Turolo S, Edefonti A, Syren M L, Morello W, Marco E A de, Berrettini A, Agostoni C, Montini G
Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
Lipids Health Dis. 2025 Mar 20;24(1):106. doi: 10.1186/s12944-025-02523-8.
Idiopathic nephrotic syndrome (INS) is the most common pediatric glomerular disease, characterized by proteinuria, hypoalbuminemia and edema and caused by an immune dysregulation of T and B cells. Fatty acids (FA) are involved in immune response, with omega-6 prevailing in pro-inflammatory states and omega-3 promoting anti-inflammatory effects. While previous studies of INS assessed FA profile in blood or serum, which may be influenced by many systemic and dietary factors, the intracellular FA metabolism in white blood cells of children with INS, critical to immune cell activation, remains still unexplored. This pilot study compares the FA profile within leukocytes (endo-leukocyte, EL) and whole blood in 35 children with INS and 34 matched controls. INS patients were stratified by steroid sensitivity vs. steroid resistance and by remission vs. proteinuric state. EL FA profiles were analyzed via gas chromatography and dietary habits were evaluated by the Kid Med questionnaire. While blood FA profile of patients demonstrated both elevated omega-6 and omega-3 levels (P-value < 0.005), EL show an inflammatory dominance, with increased omega-6 (P-value < 0.005), but similar omega-3 levels, compared to controls. Furthermore, EL profiles showed reduced saturated FA and palmitic acid but elevated oleic acid levels (P-value < 0.005), possibly indicating a compensatory anti-inflammatory response. This study suggests that EL FA profile may provide unique insights into intracellular mechanisms of inflammation in INS, complementing data arising from blood FA analysis. Despite some limitations, including the small sample size, the study of FA inside the cellular population directly involved in INS underscores its potential in increasing diagnostic precision of FA anomalies in the course of nephrotic syndrome. This new approach may also represent the prerequisite for a clearcut evaluation of the effectiveness of pharmacologic and dietary therapies, like the supplementation with omega 3 metabolites and a diet rich in omega-3.
特发性肾病综合征（INS）是最常见的儿童肾小球疾病，其特征为蛋白尿、低白蛋白血症和水肿，由T细胞和B细胞的免疫失调引起。脂肪酸（FA）参与免疫反应，在促炎状态下ω-6占主导，而ω-3具有抗炎作用。尽管先前关于INS的研究评估了血液或血清中的脂肪酸谱，而这可能受许多全身和饮食因素的影响，但INS患儿白细胞内对免疫细胞激活至关重要的脂肪酸代谢仍未得到探索。这项初步研究比较了35例INS患儿和34例匹配对照的白细胞（内白细胞，EL）和全血中的脂肪酸谱。INS患者根据类固醇敏感性与类固醇抵抗以及缓解与蛋白尿状态进行分层。通过气相色谱分析EL脂肪酸谱，并通过儿童医学问卷评估饮食习惯。虽然患者的血液脂肪酸谱显示ω-6和ω-3水平均升高（P值<0.005），但与对照组相比，EL显示出炎症优势，ω-6增加（P值<0.005），但ω-3水平相似。此外，EL谱显示饱和脂肪酸和棕榈酸减少，但油酸水平升高（P值<0.005），这可能表明存在代偿性抗炎反应。这项研究表明，EL脂肪酸谱可能为INS炎症的细胞内机制提供独特见解，补充血液脂肪酸分析的数据。尽管存在一些局限性，包括样本量小，但对直接参与INS的细胞群体内脂肪酸的研究强调了其在提高肾病综合征过程中脂肪酸异常诊断准确性方面的潜力。这种新方法也可能是明确评估药物和饮食疗法有效性的先决条件，如补充ω-3代谢物和富含ω-3的饮食。
