comparable tacrolimus doses to the low tacrolimus Ab+ group (7 ± 1.28 ng/mL average tacrolimus trough). Proteinuria was measured using the pyrogallol method. All patients were followed for 5 years after renal transplantation. Associations between tacrolimus, proteinuria, and survival were analyzed. RESULTS In the HLA or MICA Ab+ patients, proteinuria decreased after 5 years in the high tacrolimus Ab+ group unlike the low tacrolimus Ab+ group. Allograft survival in the high tacrolimus Ab+ group was significantly higher than the low tacrolimus Ab+ group and was similar to that of the Ab- group. CONCLUSIONS High-dose tacrolimus might play a role in improving allograft survival in HLA or MICA Ab+ post-transplant patients. Increasing tacrolimus concentration might be a plausible treatment for Ab+ post-transplant patients.
Collapse
|
39
|
Abstract
Preeclampsia (PE) is an important, common, and dangerous complication of pregnancy; it causes maternal and perinatal illness and is responsible for a high proportion of maternal and infant deaths. PE is associated with increased blood pressure and proteinuria, with a whole host of other potentially serious complications in the mother and fetus. The maternal syndrome in PE is primarily that of generalized dysfunction of the maternal endothelium, and this generalized endothelial dysfunction appears to be part of an exaggerated systemic inflammatory response that involves maternal leukocytes and proinflammatory cytokines. This review examines evidence that points to a significant role for the maternal immune system; inadequate trophoblast invasion of spiral arteries initiates ischemia and hypoxia in the placenta, resulting in an increased release of proinflammatory cytokines in the placenta. Placental ischemia and hypoxia also cause the enhanced release of trophoblast microparticles into the maternal circulation which stimulates increased induction of proinflammatory cytokines and the activation of maternal endothelial cells. This activation results in a systemic, diffuse endothelial cell dysfunction which is the fundamental pathophysiological feature of this syndrome. Recent evidence also supports important roles for proinflammatory cytokines in hypertension, proteinuria, and edema which are characteristic features of PE.
Collapse
Affiliation(s)
- Raj Raghupathy
- Department of Microbiology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Safat, Kuwait
| |
Collapse
|
40
|
Eller K, Schroll A, Banas M, Kirsch AH, Huber JM, Nairz M, Skvortsov S, Weiss G, Rosenkranz AR, Theurl I. Lipocalin-2 expressed in innate immune cells is an endogenous inhibitor of inflammation in murine nephrotoxic serum nephritis. PLoS One 2013; 8:e67693. [PMID: 23861783 PMCID: PMC3701542 DOI: 10.1371/journal.pone.0067693] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 04/03/2013] [Accepted: 05/19/2013] [Indexed: 12/12/2022] Open
Abstract
Lipocalin-2 (Lcn-2) is involved in divergent processes such as acute kidney injury or bacterial host defence. Our study was designed to evaluate the functional role of Lcn-2 in nephrotoxic serum nephritis (NTS). Since Lcn-2 is expressed in tubular epithelial cells as well as in cells of innate immunity such as macrophages and polymorphonuclear neutrophils (PMN), we induced NTS in wild-type (WT), Lcn-2 knock-out (KO) mice and WT/Lcn-2 KO chimeras. Mice lacking Lcn-2 exhibited more glomerular damage with increased proteinuria and interstitial leukocyte accumulation compared to WT mice. Chimeras able to express Lcn-2 in macrophages and PMN but not in epithelial cells were found to develop NTS comparable to wild-type controls. In contrast, chimeras expressing Lcn-2 in tubular epithelial cells with no expression in innate immune cells developed increased NTS due to decreased concerted apoptosis but increased necrosis and formation of damage-associated molecular patterns (DAMPs) such as high-mobility group box 1 (HMGB-1) in the kidney. In vivo blockade of HMGB-1, a toll-like receptor (TLR)-2 agonist, significantly reduced inflammation and NTS in Lcn-2 knock-out mice. In parallel, TLR-2 signalling was found to drive Lcn-2 transcription in vitro. Taken together, Lcn-2 expressed in innate immune cells is protective in NTS by inducing concerted apoptosis and inhibiting the formation of HMGB-1 thereby limiting cytokine production via TLR-2 signalling. In parallel, TLR-2 dependent transcription of Lcn-2 is an endogenous inhibitor of inflammation in NTS.
Collapse
Affiliation(s)
- Kathrin Eller
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail: (KE); (IT)
| | - Andrea Schroll
- Clinical Immunology and Infectious Diseases, Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Miriam Banas
- Department of Nephrology, Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alexander H. Kirsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia M. Huber
- Laboratory for Molecular Cell Biology, Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Manfred Nairz
- Clinical Immunology and Infectious Diseases, Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Sergej Skvortsov
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Günter Weiss
- Clinical Immunology and Infectious Diseases, Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Alexander R. Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Igor Theurl
- Clinical Immunology and Infectious Diseases, Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
- * E-mail: (KE); (IT)
| |
Collapse
|
41
|
Moritoki M, Kadowaki T, Niki T, Nakano D, Soma G, Mori H, Kobara H, Masaki T, Kohno M, Hirashima M. Galectin-9 ameliorates clinical severity of MRL/lpr lupus-prone mice by inducing plasma cell apoptosis independently of Tim-3. PLoS One 2013; 8:e60807. [PMID: 23585851 PMCID: PMC3621869 DOI: 10.1371/journal.pone.0060807] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 11/05/2012] [Accepted: 03/03/2013] [Indexed: 11/19/2022] Open
Abstract
Galectin-9 ameliorates various murine autoimmune disease models by regulating T cells and macrophages, although it is not known what role it may have in B cells. The present experiment shows that galectin-9 ameliorates a variety of clinical symptoms, such as proteinuria, arthritis, and hematocrit in MRL/lpr lupus-prone mice. As previously reported, galectin-9 reduces the frequency of Th1, Th17, and activated CD8(+) T cells. Although anti-dsDNA antibody was increased in MRL/lpr lupus-prone mice, galectin-9 suppressed anti-dsDNA antibody production, at least partly, by decreasing the number of plasma cells. Galectin-9 seemed to decrease the number of plasma cells by inducing plasma cell apoptosis, and not by suppressing BAFF production. Although about 20% of CD19(-/low) CD138(+) plasma cells expressed Tim-3 in MRL/lpr lupus-prone mice, Tim-3 may not be directly involved in the galectin-9-induced apoptosis, because anti-Tim-3 blocking antibody did not block galectin-9-induced apoptosis. This is the first report of plasma cell apoptosis being induced by galectin-9. Collectively, it is likely that galectin-9 attenuates the clinical severity of MRL lupus-prone mice by regulating T cell function and inducing plasma cell apoptosis.
Collapse
Affiliation(s)
- Masahiro Moritoki
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takeshi Kadowaki
- Department of Immunology and Immunopathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Holistic Immunology, Kagawa University, Kagawa, Japan
| | - Toshiro Niki
- Department of Immunology and Immunopathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Genichiro Soma
- Department of Holistic Immunology, Kagawa University, Kagawa, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masakazu Kohno
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mitsuomi Hirashima
- Department of Immunology and Immunopathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- * E-mail:
| |
Collapse
|
42
|
Sun Q, Jiang S, Li X, Huang X, Xie K, Cheng D, Chen J, Ji S, Wen J, Zhang M, Zeng C, Liu Z. The prevalence of immunologic injury in renal allograft recipients with de novo proteinuria. PLoS One 2012; 7:e36654. [PMID: 22586485 PMCID: PMC3346732 DOI: 10.1371/journal.pone.0036654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/13/2011] [Accepted: 04/04/2012] [Indexed: 11/19/2022] Open
Abstract
Post-transplant proteinuria is a common complication after renal transplantation; it is associated with reduced graft and recipient survival. However, the prevalence of histological causes has been reported with considerable variation. A clinico-pathological re-evaluation of post-transplant proteinuria is necessary, especially after dismissal of the term “chronic allograft nephropathy,” which had been considered to be an important cause of proteinuria. Moreover, urinary protein can promote interstitial inflammation in native kidney, whether this occurs in renal allograft remains unknown. Factors that affect the graft outcome in patients with proteinuria also remain unclear. Here we collected 98 cases of renal allograft recipients who developed proteinuria after transplant, histological features were characterized using Banff scoring system. Cox proportional hazard regression models were used for graft survival predictors. We found that transplant glomerulopathy was the leading (40.8%) cause of post-transplant proteinuria. Immunological causes, including transplant glomerulopathy, acute rejection, and chronic rejection accounted for the majority of all pathological causes of proteinuria. Nevertheless, almost all patients that developed proteinuria had immunological lesions in the graft, especially for interstitial inflammation. Intraglomerular C3 deposition was unexpectedly correlated with the severity of proteinuria. Moreover, the severity of interstitial inflammation was an independent risk factor for graft loss, while high level of hemoglobin was a protective factor for graft survival. This study revealed a predominance of immunological parameters in renal allografts with post-transplant proteinuria. These parameters not only correlate with the severity of proteinuria, but also with the outcome of the graft.
Collapse
Affiliation(s)
- Qiquan Sun
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Shalaby SA, El Idrissy HM, Safar RA, Hussein ST. Glucocorticoid receptors and the pattern of steroid response in idiopathic nephrotic syndrome. Arab J Nephrol Transplant 2012; 5:13-17. [PMID: 22283861] [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: 05/31/2023]
Abstract
INTRODUCTION Little is known about the relationships between the T lymphocytes (CD3+) expression of glucocorticoid receptors (GCR) and the response to glucocorticoid treatment in children with idiopathic nephrotic syndrome (NS). The aim of the current study is to determine whether steroid responsiveness is dependent on the amount of T lymphocytes GCR expression. METHODS We studied 60 children with idiopathic NS in the age group from 2-10 years. According to the response to steroids we classified our patients into early responders (ER; n = 46) and late responders (LR; n = 14). Sixty age and gender matched healthy children represented the control group. The clinical and laboratory findings at baseline and GCR expression by T lymphocytes (CD3+) as determined by flow cytometry were compared between the three groups. RESULTS The T lymphocytes (CD3+) expression of GCR was significantly lower in the LR than that in the control group (P < 0.01), whereas it was similar in the ER and control groups. GCR expression was also decreased in the LR group compared to the ER group (P < 0.01). Furthermore, the T lymphocytes (CD3+) expression of GCR correlated inversely with the time to complete remission (CR) (r = -0.54, P < 0.05), but not with urinary protein excretion at baseline. CONCLUSION The levels of T lymphocytes (CD3+) expression of GCR may be a useful predictor of steroid responsiveness in children presenting with idiopathic NS.
Collapse
Affiliation(s)
- Sherein A Shalaby
- Department of Pediatrics, College of Medicine, Taibah University, Saudi Arabia.
| | | | | | | |
Collapse
|
44
|
Sato N, Ohsawa I, Nagamachi S, Ishii M, Kusaba G, Inoshita H, Toki A, Horikoshi S, Ohi H, Matsushita M, Tomino Y. Significance of glomerular activation of the alternative pathway and lectin pathway in lupus nephritis. Lupus 2011; 20:1378-86. [PMID: 21893562 DOI: 10.1177/0961203311415561] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [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: 01/28/2023]
Abstract
The objective of the present study was to elucidate the association between glomerular complement depositions belonging to the alternative (AP) and lectin (LP) pathways, and clinical findings of lupus nephritis (LN). Immunofluorescence (IF) was performed on 17 LN patients using antibodies against factor B, factor H, properdin, mannose-binding lectin (MBL) and L-ficolin. Compared with factor B/factor H negative patients (n = 9), positive patients (n = 8) showed longer duration of LN (p < 0.05) and more severe interstitial fibrosis (p < 0.05). Eleven patients had properdin deposition in glomeruli, and in three of them, with a duration of LN of less than 1 month, factor B was undetectable. Compared with properdin negative patients (n = 6), positive patients (n = 11) showed significantly higher urinary protein excretion (p < 0.01). MBL/L-ficolin positive patients (n = 11) also had significantly higher urinary protein excretion (p < 0.05) compared with negative patients (n = 6). An independent association was found between glomerular deposition of properdin and that of MBL/L-ficolin (p < 0.01) in addition to factor B/factor H. Traces of glomerular activation of AP and LP reflected the clinical status of LN. It appears that glomerular deposition of each complement component, especially properdin, may be an index of the histological activity of LN.
Collapse
Affiliation(s)
- N Sato
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Wan YG, Sun W, Zhen YJ, Che XY, Pu HP, Wang Y, Li M, Ruan JG, Yan QJ. Multi-glycoside of Tripterygium wilfordii Hook. f. reduces proteinuria through improving podocyte slit diaphragm dysfunction in anti-Thy1.1 glomerulonephritis. J Ethnopharmacol 2011; 136:322-333. [PMID: 21570456 DOI: 10.1016/j.jep.2011.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 05/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Multi-glycoside of Tripterygium wilfordii Hook. f. (GTW) has been proved clinically effective in reducing proteinuria in chronic kidney disease in China. However, the mechanisms involved are still unclear. In this study we examined the effects of GTW at the different dosages on proteinuria and podocyte slit diaphragm (SD) dysfunction in anti-Thy1.1 glomerulonephritis (GN). MATERIALS AND METHODS Rats with anti-Thy1.1 GN were divided into 2 groups, a GTW group and a vehicle group, and sacrificed at 30 min, on day 7, and on day 14 in Experiments 1, 2 and 3, respectively. The administration of GTW at the moderate and high doses was started 3 days before or at the same time of antibody injection till sacrifice. Proteinuria was determined in Experiments 1, 2, and 3. After sacrifice, the staining intensity of SD-associated key functional molecules including nephrin and podocin, podocyte structure, mesangial change, macrophage infiltration, and blood biochemical parameters were examined, respectively. Protein and mRNA expressions of nephrin and podocin in glomeruli were also investigated. Besides, liver histological characteristics were analyzed. RESULTS In Experiment 1, GTW pretreatment at the medium dose (75 mg/kg body weight) caused no influence on the induction of anti-Thy1.1 GN and the basal nephrin expression. In Experiment 2, the high dosage (100mg/kg body weight) of GTW ameliorated proteinuria, the distribution of nephrin and podocin, mesangial proliferation, and the activated macrophage accumulation, as compared with vehicle group (P<0.05). Additionally, it increased mRNA and protein expressions of nephrin and podocin in glomeruli on day 7, but had no influence on podocyte structure. In Experiment 3, the medium dosage (75 mg/kg body weight) of GTW improved proteinuria, the partial matrix expansion, and the distribution of nephrin and podocin on day 14, as compared with anti-Thy1.1 GN rats (P<0.05). GTW at the high or moderate dose did not affect hepatic function on day 7 and on day 14. CONCLUSIONS Podocyte SD dysfunction, such as the disordered distribution and down-regulation of nephrin and podocin expression, is critically involved in the pathogenesis of anti-Thy1.1 GN induced by mAb 1-22-3. The restoration of the distribution and expression of nephrin and podocin by GTW could be an important mechanism by which GTW ameliorates proteinuria and podocyte SD dysfunction.
Collapse
Affiliation(s)
- Yi-Gang Wan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Trachtman H, Fervenza FC, Gipson DS, Heering P, Jayne DRW, Peters H, Rota S, Remuzzi G, Rump LC, Sellin LK, Heaton JPW, Streisand JB, Hard ML, Ledbetter SR, Vincenti F. A phase 1, single-dose study of fresolimumab, an anti-TGF-β antibody, in treatment-resistant primary focal segmental glomerulosclerosis. Kidney Int 2011; 79:1236-43. [PMID: 21368745 PMCID: PMC3257033 DOI: 10.1038/ki.2011.33] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [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] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/20/2010] [Accepted: 01/04/2011] [Indexed: 11/23/2022]
Abstract
Primary focal segmental glomerulosclerosis (FSGS) is a disease with poor prognosis and high unmet therapeutic need. Here, we evaluated the safety and pharmacokinetics of single-dose infusions of fresolimumab, a human monoclonal antibody that inactivates all forms of transforming growth factor-β (TGF-β), in a phase I open-label, dose-ranging study. Patients with biopsy-confirmed, treatment-resistant, primary FSGS with a minimum estimated glomerular filtration rate (eGFR) of 25 ml/min per 1.73 m(2), and a urine protein to creatinine ratio over 1.8 mg/mg were eligible. All 16 patients completed the study in which each received one of four single-dose levels of fresolimumab (up to 4 mg/kg) and was followed for 112 days. Fresolimumab was well tolerated with pustular rash the only adverse event in two patients. One patient was diagnosed with a histologically confirmed primitive neuroectodermal tumor 2 years after fresolimumab treatment. Consistent with treatment-resistant FSGS, there was a slight decline in eGFR (median decline baseline to final of 5.85 ml/min per 1.73 m(2)). Proteinuria fluctuated during the study with the median decline from baseline to final in urine protein to creatinine ratio of 1.2 mg/mg with all three Black patients having a mean decline of 3.6 mg/mg. The half-life of fresolimumab was ∼14 days, and the mean dose-normalized Cmax and area under the curve were independent of dose. Thus, single-dose fresolimumab was well tolerated in patients with primary resistant FSGS. Additional evaluation in a larger dose-ranging study is necessary.
Collapse
MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Biomarkers/urine
- Biopsy
- Creatinine/urine
- Dose-Response Relationship, Drug
- Europe
- Female
- Glomerular Filtration Rate/drug effects
- Glomerulosclerosis, Focal Segmental/drug therapy
- Glomerulosclerosis, Focal Segmental/immunology
- Glomerulosclerosis, Focal Segmental/pathology
- Glomerulosclerosis, Focal Segmental/physiopathology
- Humans
- Infusions, Parenteral
- Kidney/drug effects
- Kidney/immunology
- Kidney/pathology
- Kidney/physiopathology
- Male
- Middle Aged
- Proteinuria/drug therapy
- Proteinuria/immunology
- Transforming Growth Factor beta/antagonists & inhibitors
- Transforming Growth Factor beta/immunology
- Treatment Outcome
- United States
- Young Adult
Collapse
Affiliation(s)
- Howard Trachtman
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Malleshappa P, Ranganath R, Chaudhari AP, Ayiangar A, Lohitaksha S. C1q nephropathy presenting as acute renal failure. Saudi J Kidney Dis Transpl 2011; 22:324-326. [PMID: 21422635] [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: 05/30/2023] Open
Abstract
We describe a 42-year-old male patient who presented with high grade fever associated with acute renal failure requiring hemodialysis. Renal biopsy revealed that he had focal proliferative glomerulonephritis on light microscopy, dominant mesangial deposition of C1q by immunofluorescent staining, and electron dense deposits on electron microscopy, with no evidence of systemic lupus erythematosus, compatible with the diagnosis of C1q nephropathy. Intensive treatment with a combination of methyl prednisolone pulse therapy and oral prednisolone was successful in achieving complete remission and disappearance of proteinuria in our patient.
Collapse
Affiliation(s)
- Pavan Malleshappa
- Department of Nephrology, Lilavati Hospital and Research Centre, Mumbai, India.
| | | | | | | | | |
Collapse
|
48
|
Inoue T, Sugiyama H, Hiki Y, Takiue K, Morinaga H, Kitagawa M, Maeshima Y, Fukushima K, Nishizaki K, Akagi H, Narimatsu Y, Narimatsu H, Makino H. Differential expression of glycogenes in tonsillar B lymphocytes in association with proteinuria and renal dysfunction in IgA nephropathy. Clin Immunol 2010; 136:447-55. [PMID: 20538527 DOI: 10.1016/j.clim.2010.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 05/01/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
Abstract
Aberrant O-glycosylation of serum and tonsillar IgA1 is one of the main pathogeneses of IgA nephropathy (IgAN). However, the synthesis of underglycosylated IgA1 in tonsils has not yet been characterized. This study examined tonsillar B lymphocytes of IgAN (n=34) using tonsils derived from patients with chronic tonsillitis (n=24) and sleep apnea syndrome (n=14) as a control. Gene expression of beta1,3-galactosyltransferase (beta3GalT), and the core 1 beta3GalT-specific molecular chaperone, Cosmc, UDP-N-acetyl-alpha-D-galactosamine: polypeptide N-acetylgalactosaminyl-transferase 2, were significantly decreased in tonsillar CD19-positive B lymphocytes from IgAN patients compared to control tonsillar tissues as determined by real-time RT-PCR. Tonsillar B cell beta3GalT gene expression significantly correlated with estimated GFR and negatively correlated with proteinuria and histological injury score. Western blotting showed the protein expression of beta3GalT in the tonsils to significantly decrease in IgAN in comparison to the controls. These data suggest the downregulation of beta3GalT in tonsillar B lymphocytes to be closely associated with the clinical characteristics of IgAN.
Collapse
Affiliation(s)
- Tatsuyuki Inoue
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lee SW, Kim BS. Comparison of therapeutic efficacy between bortezomib and combination treatment of prednisolone and mycophenolate mofetil on nephritis in NZB/WF1 mice. Clin Exp Rheumatol 2010; 28:393-396. [PMID: 20497633] [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] [Received: 08/12/2009] [Accepted: 01/08/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES We investigated the efficacy of bortezomib on nephritis in NZB/WF1 mice, and compared it to prednisolone (PL) and mycophenolate mofetil (MMF) treatment. METHODS Twenty-three NZB/WF1 mice were divided into four groups (untreated, 0.1 mg/kg and 1 mg/kg bortezomib-treated, and PL plus MMF-treated). Proteinuria, glomerular IgG deposition, cellular proliferation and histologic damages were evaluated. RESULTS In comparison with the untreated mice, 1 mg/kg bortezomib significantly reduced proteinuria and attenuated glomerular IgG deposition, cellular proliferation and histologic damages similar to PL plus MMF. 0.1 mg/kg bortezomib significantly improved glomerular IgG deposition and histologic damages except proteinuria or cellular proliferation compared to untreated mice. PL plus MMF showed significantly greater inhibition of cellular proliferation and histologic damage than 1 mg/kg bortezomib. CONCLUSIONS We found that 1 mg/kg bortezomib significantly improved lupus nephritis in NZB/WF1 mice. However, its efficacy did not exceed PL plus MMF treatment.
Collapse
Affiliation(s)
- Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | |
Collapse
|
50
|
Lubetzky M, Auli MJ, Walker J, Leeser D, Kapur S, Hartono C, Dadhania D. Reduction in proteinuria with bortezomib based therapy for antibody mediated rejection. Clin Transpl 2010:437-440. [PMID: 21696061] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Michelle Lubetzky
- Department of Transplantation Medicine, New York Presbyterian Hospital/Weill Cornell Medical College, New York, USA
| | | | | | | | | | | | | |
Collapse
|