The proinflammatory role of hyaluronan-CD44 interactions in renal injury.

An accumulation of the connective tissue component, hyaluronan (HA), is known to occur in both syngeneic and allogeneic kidney grafts during the early postoperative period. The presence of HA in the interstitial tissue of the grafts is paralleled by an increased water content, suggesting a role for HA in the development of the transplantation edema. In the present work, the kidney content and distribution of HA was studied in a model of warm renal ischemia in the rat to investigate whether renal ischemia is associated with HA accumulation. Seventy-two hours after a period of warm renal ischemia (30 or 60 min) significantly higher amounts of HA were observed in the left kidney that had been exposed to ischemia, than in the right, healthy kidney. The most pronounced increase was found to occur in the cortex (20 to 40 times), a structure where there normally is almost no presence of HA. In addition, there was a correlation between the relative water content of the kidney and the amount of HA possible to extract from the tissue. The renal accumulation of HA and water was prevented by daily intravenous administration of hyaluronidase. We conclude that renal ischemia induces an accumulation of HA that may increase the risk for the development of interstitial edema, a situation that may be circumvented by hyaluronidase treatment.

The cell surface glycoprotein CD44 is expressed by cells of hematopoietic origin and constitutes a receptor for hyaluronic acid and matrix proteins. Because CD44 could play a role in recruiting inflammatory cells to sites of immune injury, we examined the renal CD44 expression in normal and in autoimmune MRL-lpr mice by immunohistochemistry and at a molecular level. In normal kidneys, immunoperoxidase staining for CD44 is restricted to interstitial cells and certain urothelial cells. In nephritic MRL-lpr, CD44 expression is prominent in perivascular inflammatory infiltrates and in glomerular crescents. Interestingly, CD44 is also focally expressed by cortical tubular epithelial cells (TEC) in nephritic MRL-lpr kidneys but not in normal kidneys. Reverse transcription-polymerase chain reaction (RT-PCR) as well as Northern blotting demonstrate that CD44 kidney mRNA levels are increased in nephritic MRL-lpr mice compared with normal mice. To further characterize the tubular CD44 expression, we examined cultured TEC (primary cultures and SV40-transformed TEC lines C1 and MCT). TEC constitutively express abundant cell surface CD44 that is modestly up-regulated in response to 18 hours stimulation with TNF-alpha (100 ng/ml), IFN-gamma (100 U/ml) and IL-1 (100 ng/ml). Northern analysis of TEC mRNA reveals a constitutive CD44 mRNA transcript at 3 kb. Stimulation with IFN-gamma or TNF-alpha for six hours markedly up-regulates CD44 mRNA expression in these cells. We conclude that mononuclear infiltration with CD44 positive cells and cytokine-induced up-regulation of CD44 by renal TEC is a prominent feature of MRL-lpr lupus nephritis. The contribution of CD44 induction on TEC to the pathogenesis of the autoimmune nephritic process in MRL-lpr remains to be determined.

CD44 is a transmembrane proteoglycan that serves as a cell adhesion receptor and is involved in cell-cell and cell-matrix interactions, both key events in the pathogenesis of clinical and experimental glomerulonephritis. In addition, recent evidence suggests that the binding of cytokines to proteoglycans could regulate cytokine function. We have, therefore, studied the expression of CD44 by mesangial cells in culture and in experimental (Thy 1.1 model) and human glomerulonephritis. Mesangial expression of CD44 detected by immunohistochemistry was markedly increased four days after induction of the Thy 1.1 model, coinciding with the peak of mesangial cell proliferation and macrophage infiltration. Analysis of 92 human renal biopsies by immunohistochemistry showed that CD44 expression by infiltrating cells within the glomerulus, in focal interstitial infiltrates and within the interstitium (interstitial fibroblasts, and extracellular matrix), was significantly increased in biopsies with a greater degree of histological damage. There was, however, no increase in mesangial staining in diseased kidneys as compared with control sections. In contrast, cultured human mesangial cells expressed CD44 strongly when assayed by immunohistochemistry, immunoprecipitation and Northern blotting. CD44, therefore, is an example of a protein strongly expressed by mesangial cells in vitro and weakly or not at all in vivo, but which is up-regulated in a disease model. In human disease, however, little expression was detected within the glomerular mesangium, which may be related to the greater proliferation and more profound disruption of mesangial architecture seen in the Thy 1.1 model. CD44 expression by infiltrating cells and by components of the interstitium could, however, play an important role in the pathogenesis of chronic progressive renal disease in humans.