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糖尿病肾病中的上皮-间充质转化:事实还是虚构?

Epithelial-to-Mesenchymal Transition in Diabetic Nephropathy: Fact or Fiction?

机构信息

Department of Internal Medicine III, University Hospital, University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.

出版信息

Cells. 2015 Oct 9;4(4):631-52. doi: 10.3390/cells4040631.

Abstract

The pathophysiology of diabetic nephropathy (DN), one of the most serious complications in diabetic patients and the leading cause of end-stage renal disease worldwide, is complex and not fully elucidated. A typical hallmark of DN is the excessive deposition of extracellular matrix (ECM) proteins in the glomerulus and in the renal tubulointerstitium, eventually leading to glomerulosclerosis and interstitial fibrosis. Although it is obvious that myofibroblasts play a major role in the synthesis and secretion of ECM, the origin of myofibroblasts in DN remains the subject of controversial debates. A number of studies have focused on epithelial-to-mesenchymal transition (EMT) as one source of matrix-generating fibroblasts in the diseased kidney. EMT is characterized by the acquisition of mesenchymal properties by epithelial cells, preferentially proximal tubular cells and podocytes. In this review we comprehensively review the literature and discuss arguments both for and against a function of EMT in renal fibrosis in DN. While the precise extent of the contribution to nephrotic fibrosis is certainly arduous to quantify, the picture that emerges from this extensive body of literature suggests EMT as a major source of myofibroblasts in DN.

摘要

糖尿病肾病(DN)是糖尿病患者最严重的并发症之一,也是全球终末期肾病的主要原因,其病理生理学十分复杂,尚未完全阐明。DN 的一个典型特征是细胞外基质(ECM)蛋白在肾小球和肾小管间质中的过度沉积,最终导致肾小球硬化和间质纤维化。尽管肌成纤维细胞在 ECM 的合成和分泌中起主要作用是显而易见的,但 DN 中肌成纤维细胞的起源仍然是有争议的话题。许多研究集中在上皮-间充质转化(EMT)作为病变肾脏中产生基质的成纤维细胞的一个来源。EMT 的特征是上皮细胞获得间充质特性,优先是近端肾小管细胞和足细胞。在这篇综述中,我们全面回顾了文献,并讨论了 EMT 在 DN 肾纤维化中的作用的正反两方面的观点。虽然确切的 EMT 对肾病性纤维化的贡献程度很难定量,但从大量文献中得出的结论表明 EMT 是 DN 中肌成纤维细胞的主要来源。

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