Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University.
Department of Anatomy, Faculty of Medicine, Tottori University.
Biomed Res. 2020;41(2):81-90. doi: 10.2220/biomedres.41.81.
Antibody-mediated rejection (ABMR) is an important cause of both short- and long-term injury to renal allografts. Transplant glomerulopathy (TG) is strongly associated with ABMR and reduced graft survival. Ultrastructural changes in early-stage ABMR include TG as a duplication of the glomerular basement membrane (GBM), which can be observed only by transmission electron microscopy (TEM). Low-vacuum scanning electron microscopy (LVSEM) is a new technique that allows comparatively inexpensive, rapid, and convenient observations with high magnification. We analyzed human renal transplants using LVSEM and evaluated the ultrastructural changes representing TG in ABMR. GBM duplication was more clearly visible in the LVSEM images than in the light microscopy (LM) images. In the ABMR group, the cg score of the Banff classification was higher in 54% (7/13) of specimens for LVSEM images than for LM images. And 4 specimens exhibited duplication of the GBM analyzed by LVSEM, but not by LM. In addition, three-dimensional ultrastructural changes, such as coarse meshwork structures of GBM, were observed in ABMR specimens. The ABMR group also exhibited ultrastructural changes in the peritubular capillary basement membranes. In conclusion, analyses of renal transplant tissues using LVSEM allows the identification of GBM duplication and ultrastructural changes of basement membranes at the electron microscopic level, and is useful for early-stage diagnosis of ABMR.
抗体介导的排斥反应（ABMR）是导致肾移植短期和长期损伤的重要原因。移植肾小球病（TG）与 ABMR 和移植物存活率降低密切相关。早期 ABMR 的超微结构变化包括 TG 作为肾小球基底膜（GBM）的重复，只能通过透射电子显微镜（TEM）观察到。低真空扫描电子显微镜（LVSEM）是一种新技术，允许以高倍放大倍数进行相对便宜、快速和方便的观察。我们使用 LVSEM 分析了人类肾移植，并评估了代表 ABMR 中 TG 的超微结构变化。GBM 重复在 LVSEM 图像中比在光镜（LM）图像中更清晰可见。在 ABMR 组中，Banff 分类的 cg 评分在 54%（7/13）的 LVSEM 图像标本中高于 LM 图像，而在 4 个标本中，GBM 的重复通过 LVSEM 分析，但不是通过 LM。此外，在 ABMR 标本中观察到 GBM 的三维超微结构变化，如粗网格结构。ABMR 组还表现出肾小管毛细血管基底膜的超微结构变化。总之，使用 LVSEM 分析肾移植组织可以识别 GBM 重复和基底膜的超微结构变化，有助于 ABMR 的早期诊断。
