Soma J, Saito T, Ootaka T, Sato H, Abe K
The Second Department of Internal Medicine, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan.
Am J Kidney Dis. 1996 Nov;28(5):685-94. doi: 10.1016/s0272-6386(96)90249-8.
Marked intraglomerular infiltration of leukocytes is observed in membranoproliferative glomerulonephritis (MPGN). We recently demonstrated that this leukocyte infiltration develops partly through macrophage-1 (Mac-1)-positive cells and glomerular C3c deposits (Clin Exp Immunol 100:269-276, 1995). To further investigate the mediation of adhesion molecules in the leukocyte accumulation, we immunohistochemically examined the expression of intraglomerular leukocyte integrins and their ligands as well as surface markers for granulocytes/monocytes (CD15) and macrophages (CD68) in 26 patients with MPGN type I who had undergone repeated biopsies. These patients were divided into two groups. Group A included the patients who showed both normo-complementemia and urinary protein excretion less than 1 g/d at the follow-up biopsy (recovery group: n = 14). Group B (persistent group: n = 12) included the patients other than those in group A. At the initial biopsy, there was no difference in the degree of glomerular C3c deposition, glomerular intercellular adhesion molecule (ICAM)-1 expression, or the numbers of cells bearing leukocyte function-associated antigen-1 (LFA-1), Mac-1, and ICAM-3 between the two groups. At the follow-up biopsy, the degree of glomerular C3c deposition, and the numbers of cells bearing LFA-1, Mac-1, and ICAM-3, were significantly decreased only in group A (P < 0.01, P < 0.001, P < 0.001, and P < 0.01, respectively). No chronological change in ICAM-1 expression was observed in either group. Group B showed a chronological increase in the severity of glomerular injury and serum creatinine level, associated with persistent heavy proteinuria. Neither LFA-1- nor Mac-1-positive cells were positively correlated with ICAM-1 expression. Most of Mac-1-positive cells were CD15-positive cells (granulocytes/monocytes), and a considerable number of Mac-1-positive cells concurrently expressed ICAM-3. In contrast, most LFA-1-positive cells were considered to be CD68-positive cells (macrophages). The number of cells bearing LFA-1 was positively correlated with that of cells bearing ICAM-3 (P < 0.00001). These results suggest that the glomerular leukocytes, infiltrating through Mac-1/complement interaction, express ICAM-3 by themselves, and that LFA-1/ICAM-3 interaction might participate in the glomerular aggregation of leukocytes in MPGN type I. In this study, we could not conclude that LFA-1/ICAM-1 or Mac-1/ICAM-1 interaction was involved in the leukocyte accumulation in this disease.
在膜增生性肾小球肾炎(MPGN)中可观察到肾小球内有明显的白细胞浸润。我们最近证明,这种白细胞浸润部分是通过巨噬细胞-1(Mac-1)阳性细胞和肾小球C3c沉积物发生的(《临床与实验免疫学》100:269 - 276,1995年)。为了进一步研究黏附分子在白细胞积聚中的介导作用,我们对26例接受过多次活检的I型MPGN患者进行了免疫组织化学检查,检测肾小球内白细胞整合素及其配体的表达以及粒细胞/单核细胞(CD15)和巨噬细胞(CD68)的表面标志物。这些患者被分为两组。A组包括在随访活检时显示补体正常血症且尿蛋白排泄量小于1 g/d的患者(恢复组:n = 14)。B组(持续组:n = 12)包括A组以外的患者。在初次活检时,两组之间肾小球C3c沉积程度、肾小球细胞间黏附分子(ICAM)-1表达或携带白细胞功能相关抗原-1(LFA-1)、Mac-1和ICAM-3的细胞数量没有差异。在随访活检时,仅A组的肾小球C3c沉积程度以及携带LFA-1、Mac-1和ICAM-3的细胞数量显著降低(分别为P < 0.01、P < 0.001、P < 0.001和P < 0.01)。两组中均未观察到ICAM-1表达随时间的变化。B组显示肾小球损伤严重程度和血清肌酐水平随时间增加,伴有持续性大量蛋白尿。LFA-1阳性细胞和Mac-1阳性细胞均与ICAM-1表达无正相关。大多数Mac-1阳性细胞是CD15阳性细胞(粒细胞/单核细胞),相当数量的Mac-1阳性细胞同时表达ICAM-3。相比之下,大多数LFA-1阳性细胞被认为是CD68阳性细胞(巨噬细胞)。携带LFA-1的细胞数量与携带ICAM-3的细胞数量呈正相关(P < 0.00001)。这些结果表明,通过Mac-1/补体相互作用浸润的肾小球白细胞自身表达ICAM-3,并且LFA-1/ICAM-3相互作用可能参与I型MPGN中白细胞的肾小球聚集。在本研究中,我们不能得出LFA-1/ICAM-1或Mac-1/ICAM-1相互作用参与该疾病白细胞积聚的结论。