Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
J Diabetes Investig. 2022 Feb;13(2):213-226. doi: 10.1111/jdi.13725. Epub 2021 Dec 21.
Diabetic kidney disease (DKD) is a highly prevalent complication of diabetes and the leading cause of end-stage kidney disease. Inflammation is recognized as an important driver of progression of DKD. Activation of the immune response promotes a pro-inflammatory milieu and subsequently renal fibrosis, and a progressive loss of renal function. Although the role of the innate immune system in diabetic renal disease has been well characterized, the potential contribution of the adaptive immune system remains poorly defined. Emerging evidence in experimental models of DKD indicates an increase in the number of T cells in the circulation and in the kidney cortex, that in turn triggers secretion of inflammatory mediators such as interferon-γ and tumor necrosis factor-α, and activation of cells in innate immune response. In human studies, the number of T cells residing in the interstitial region of the kidney correlates with the degree of albuminuria in people with type 2 diabetes. Here, we review the role of the adaptive immune system, and associated cytokines, in the development of DKD. Furthermore, the potential therapeutic benefits of targeting the adaptive immune system as a means of preventing the progression of DKD are discussed.
糖尿病肾病（DKD）是糖尿病的一种高发并发症，也是终末期肾病的主要病因。炎症被认为是 DKD 进展的重要驱动因素。免疫应答的激活会促进促炎环境的形成，进而导致肾纤维化和肾功能的进行性丧失。尽管先天免疫系统在糖尿病肾病中的作用已得到充分阐明，但适应性免疫系统的潜在作用仍未得到明确界定。DKD 实验模型中的新证据表明，循环中和肾脏皮质中的 T 细胞数量增加，进而触发干扰素-γ和肿瘤坏死因子-α等炎症介质的分泌，以及先天免疫反应细胞的激活。在人类研究中，驻留在肾脏间质区域的 T 细胞数量与 2 型糖尿病患者蛋白尿的程度相关。本文综述了适应性免疫系统及其相关细胞因子在 DKD 发展中的作用。此外，还讨论了靶向适应性免疫系统作为预防 DKD 进展的一种手段的潜在治疗益处。
