Abstract
Background
Plasmin has recently been reported to be associated with renal fibrosis in experimental models, but its role in human renal diseases is unclear.
Methods
Fifty-seven patients with IgA nephropathy (IgAN) were evaluated retrospectively. Plasmin in their renal biopsy tissues was assessed by in situ zymography using a plasmin-sensitive synthetic peptide, and the relationships between patients’ histologic or clinical parameters and their renal plasmin activity [assessed semiquantitatively by calculating the positively stained percentage of the total tubulointerstitial (TI) area] were evaluated.
Results
Plasmin activity was observed almost exclusively in the TI space (mainly in the interstitium and partly in the tubular epithelial cells) and was significantly stronger in patients with TI lesion (tubular atrophy/interstitial fibrosis and tubulointerstitial inflammation) than in those without TI lesion. It was significantly and positively correlated with the global glomerulosclerosis rate and significantly and negatively correlated with estimated glomerular filtration rate not only at the time of renal biopsy but also at the end of the follow-up period. Double stainings for plasmin activity and inflammatory cells, cytokeratin, or α-smooth muscle actin (α-SMA) in selected patients revealed TI infiltration of inflammatory cells, attenuated tubular epithelial expression of cytokeratin, and augmented interstitial expression of α-SMA close to upregulated plasmin activity in the TI space.
Conclusions
These data suggest that TI plasmin is associated with TI inflammation leading to renal fibrosis, and can cause the decline in renal function seen in patients with IgAN. Reducing plasmin in situ may therefore be a promising therapeutic approach slowing renal fibrogenesis and improving renal function.
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Acknowledgments
We thank our colleague Ms. Toshie Fujiwara for expert secretarial assistance.
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
The study protocols were approved by the Ethical Committee of National Defense Medical College.
Informed consent
Informed consent was obtained from each participating patient in accordance with the principles of the Declaration of Helsinki.
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Uchida, T., Oda, T., Takechi, H. et al. Role of tubulointerstitial plasmin in the progression of IgA nephropathy. J Nephrol 29, 53–62 (2016). https://doi.org/10.1007/s40620-015-0205-1
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DOI: https://doi.org/10.1007/s40620-015-0205-1