Department of Pathology, University Medical Center Utrecht, H04.312, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, Netherlands.
Nat Rev Nephrol. 2015 Apr;11(4):233-44. doi: 10.1038/nrneph.2014.246. Epub 2015 Jan 13.
Fibrosis is the common end point of chronic kidney disease. The persistent production of inflammatory cytokines and growth factors leads to an ongoing process of extracellular matrix production that eventually disrupts the normal functioning of the organ. During fibrosis, the myofibroblast is commonly regarded as the predominant effector cell. Accumulating evidence has demonstrated a diverse origin of myofibroblasts in kidney fibrosis. Proposed major contributors of myofibroblasts include bone marrow-derived fibroblasts, tubular epithelial cells, endothelial cells, pericytes and interstitial fibroblasts; the published data, however, have not yet clearly defined the relative contribution of these different cellular sources. Myofibroblasts have been reported to originate from various sources, irrespective of the nature of the initial damage responsible for the induction of kidney fibrosis. Here, we review the possible relevance of the diversity of myofibroblast progenitors in kidney fibrosis and the implications for the development of novel therapeutic approaches. Specifically, we discuss the current status of preclinical and clinical antifibrotic therapy and describe targeting strategies that might help support resident and circulating cells to maintain or regain their original functional differentiation state. Such strategies might help these cells resist their transition to a myofibroblast phenotype to prevent, or even reverse, the fibrotic state.
纤维化是慢性肾脏病的共同终点。持续产生的炎症细胞因子和生长因子导致细胞外基质的持续产生,最终破坏器官的正常功能。在纤维化过程中,肌成纤维细胞通常被认为是主要的效应细胞。越来越多的证据表明,肾脏纤维化中肌成纤维细胞具有多种来源。提出的肌成纤维细胞的主要来源包括骨髓来源的成纤维细胞、肾小管上皮细胞、内皮细胞、周细胞和间质成纤维细胞;然而,已发表的数据尚未明确界定这些不同细胞来源的相对贡献。尽管导致肾脏纤维化的初始损伤的性质不同,但肌成纤维细胞已被报道起源于各种来源。在这里,我们综述了肾脏纤维化中肌成纤维细胞前体细胞多样性的可能相关性及其对新型治疗方法发展的意义。具体来说,我们讨论了抗纤维化治疗的临床前和临床现状,并描述了可能有助于支持常驻细胞和循环细胞维持或恢复其原始功能分化状态的靶向策略。这些策略可能有助于这些细胞抵抗向肌成纤维细胞表型的转变,从而预防甚至逆转纤维化状态。