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      CD68 and MCP-1/CCR2 Expression of Initial Biopsies Reflect the Outcomes of Membranous Nephropathy

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          Background: A considerable diversity of prognosis is seen with idiopathic membranous nephropathy (IMN). The initial factors affecting long-term outcome remain unclear. Methods: We studied retrospectively 30 patients with IMN who had been followed up for at least 5 years, or until end-stage renal failure (ESRF). We analyzed the prognostic factors of ESRF in the first renal biopsies; these factors included presence of tubulointerstitial lesions and foam cells, as well as expression of CD68, monocyte chemoattractant protein-1 (MCP-1), its cognate receptor chemokine receptor 2 (CCR2) and α-smooth muscle actin. Results: The patients who developed ESRF showed higher percentages of glomerular segmental sclerosis, interstitial MCP-1 expression, CCR2- or CD68-positive monocyte/macrophages and foam cells in the interstitium, and these proved on multivariate analysis to be independent risk factors for ESRF. Finally, ESRF was characterized by the presence of ten interstitial CD68-positive cells per visual field at 200× magnification (hazard ratio 4.096, CI 1.271–15.029, p < 0.001). Conclusions: Our results suggested that an interstitial infiltration of CD68-positive cells accompanied by MCP-1/CCR2 expression is the most significant indicator of ESRF in IMN.

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          Fibroblasts regulate the switch from acute resolving to chronic persistent inflammation.

          Fibroblasts are important sentinel cells in the immune system and, here, it is proposed that these cells play a critical role in the switch from acute inflammation to adaptive immunity and tissue repair. It is suggested that chronic inflammation occurs because of disordered fibroblast behaviour in which failure to switch off their inflammatory programme leads to the inappropriate survival and retention of leukocytes within inflamed tissue.
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            Overexpression of chemokines, fibrogenic cytokines, and myofibroblasts in human membranous nephropathy.

            Overexpression of chemokines, fibrogenic cytokines, and myofibroblasts in human membranous nephropathy. Proteinuria plays a central role in the progression of glomerular disease, and there is growing evidence suggesting that it may determine tubular cell activation with release of chemokines and fibrogenic factors, leading to interstitial inflammatory reaction. However, most studies on this subject have been performed in experimental models, and the experience in human kidney biopsies has been scarce. We analyzed the tissue sections of patients with idiopathic membranous nephropathy (IMN), a noninflammatory glomerular disease that may follow a progressive disease with heavy persistent proteinuria, interstitial cell infiltration, and decline of renal function. Paraffin-embedded biopsy specimens from 25 patients with IMN (13 progressive and 12 nonprogressive) were retrospectively studied by immunohistochemistry [monocyte chemoattractant protein-1 (MCP-1), regulated on activation normal T-cell expressed and secreted chemokine (RANTES), osteopontin (OPN), platelet-derived growth factor-BB (PD-GF-BB)] and in situ hybridization [MCP-1, RANTES, PDGF-BB, transforming growth factor-beta1 (TGF-beta1)]. Moreover, we studied the presence of myofibroblasts, which were identified by the expression of alpha-smooth muscle actin (alpha-SMA), the monocytes/macrophages (CD68-positive cells), and T-cell infiltration (CD4+ and CD8+ cells). All of the patients were nephrotic and without treatment at time of the biopsy. A strong up-regulation of MCP-1, RANTES, and OPN expression was observed, mainly in tubular epithelial cells, with a significant major intensity in the progressive IMN patients. A strong correlation between the mRNA expression and the corresponding protein was noted. The presence of these chemokines and OPN was associated with interstitial cell infiltration. TGF-beta and PDGF were also up-regulated, mainly in tubular epithelial cells, with a stronger expression in the progressive IMN, and an association with the presence of myofibroblasts was found. Patients with severe proteinuria and progressive IMN have an overexpression in tubular epithelial cells of the chemokines MCP-1, RANTES, and OPN and the profibrogenic cytokines PDGF-BB and TGF-beta. Because this up-regulation was associated with an interstitial accumulation of mononuclear cells and an increase in myofibroblastic activity, it is suggested that those mediators are potential predictors of progression in IMN. Finally, based on experimental data and the findings of this article, we speculate that severe proteinuria is the main factor responsible for the up-regulation of these factors in tubular epithelial cells.
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              Two novel 1alpha-hydroxylase mutations in French-Canadians with vitamin D dependency rickets type I1.

              Vitamin D dependency rickets type I (VDDR-I) is an autosomal recessive disorder in which 25-hydroxyvitamin D 1alpha-hydroxylase (1alpha-hydroxylase) activity in renal proximal tubules is deficient. VDDR-I is recognized throughout the world, but occurs more frequently in a subset of the French-Canadian population. We and others have recently cloned the human 1alpha-hydroxylase cDNA and gene, making it possible to screen for mutations. The first VDDR-I mutations were reported in one American and four Japanese patients. In this study, we screened for 1alpha-hydroxylase mutations in French-Canadian patients with VDDR-I. The nine exons of the 1alpha-hydroxylase gene were amplified by polymerase chain reaction (PCR) from genomic DNA of four unrelated French-Canadian patients with VDDR-I and their parents, and sequenced. Three of the patients were homozygous for a single base-pair deletion (G) at position 262 in the cDNA that lies in exon 2, and causes a premature termination codon upstream from the putative ferredoxin- and heme-binding domains. The fourth patient was homozygous for a 7-bp insertion (CCCCCCA) at position 1323 of the cDNA that lies in exon 8, and causes a premature termination upstream from the putative heme-binding domain. In each family, obligate carriers have one copy of the mutant allele. These mutations, which could be detected by PCR-restriction fragment length polymorphism and polyacrylamide gel electrophoresis of the PCR products, were not found in 25 normal French-Canadians. We describe two novel 1alpha-hydroxylase mutations that are consistent with loss of function in four French-Canadian patients with VDDR-I and suggest that the 1alpha-hydroxylase mutations arise from more than one founder in this population.

                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                September 2004
                17 November 2004
                : 98
                : 1
                : c25-c34
                Department of Gastroenterology and Nephrology and Division of Blood Purification, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
                79924 Nephron Clin Pract 2004;98:c25–c34
                © 2004 S. Karger AG, Basel

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                Figures: 7, Tables: 1, References: 29, Pages: 1
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