Pilia P A, Boackle R J, Swain R P, Ainsworth S K
Lab Invest. 1983 May;48(5):585-97.
Immunologic mechanisms of proteinuria and ultrastructural alterations of the slit pore complex and glomerular charge barrier were investigated in Munich Wistar (MW) rats with nephrotoxic serum nephritis. Prior to disease induction, normal MW sera demonstrated 50% of the complement hemolytic activity compared with sera obtained from Sprague-Dawley rats. MW rats were sacrificed prior to, at onset (5 to 6 hours), and during maximal proteinuria (heterologous phase). Immunofluorescence revealed binding of rabbit antirat IgG antibodies in a linear pattern to the glomerular basement membrane (GBM) within 15 minutes postinjection. Complement deposition was not demonstrable in vivo in this model. Immediately after injection of nephrotoxic serum a decreased penetration of the GBM occurred, restricting ferritin to the level of the endothelium in in situ fixed glomeruli. GBM permeability to native ferritin did not increase despite areas of epithelial cell detachment, endothelial cell sloughing, and proteinuria between 2 and 24 hours postnephrotoxic serum injection. Colloidal iron initially decreased staining intensity between 6 and 8 hours, with a major decrease at 24 hours, indicating a loss in glomerular sialoprotein coincident with the onset of proteinuria. Polyethyleneimine (PEI) localization revealed an initial loss of anionic binding sites by 2 hours postinjection. At 6 hours peripheral capillary loops demonstrated only scattered, random polyethyleneimine-binding sites. Splitting of the lamina densa occurred at 24 hours with the exposure of previously undetected anionic binding sites within the lamina densa. Ultrastructurally, as early as 2 hours postnephrotoxic serum injection tissue perfused with tannic acid-glutaraldehyde showed epithelial membranes forming numerous pinocytotic vesicles. Blunting and retraction of foot processes caused displacement and stacking of slit diaphragms prior to the onset of proteinuria. Between 6 and 24 hours postinjection, slit diaphragms appeared to stretch and contract to compensate for epithelial cell retraction. Tangential sections showed neither alterations nor condensation products disrupting the isoporous substructure of the slit diaphragm 24 hours postnephrotoxic serum injection. Polymorphonuclear leukocytes were not found within capillary loops during the heterologous phase of nephrotoxic serum nephritis in MW rats. The absence of complement and polymorphonuclear leukocytes accompanying anti-GBM antibody deposition suggests that early epithelial cell injury and GBM charge alterations in MW rats are mediated by heterologous antibody via a complement-independent mechanism. The lower complement hemolytic activity in normal MW sera may explain the lack of complement involvement in renal lesions in this model of nephrotoxic serum nephritis. Loss of characteristic staining for both glomerular sialoprotein and discrete anionic sites in the GBM coincided with early epithelial cell alterations and occurred prior to the onset of measurable proteinuria.
在患有肾毒性血清肾炎的慕尼黑Wistar(MW)大鼠中,研究了蛋白尿的免疫机制以及裂孔复合体和肾小球电荷屏障的超微结构改变。在诱发疾病之前,与从Sprague-Dawley大鼠获得的血清相比,正常MW血清显示出50%的补体溶血活性。在疾病发作前、发作时(5至6小时)和蛋白尿最大时(异源期)处死MW大鼠。免疫荧光显示,注射后15分钟内,兔抗大鼠IgG抗体以线性模式与肾小球基底膜(GBM)结合。在该模型中,体内未检测到补体沉积。注射肾毒性血清后立即发生GBM通透性降低,在原位固定的肾小球中,铁蛋白被限制在内皮细胞水平。尽管在注射肾毒性血清后2至24小时出现上皮细胞脱离、内皮细胞脱落和蛋白尿区域,但GBM对天然铁蛋白的通透性并未增加。胶体铁最初在6至8小时之间染色强度降低,在24小时时显著降低,表明肾小球涎蛋白丢失与蛋白尿发作同时发生。聚乙烯亚胺(PEI)定位显示注射后2小时阴离子结合位点开始丢失。在6小时时,外周毛细血管袢仅显示散在、随机的聚乙烯亚胺结合位点。在24小时时,致密层出现分裂,致密层内先前未检测到的阴离子结合位点暴露。超微结构上,早在注射肾毒性血清后2小时,用单宁酸-戊二醛灌注的组织显示上皮细胞膜形成大量吞饮小泡。在蛋白尿发作之前,足突的变钝和回缩导致裂孔隔膜移位和堆叠。在注射后6至24小时之间,裂孔隔膜似乎伸展和收缩以补偿上皮细胞回缩。肾毒性血清注射后24小时的切线切片显示,裂孔隔膜的等孔亚结构既没有改变也没有凝聚产物破坏。在MW大鼠肾毒性血清肾炎的异源期,毛细血管袢内未发现多形核白细胞。抗GBM抗体沉积时补体和多形核白细胞的缺乏表明,MW大鼠早期上皮细胞损伤和GBM电荷改变是由异源抗体通过补体非依赖机制介导的。正常MW血清中较低的补体溶血活性可能解释了在该肾毒性血清肾炎模型中肾损伤缺乏补体参与的原因。肾小球涎蛋白和GBM中离散阴离子位点的特征性染色丢失与早期上皮细胞改变同时发生,且发生在可测量蛋白尿发作之前。