Mesangial phenotypic changes associated with cellular lesions in primary focal segmental glomerulosclerosis.

Injury to glomerular visceral epithelial cells has been proposed as the initial step in glomerular scar formation in primary focal segmental glomerulosclerosis (FSGS); however, the subsequent process that ultimately results in glomerular scar formation remains uncertain. This study examined whether phenotypically altered mesangial cells determine the early progression of primary FSGS. Cellular lesion characterized by proliferative epithelial cell reaction with occasional endocapillary hypercellularity has been considered to be an early morphologic feature in the development of glomerular scar in primary FSGS. We compared the immunohistologic findings of 10 patients with primary FSGS showing cellular lesion, 15 patients with primary FSGS showing only segmental scar, and 10 patients with minimal-change nephrotic syndrome. Histologically normal kidney tissue samples obtained from three patients with renal trauma were used as normal controls. Alpha-smooth muscle actin expression detected by a mouse anti-human monoclonal antibody as well as de novo type III collagen expression determined by a goat polyclonal antibody were prominent in the glomerular tufts with cellular lesions in FSGS patients. A significant increase in the number of glomerular CD68+ (a mouse anti-human monoclonal antibody) macrophages was also observed in association with the cellular lesion. Repeat renal biopsies in six of the 10 FSGS patients with a cellular lesion showed disappearance of the cellular lesion, reduced glomerular alpha-smooth muscle actin expression, decreased number of glomerular CD68+ macrophage, and progression of glomerular scar formation. These results indicate that mesangial cells undergo phenotypic changes to myofibroblasts in association with the cellular lesion in primary FSGS. Thus, the phenotypically altered mesangial cells acquiring features of a myofibroblast may have an important role in the early process of glomerular scar formation in certain types of primary FSGS.