京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21013号 / 医博第4359号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 瀬原 淳子, 教授 小川 修 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Made available in DSpace on 2015-07-22T20:49:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-31 / O rim é responsável pela maior parte da excreção de substâncias, tornando-se alvo de componentes tóxicos, tais como os meios de contrastes (MCTR). Os MCTR a base de iodo são substâncias utilizadas na angiografia, urologia ou tomografia computadorizada. Essas substâncias não deveriam interagir com o organismo, porém, na prática clínica, demonstram certo grau de interação orgânica onde são filtradas e metabolizadas livremente pelos rins, podendo ocasionar insuficiência renal aguda (IRA) devido a vasoconstrição e a isquemia medular O objetivo do presente estudo foi identificar, por meio de análise bidimensional, proteínas da célula mesangial imortalizada (CMI), que poderiam eStar sub ou supra expressas quando em contato com o MCTRH e, por conseqOência desta alteração, estejam envolvidas no processo de nefrotoxicidade Essas células foram divididas em 3 grupos" controle (Ct), manitol (Man) e tratado com HexabrixR (Hx), as quais foram tratadas e em seguida, aplicou-se a análise por gel de eletroforese bidimensional (2-DE). O método inicia-se pela focalização isoelétrica (1. dimensão), onde as proteínas são separadas de acordo com seu pl. Em seguida, essas proteínas são submetidas a uma separação de acordo com sua massa molecular (2. dimensão). Como os parâmetros usados anteriormente são independentes, uma grande resolução de spots (marcações protéicas) foi atingida. Os géis bidimensionais foram corados com Coomassie. Após a identificação dos spots nos géis 2-DE, extração das proteínas e análise por espectrometria de massa, constatamos o aparecimento de algumas proteínas com expressões variadas entre os géis Ct, Man e Hx. Dentre as proteínas identifica das localizamos algumas apenas nos géis submetidos à Hx, como. Canal de tropomiosina-1alfa (TPMA), e antígeno de proliferação de núcleo celular (PCNA). Outras localizadas nos géis Man e H x estavam supra expressas em relação ao gel Ct, como a proteína de controle da translação tumoral. Em contrapartida, houve proteínas que foram apenas expressas nos géis Ct e Man, evidenciando que provavelmente o iodo contido no HexabrixR tenha ocasionado uma sub expressão dessas proteínas, tais como anexina3 e Dna ligase. Finalmente houve a identificação de proteínas que estavam expressas nos três géis (Ct, Man e Hx) embora em concentrações variáveis, como Hsp27, Erp57 e Beta actina-1. De maneira geral, fatos relevantes foram analisados, um deles é de que todas as proteínas que foram expressas nos géis Ct e Hx, também foram detectadas nos géis Man, permitindo- nos enfatizar a possibilidade de descartar o papel da osmolaridade no aumento da expressão das proteínas que foram identificadas somente no gel Hx, sugerindo, portanto, ser o iodo e não a osmolaridade o fator desencadeador das alterações da expressão protéica. Em contrapartida supõe- se ainda que a osmolaridade tenha sido a causadora do aumento da expressão de algumas proteínas apenas nos géis Man e Hx, e não no CT. Sendo assim sugerimos que o MCTR, tanto pela sua osmolaridade como por outros fatores entre eles a influência da molécula do iodo, pode regular a síntese e/ou expressão das proteínas nas células mesangiais. / The kidney is a common target organ for toxic agents, like contrast media (CM). The CM with iodine is normally used in angiography, urography and tomography. CM is filtrated and metabolized in the kidney, being the major cause of acute renal failure (ARF). Nowadays, proteome is actually a powerful tool in the Nephrology Research, mainly in the identification of protein modifications when in contact with toxic agents. This technique also gives the possibility of biomarkers identification to help the physicians in the patient treatments. The aim of this study was to separate by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and to identify by matrix-assisted laser desorption ionization-time-of-flight (MALDI-TOF) mass spectrometry the proteins that were up- or down-regulated in immortalized mesangial cell in culture (IMC) in the presence of CM. We evaluated three groups of IMC: control (CT), manitol (Man) and HexabrixTM (Hx). The samples were treated and submitted to the 2D-PAGE analysis, where the proteins were separated according to their isoelectric points and molecular weights. We identified by MALDI-TOF around 11 proteins. Some proteins were expressed only in the Hx group (Proliferating Cell Nuclear Antigen and Masp 1); others were more expressed in the Man group when compared with Hx and Ct groups (Translationally Controlled Tumor Protein). On the other hand, some proteins were expressed only in the Ct and Man groups (Annexin A3 and DNA ligase), suggesting that probably the Hx caused injury in these cells and it was responsible for the down-regulation of these proteins. Finally, we identified proteins that were expressed in the three cell groups (Heat Shock Protein 27, Heat Shock Protein 84), but with different levels. We concluded that the osmolarity of manitol and Hx could influenciate the alterations in the concentration of a specific protein. We believe that osmolarity and other factors of the CM could be responsible for the nephrotoxicity observed in this model. Proteomic analysis is a promising tool to study the renal pathophysiology making possible in the future the identification of biomarkers of renal diseases that can constitute therapeutically targets, minimizing the actual damages for the ARF. / TEDE / BV UNIFESP: Teses e dissertações

Background Glomerulonephritis is a major cause of end-stage kidney disease (ESRD) in Africa. There is scanty data on the clinico-pathological characteristics and outcome of the mesangioproliferative glomerulonephritides in Africa, despite the non-IgA subtype being reported as a common cause of nephrotic syndrome. This study will assess the outcome of patients with biopsy proven mesangioproliferative glomerulonephritis (MesPGN) from a single centre in Cape Town, South Africa. Methods The study is designed as 10-year retrospective analysis of patients with biopsy proven MesPGN. The MesPGN patterns were divided into non-IgA MesPGN and IgA nephropathy (IgAN), depending on the predominant type of immune deposit. Univariate cox regression analysis was used to determine factors associated with ESRD. Results Data of 109 patients with renal biopsy-proven MesPGN were included for the period between 2005-2014. The mean age at biopsy was 33.8 ±14.9 years, 53.2% were males, and 39.4% were black Africans. Clinically, 58.7% presented with nephrotic syndrome. On histology 79.8% had non-IgA MesPGN, and 20.2% had IgAN. Compared to the non-IgA group, most patients with IgAN were not treated with immunosuppression (72.7% vs. 40.2%; p=0.006). At the last visit, 10.1% reached ESRD (40.9% vs. 2.3%; p<0.0001) and 30.2% achieved complete remission (9.1% vs. 35.7%; p=0.015) for IgAN and non-IgA MesPGN respectively. The 5-year renal survival for IgAN and non-IgA MesPGN respectively, were: 63.3% vs. 97.6%, log rank p=0.001. Overall, hypertension (p=0.019), not receiving immunosuppression (p=0.046) and having IgAN (p=0.007) were independent predictors of progression to ESRD. Conclusion There is a significantly higher ESRD-free survival of patients with biopsy proven non-IgA MesPGN than IgAN. Whether this is related to the limited use of immunosuppressive therapy in IgAN patients or represents a true nature of the disease still requires further research.

No description available.

La glomérulonéphrite mésangioproliférative (GNMP) se caractérise par une inflammation locale et la prolifération et l’apoptose des cellules mésangiales (CM). La protéine apparentée à l’hormone parathyroïdienne (PTHrP) a été impliquée dans ces processus dans divers types cellulaires. Nous avons analysé les effets de la PTHrP sur ces processus dans les CM. Nous montrons que la PTHrP majore la prolifération des CM par voie intracrine et diminue leur apoptose par voie paracrine. La PTHrP stimule les voies de l’AMPc/PKA et PI3-K/Akt conduisant à l’activation du NFkB et à la majoration de la cyclooxygénase-2 (Cox-2). La Cox-2 était responsable de la survie des CM par la PTHrP. Par ailleurs, l’IL-1beta et le TNF-alpha majorent l’expression de la PTHrP dans les CM, et la PTHrP elle-même induisait l’expression de cytokines et chimiokines. L’expression des cytokines (IL-17, IL-16), était brève (pic à 2h). L’expression des chimiokine (RANTES, MIP-2, TARC et I-TAC) était plus prolongée (4h). Dans un modèle murin de GNMP, la PTHrP était surexprimée à J1 dans les glomérules malades. Elle pourrait contribuer à l’inflammation locale, à la prolifération et à la survie des CM. / Mesangial proliferative glomerulonephritis (MPGN) is characterized by mesangial cells (MC) inflammation, proliferation and apoptosis. The parathyroid hormone-related protein (PTHrP) is known to influence these processes in many cell types. In this work we analyzed the effects of PTHrP on MC proliferation, apoptosis and inflammation. Our results show that PTHrP induced MC proliferation through the intracrine pathway while it promoted their survival through the paracrine one. PTHrP activating its receptor PTH1R, led to the activation of cAMP/PKA and PI3-K/Akt pathways, which induced NF-kappaB, and upregulated the cyclooxygenase-2 (Cox-2). We have shown that the Cox-2 was responsible of the anti-apoptotic effect of PTHrP on MC. Otherwise, IL-1beta and TNF-alpha importantly upregulated the PTHrP in MC and PTHrP itself led to an overexpression of many cytokines and chemokines. The overexpression of cytokines (IL-17 and IL-16) was brief (2h) while that of chemokines was extended (4h). In a mouse model of MPGN, PTHrP was upregulated in the injured glomeruli at day 1. PTHrP may then contribute to the inflammation, the proliferation and the survival of MC.

<p>The tubuloglomerular feedback mechanism is an important regulator in the juxtaglomerular apparatus and it detects flow dependent alterations in luminal NaCl concentration ([NaCl]) at the macula densa (MD) cell site via a Na+-K+-2Cl cotransporter. Signals are sent by the MD to adjust the afferent arteriole tone and altering release of renin. This signaling mechanism is unclear but MD cell calcium concentration, release of ATP and nitric oxide (NO) might be important.</p><p>In cultured rat glomerular mesangial cells the NO production was measured using confocal microscopy and calcium responses to ATP was measured with fura-2 using imaging techniques. NO from spermine-NONOate and L-arginine could resensitize, desensitized ATP receptors in a cGMP independent way. In mesangial cells from spontaneously hypertensive rats (SHR) less NO effect was found on ATP receptor de/resensitization indicating an impaired NO release or effect.</p><p>The macula densa cells were studied using microperfusion techniques with confocal and video imaging systems. Changes in [Ca2+]i from exposed macula densa plaques were assessed upon addition of agonists added to bath. The order of efficacy of agonists was UTP = ATP >> 2MesATP = ADP. Dose response curve for ATP added in bath showed an EC50 of 15 μM. Macula densa cell volume and NO concentration increased considerably with increasing luminal [NaCl] indicating an important role for NO in the signaling process to counteract a vasoconstrictor response and reset the sensitivity of the tubuloglomerular feedback mechanism. </p><p>In conclusion, the results showed 1). NO can increase the P2Y receptor resensitization in rat glomerular mesangial cells, acting through a cGMP-independent pathway. 2) An impaired NO generation/effect on P2Y receptors in mesangial cells from SHR rats. 3) Macula densa cells possess P2Y2, purinergic receptors on basolateral and that activation of these receptors results in the mobilization of Ca2+. 4) Increased luniinal [NaCl] delivery increased cell volume and the NO productions in the macula densa cells. </p>

The tubuloglomerular feedback mechanism is an important regulator in the juxtaglomerular apparatus and it detects flow dependent alterations in luminal NaCl concentration ([NaCl]) at the macula densa (MD) cell site via a Na+-K+-2Cl cotransporter. Signals are sent by the MD to adjust the afferent arteriole tone and altering release of renin. This signaling mechanism is unclear but MD cell calcium concentration, release of ATP and nitric oxide (NO) might be important. In cultured rat glomerular mesangial cells the NO production was measured using confocal microscopy and calcium responses to ATP was measured with fura-2 using imaging techniques. NO from spermine-NONOate and L-arginine could resensitize, desensitized ATP receptors in a cGMP independent way. In mesangial cells from spontaneously hypertensive rats (SHR) less NO effect was found on ATP receptor de/resensitization indicating an impaired NO release or effect. The macula densa cells were studied using microperfusion techniques with confocal and video imaging systems. Changes in [Ca2+]i from exposed macula densa plaques were assessed upon addition of agonists added to bath. The order of efficacy of agonists was UTP = ATP &gt;&gt; 2MesATP = ADP. Dose response curve for ATP added in bath showed an EC50 of 15 μM. Macula densa cell volume and NO concentration increased considerably with increasing luminal [NaCl] indicating an important role for NO in the signaling process to counteract a vasoconstrictor response and reset the sensitivity of the tubuloglomerular feedback mechanism. In conclusion, the results showed 1). NO can increase the P2Y receptor resensitization in rat glomerular mesangial cells, acting through a cGMP-independent pathway. 2) An impaired NO generation/effect on P2Y receptors in mesangial cells from SHR rats. 3) Macula densa cells possess P2Y2, purinergic receptors on basolateral and that activation of these receptors results in the mobilization of Ca2+. 4) Increased luniinal [NaCl] delivery increased cell volume and the NO productions in the macula densa cells.

<p>Glomerulosclerosis (GS) is the irreversible scarring of glomerular tissue which underlies the development of chronic kidney disease (CKD). Increased intraglomerular capillary pressure (P_gc) is a major contributor to the development of GS and can occur in both hypertensive and diabetic patients. With elevated P_gc, <em>in vitro</em> and <em>in vivo</em> evidence suggest that mesangial cells (MC) experience cyclic stretch and secrete pro-fibrotic factors such as connective tissue growth factor (CTGF) which contributes to GS. The signaling pathways that are activated in response to elevated P_gc and lead to extracellular matrix (ECM) production in MCs are the main focus of this thesis.</p> <p>Previous data demonstrated activation of the Rho GTPase, Rac1, with cyclic stretch in MCs. Furthermore, the most characterized effector of Rac1, p21-activated kinase (PAK), has been observed to have a role in endothelial cells (ECs) exposed to mechanical stress. We thus proposed that the Rac1-PAK signaling pathway is involved in mechanical stress signaling in MCs.</p> <p>Our data demonstrate that Rac1-PAK signaling was activated in response to cyclic stretch and required for stretch-induced CTGF production in MCs. RhoA activation was also regulated by Rac1-PAK signaling, and RhoA/ROCK were observed to mediate CTGF upregulation with stretch. Further investigation on the role of Rac1-PAK signaling and how it regulates CTGF in MCs exposed to stretch, will provide insight into potential therapeutic targets to delay the progression of hypertension-mediated CKD.</p> / Master of Science in Medical Sciences (MSMS)

科学研究費補助金 研究種目:一般研究(B)(2) 課題番号:07457240 研究代表者:宮田 敏男 研究期間:1995-1996年度