Mechanisms of Proteinuria in HIV.

Mechanisms of Proteinuria in HIV.
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DOI:
10.3389/fmed.2021.749061
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发表时间:
2021
影响因子:
3.9
通讯作者:
Wyatt CM
Wyatt CM
中科院分区:
医学3区
文献类型:
--
作者:
Hall G;Wyatt CM

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蛋白尿在HIV感染的情况下是常见的,并且可能反映共病肾脏疾病、治疗相关的肾毒性和HIV相关的肾小球疾病。在过去的四十年里,足细胞和肾小管损伤在HIV相关肾病(HIVAN)中的机制一直是研究的主题。病毒基因表达、先天免疫信号失调和祖先驱动的遗传风险调节因子的病理作用已经在复杂的细胞和整体动物疾病模型中进行了探索。这些研究提供的证据表明,损伤诱导的足细胞去分化,增生,细胞骨架失调和凋亡可能会导致肾小球滤过屏障完整性和裂隙隔膜性能的损失,促进蛋白尿和簇塌陷在HIVAN。虽然随着抗逆转录病毒治疗的引入,HIVAN的发病率有所下降,但在其他病毒感染和慢性自身免疫性疾病的背景下,以及在遗传易感人群中使用基于干扰素的治疗时,已观察到FSGS病变的塌陷。这突出了这样一个事实,即病变不是HIVAN所特有的,免疫系统在加重足细胞损伤中的作用值得进一步探讨。本文将总结我们在表征HIVAN和其他形式的HIV相关肾脏疾病中足细胞功能障碍的分子机制方面的进展。
Proteinuria is common in the setting of HIV infection, and may reflect comorbid kidney disease, treatment-related nephrotoxicity, and HIV-related glomerular diseases. The mechanisms of podocyte and tubulointerstial injury in HIV-associated nephropathy (HIVAN) have been the subject of intense investigation over the past four decades. The pathologic contributions of viral gene expression, dysregulated innate immune signaling, and ancestry-driven genetic risk modifiers have been explored in sophisticated cellular and whole animal models of disease. These studies provide evidence that injury-induced podocyte dedifferentiation, hyperplasia, cytoskeletal dysregulation, and apoptosis may cause the loss of glomerular filtration barrier integrity and slit diaphragm performance that facilitates proteinuria and tuft collapse in HIVAN. Although the incidence of HIVAN has declined with the introduction of antiretroviral therapy, the collapsing FSGS lesion has been observed in the context of other viral infections and chronic autoimmune disorders, and with the use of interferon-based therapies in genetically susceptible populations. This highlights the fact that the lesion is not specific to HIVAN and that the role of the immune system in aggravating podocyte injury warrants further exploration. This review will summarize our progress in characterizing the molecular mechanisms of podocyte dysfunction in HIVAN and other forms of HIV-associated kidney disease.
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