Tsuji Shoji, Kimata Takahisa, Yamanouchi Sohsaku, Kitao Tetsuya, Kino Jiro, Suruda Chikushi, Kaneko Kazunari
Department of Pediatrics, Kansai Medical University, Osaka, Japan.
Pediatr Int. 2017 May;59(5):643-646. doi: 10.1111/ped.13255.
The pathogenesis of idiopathic nephrotic syndrome (INS) remains unknown. Recently, it was postulated that suppression of regulatory T cells (Treg) leads to massive proteinuria in INS, although there is some controversy. Considering the important role of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) in Treg-mediated immune suppression, the aim of this study was therefore to clarify the involvement of Treg and CTLA-4 in the pathogenesis of INS. Fifteen patients with INS were enrolled. Their blood was sampled twice, once at onset and once at remission induced by glucocorticoid. Although median Treg number was significantly lower at onset than in healthy children, it increased at remission. Similarly, serum CTLA-4 concentration significantly increased at remission compared with onset. Furthermore, a positive significant correlation was observed between Treg number and serum CTLA-4 level. This suggests that Treg and CTLA-4 are involved in the induction of remission in INS.
特发性肾病综合征（INS）的发病机制尚不清楚。最近，有人提出调节性T细胞（Treg）的抑制会导致INS出现大量蛋白尿，尽管存在一些争议。鉴于细胞毒性T淋巴细胞相关蛋白4（CTLA-4）在Treg介导的免疫抑制中的重要作用，因此本研究的目的是阐明Treg和CTLA-4在INS发病机制中的作用。招募了15例INS患者。对他们的血液进行了两次采样，一次在发病时，一次在糖皮质激素诱导缓解时。尽管发病时Treg的中位数显著低于健康儿童，但在缓解时有所增加。同样，与发病时相比，血清CTLA-4浓度在缓解时显著增加。此外，观察到Treg数量与血清CTLA-4水平之间存在显著正相关。这表明Treg和CTLA-4参与了INS的缓解诱导过程。
