Pawar Rahul D, Pitashny Milena, Gindea Simona, Tieng Arlene Tan, Levine Benjamin, Goilav Beatrice, Campbell Sean R, Xia Yumin, Qing Xiaoping, Thomas David B, Herlitz Leal, Berger Thorsten, Mak Tak W, Putterman Chaim
Albert Einstein College of Medicine, Bronx, New York, USA.
Arthritis Rheum. 2012 May;64(5):1620-31. doi: 10.1002/art.33485.
The mechanism by which anti-DNA antibodies mediate lupus nephritis has yet to be conclusively determined. Previously, we found that treatment of mesangial cells with anti-DNA antibodies induced high expression of neutrophil gelatinase-associated lipocalin (NGAL), an iron-binding protein up-regulated in response to kidney injury. We undertook this study to determine whether NGAL is instrumental in the pathogenesis of nephritis, is induced as part of repair, or is irrelevant to damage/repair pathways.
To investigate the role of NGAL in antibody-mediated nephritis, we induced nephrotoxic nephritis by passive antibody transfer to 129/SyJ and C57BL/6 mice. To determine if NGAL up-regulation is instrumental, we compared the severity of renal damage in NGAL wild-type mice and NGAL-knockout mice following induction of nephrotoxic nephritis.
We found that kidney NGAL expression, as well as urine NGAL levels, were significantly increased in mice with nephrotoxic nephritis as compared to control-injected mice. Tight correlations were observed between NGAL expression, renal histopathology, and urine NGAL excretion. NGAL-knockout mice had attenuated proteinuria and improved renal histopathology compared to wild-type mice. Similarly, following nephritis induction, NGAL injection significantly exacerbated nephritis and decreased survival. NGAL induced apoptosis via caspase 3 activation and up-regulated inflammatory gene expression in kidney cells in vitro and when injected in vivo.
We conclude that kidney binding of pathogenic antibodies stimulates local expression of NGAL, which plays a crucial role in the pathogenesis of nephritis via promotion of inflammation and apoptosis. NGAL blockade may be a novel therapeutic approach for the treatment of nephritis mediated by pathogenic antibodies, including anti-glomerular basement membrane disease and lupus nephritis.
抗DNA抗体介导狼疮性肾炎的机制尚未最终确定。此前,我们发现用抗DNA抗体处理系膜细胞可诱导中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的高表达,NGAL是一种在肾损伤时上调的铁结合蛋白。我们开展本研究以确定NGAL在肾炎发病机制中是否起作用,是作为修复的一部分被诱导产生,还是与损伤/修复途径无关。
为研究NGAL在抗体介导的肾炎中的作用,我们通过被动抗体转移给129/SyJ和C57BL/6小鼠诱导产生肾毒性肾炎。为确定NGAL上调是否起作用,我们比较了诱导肾毒性肾炎后NGAL野生型小鼠和NGAL基因敲除小鼠的肾损伤严重程度。
我们发现,与注射对照的小鼠相比,肾毒性肾炎小鼠的肾脏NGAL表达以及尿NGAL水平显著升高。观察到NGAL表达、肾组织病理学和尿NGAL排泄之间存在紧密相关性。与野生型小鼠相比,NGAL基因敲除小鼠的蛋白尿减轻,肾组织病理学改善。同样,在诱导肾炎后,注射NGAL显著加重了肾炎并降低了存活率。NGAL在体外以及注射到体内时,通过激活半胱天冬酶3诱导细胞凋亡,并上调肾细胞中的炎症基因表达。
我们得出结论,致病性抗体与肾脏的结合刺激了NGAL的局部表达,NGAL通过促进炎症和细胞凋亡在肾炎发病机制中起关键作用。阻断NGAL可能是治疗由致病性抗体介导的肾炎(包括抗肾小球基底膜病和狼疮性肾炎)的一种新的治疗方法。