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局灶节段性肾小球硬化中的足细胞损伤:来自动物模型的经验教训(一部五幕剧)

Podocyte injury in focal segmental glomerulosclerosis: Lessons from animal models (a play in five acts).

作者信息

D'Agati V D

机构信息

Department of Pathology, Columbia University, College of Physicians & Surgeons, New York, New York 10032, USA.

出版信息

Kidney Int. 2008 Feb;73(4):399-406. doi: 10.1038/sj.ki.5002655. Epub 2007 Nov 7.

Abstract

Genetic engineering in the mouse has ushered in a new era of disease modeling that has advanced our understanding of podocyte injury in the pathogenesis of focal segmental glomerulosclerosis. Historically, the major animal models of focal segmental glomerulosclerosis involve direct podocyte injury (exemplified by toxin models) and indirect podocyte injury due to adaptive responses (exemplified by renal ablation models). In both paradigms, recent evidence indicates that podocyte depletion is a major pathomechanism mediating proteinuria and glomerulosclerosis. Podocyte-specific toxin models support that podocyte loss is sufficient to cause focal segmental glomerulosclerosis in a dose-dependent manner. Knockout and transgenic models have provided proof of concept that mutations in specific podocyte proteins mediate genetic forms of focal segmental glomerulosclerosis. Transgenic models of HIV-associated nephropathy have helped to elucidate the role of direct viral infection and podocyte expression of viral gene products in the pathogenesis of this form of collapsing glomerulopathy. Taken together, emerging data support that injury directed to or inherent within the podocyte constitutes the critical event in diverse pathways to glomerulosclerosis.

摘要

小鼠基因工程开启了疾病建模的新时代,这加深了我们对局灶节段性肾小球硬化发病机制中足细胞损伤的理解。从历史上看,局灶节段性肾小球硬化的主要动物模型包括直接足细胞损伤(以毒素模型为例)和由于适应性反应导致的间接足细胞损伤(以肾切除模型为例)。在这两种范例中,最近的证据表明足细胞耗竭是介导蛋白尿和肾小球硬化的主要病理机制。足细胞特异性毒素模型表明,足细胞丢失足以以剂量依赖的方式导致局灶节段性肾小球硬化。基因敲除和转基因模型已经提供了概念验证,即特定足细胞蛋白的突变介导了局灶节段性肾小球硬化的遗传形式。HIV相关性肾病的转基因模型有助于阐明直接病毒感染和病毒基因产物在足细胞中的表达在这种塌陷性肾小球病发病机制中的作用。综上所述,新出现的数据支持,针对足细胞或足细胞固有的损伤是导致肾小球硬化的多种途径中的关键事件。

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