炎症状况和补体系统:急性肾损伤与慢性移植物损伤之间的联系。

Inflammaging and Complement System: A Link Between Acute Kidney Injury and Chronic Graft Damage.

机构信息

Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.

Department Translational Medicine, University of Piemonte Orientale, Novara, Italy.

出版信息

Front Immunol. 2020 May 7;11:734. doi: 10.3389/fimmu.2020.00734. eCollection 2020.

Abstract

The aberrant activation of complement system in several kidney diseases suggests that this pillar of innate immunity has a critical role in the pathophysiology of renal damage of different etiologies. A growing body of experimental evidence indicates that complement activation contributes to the pathogenesis of acute kidney injury (AKI) such as delayed graft function (DGF) in transplant patients. AKI is characterized by the rapid loss of the kidney's excretory function and is a complex syndrome currently lacking a specific medical treatment to arrest or attenuate progression in chronic kidney disease (CKD). Recent evidence suggests that independently from the initial trigger (i.e., sepsis or ischemia/reperfusions injury), an episode of AKI is strongly associated with an increased risk of subsequent CKD. The AKI-to-CKD transition may involve a wide range of mechanisms including scar-forming myofibroblasts generated from different sources, microvascular rarefaction, mitochondrial dysfunction, or cell cycle arrest by the involvement of epigenetic, gene, and protein alterations leading to common final signaling pathways [i.e., transforming growth factor beta (TGF-β), p16 , Wnt/β-catenin pathway] involved in renal aging. Research in recent years has revealed that several stressors or complications such as rejection after renal transplantation can lead to accelerated renal aging with detrimental effects with the establishment of chronic proinflammatory cellular phenotypes within the kidney. Despite a greater understanding of these mechanisms, the role of complement system in the context of the AKI-to-CKD transition and renal inflammaging is still poorly explored. The purpose of this review is to summarize recent findings describing the role of complement in AKI-to-CKD transition. We will also address how and when complement inhibitors might be used to prevent AKI and CKD progression, therefore improving graft function.

摘要

在几种肾脏疾病中,补体系统的异常激活表明,先天免疫系统的这一重要支柱在不同病因的肾脏损伤的病理生理学中具有关键作用。越来越多的实验证据表明,补体激活有助于急性肾损伤(AKI)的发病机制,例如移植患者的移植物功能延迟(DGF)。AKI 的特征是肾脏排泄功能迅速丧失,是一种复杂的综合征,目前缺乏特定的治疗方法来阻止或减缓慢性肾脏病(CKD)的进展。最近的证据表明,无论初始触发因素(即败血症或缺血/再灌注损伤)如何,AKI 发作与随后发生 CKD 的风险增加密切相关。AKI 向 CKD 的转变可能涉及多种机制,包括来自不同来源的形成瘢痕的肌成纤维细胞、微血管稀疏、线粒体功能障碍,或通过表观遗传、基因和蛋白质改变导致共同最终信号通路(即转化生长因子-β(TGF-β)、p16、Wnt/β-catenin 通路)的细胞周期停滞,这些改变参与肾脏衰老。近年来的研究表明,几种应激源或并发症,如肾移植后的排斥反应,可导致肾脏加速衰老,导致慢性炎症细胞表型在肾脏内建立,产生有害影响。尽管对这些机制有了更深入的了解,但补体系统在 AKI 向 CKD 转变和肾脏炎症老化中的作用仍未得到充分探索。本文旨在总结描述补体在 AKI 向 CKD 转变中的作用的最新研究结果。我们还将讨论补体抑制剂如何以及何时可用于预防 AKI 和 CKD 进展,从而改善移植物功能。

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