Changes in nephritogenic serum galactose-deficient IgA1 in IgA nephropathy following tonsillectomy and steroid therapy.
Changes in nephritogenic serum galactose-deficient IgA1 in IgA nephropathy following tonsillectomy and steroid therapy.
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扁桃体切除术和类固醇治疗后，IgA肾病中肾肾血清半乳糖缺陷型IgA1的变化。
DOI：
10.1371/journal.pone.0089707
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Tomino Y
中科院分区：
文献类型：
--
作者：
Nakata J;Suzuki Y;Suzuki H;Sato D;Kano T;Yanagawa H;Matsuzaki K;Horikoshi S;Novak J;Tomino Y
近年来的研究表明，半乳糖缺陷型IgA 1（GdIgA 1）在伊加肾病（IgAN）的发病中起重要作用。虽然新出现的数据表明，血清GdIgA1可以是一个有用的非侵入性IgAN生物标志物，肾GdIgA1生产B细胞的定位仍然不清楚。最近的临床和实验研究表明，免疫激活扁桃体Toll样受体（TLR）9可能参与IgAN的发病机制。在这里，我们评估的可能性GdIgA1生产的腭扁桃体IgAN患者。我们评估了IgAN患者血清GdIgA 1水平的变化，这些患者在扁桃体切除术和类固醇冲击治疗联合治疗后血尿和蛋白尿临床缓解。此外，临床结果和扁桃体TLR9表达之间的关联进行了评估。根据治疗反应将患者（n =37）分为两组。 在一组中，血清GdIgA1水平下降后扁桃体切除术（59%）单独，而在另一组中，大多数水平仅下降后，添加类固醇脉冲治疗扁桃体切除术（41%）。前组扁桃体TLR9表达明显高于后组，且扁桃体切除术后即刻血尿的改善明显优于后组。本研究提示腭扁桃体可能是GdIgA_1产生细胞的主要部位。然而，在某些患者中，这些细胞可能会传播到其他淋巴器官，这可能部分解释了扁桃体切除术后观察到的不同反应。这些发现有助于澄清IgAN管理中的一些临床观察结果，并可能突出未来的研究方向。
Recent studies have shown that galactose-deficient IgA1 (GdIgA1) has an important role in the pathogenesis of IgA nephropathy (IgAN). Although emerging data suggest that serum GdIgA1 can be a useful non-invasive IgAN biomarker, the localization of nephritogenic GdIgA1-producing B cells remains unclear. Recent clinical and experimental studies indicate that immune activation tonsillar toll-like receptor (TLR) 9 may be involved in the pathogenesis of IgAN. Here we assessed the possibility of GdIgA1 production in the palatine tonsils in IgAN patients. We assessed changes in serum GdIgA1 levels in IgAN patients with clinical remission of hematuria and proteinuria following combined tonsillectomy and steroid pulse therapy. Further, the association between clinical outcome and tonsillar TLR9 expression was evaluated. Patients (n = 37) were divided into two groups according to therapy response. In one group, serum GdIgA1 levels decreased after tonsillectomy (59%) alone, whereas in the other group most levels only decreased after the addition of steroid pulse therapy to tonsillectomy (41%). The former group showed significantly higher tonsillar TLR9 expression and better improvement in hematuria immediately after tonsillectomy than the latter group. The present study indicates that the palatine tonsils are probably a major sites of GdIgA1-producing cells. However, in some patients these cells may propagate to other lymphoid organs, which may partially explain the different responses observed to tonsillectomy alone. These findings help to clarify some of the clinical observations in the management of IgAN, and may highlight future directions for research.
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