Mycophenolate mofetil combined with prednisone for diffuse proliferative lupus nephritis: a histopathological study.
Mycophenolate mofetil (MMF) is a potential new treatment for diffuse proliferative lupus nephritis. This study examines the clinical and histopathological effects, and potential mechanisms, of combination MMF/prednisone therapy in diffuse proliferative lupus nephritis. Nine patients with diffuse proliferative lupus nephritis confirmed by renal biopsy received MMF/prednisone for six months when repeat biopsies were performed. Clinical and histopathological parameters of activity and chronicity were studied. Collagens were detected by Sirus red staining; leucocyte phenotype, osteopontin (OPN), fibrinectin (FN), alpha-smooth muscle actin (alpha-SMA) and TGF-beta1 were detected by immunohistochemistry. The changes of clinical and histopathologic parameters were assessed and compared to histopathologic indicators. Eight of the nine patients achieved clinical remission; renal function deteriorated in one. Histopathological activity indices reduced significantly (9.56 +/- 2.83 versus 5.22 +/- 1.86, P < 0.01); however, the chronicity indices did not change (3.56 +/- 1.42 versus 3.22 +/- 1.20). T-cell and monocyte/macrophage infiltration. OPN expression and the percentage of proliferative cells in both glomerulus and tubulo-interstitium decreased significantly. Other features of chronic lesions, except for glomerular collagen deposition, did not change. In conclusion, MMF/prednisone therapy was effective for our patients with proliferative lupus nephritis. The active inflammatory lesions could be ameliorated through reduction of lymphocyte and monocyte/macrophage infiltration, inhibition of cell proliferation and downregulation of adhesive molecules. However, the chronic fibrotic lesions could not be significantly reduced.
Ding
Lei
L
Institute of Nephrology and Renal Unit of the First Hospital, Peking University, Beijing, PR China.
Zhao
Minghui
M
Zou
Wanzhong
W
Liu
Yuchun
Y
Wang
Haiyan
H
D000199:Actins / Q000032:analysis; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003094:Collagen / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D005353:Fibronectins / Q000032:analysis; D005938:Glucocorticoids / Q000008:administration & dosage*; D006651:Histocytochemistry; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D053495:Osteopontin; D011241:Prednisone / Q000008:administration & dosage*; D012795:Sialoglycoproteins / Q000032:analysis
D000199:Actins; D005353:Fibronectins; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C506895:SPP1 protein, human; D012795:Sialoglycoproteins; D053495:Osteopontin; D003094:Collagen; D009173:Mycophenolic Acid; D011241:Prednisone