title: Mycophenolate mofetil slows progression in anti-thy1-induced chronic renal fibrosis but is not additive to a high dose of enalapril.
abstract: Tubulointerstitial inflammation and fibrosis are hallmarks of chronic progressive renal diseases. To characterize the functional interaction between cell infiltration and matrix expansion, this study compared the immunosuppressant mycophenolate mofetil (MMF), intended as primarily anti-inflammatory intervention, the angiotensin-converting enzyme inhibitor enalapril, intended as primarily an anti-fibrotic drug, and a combination of both as anticipated anti-inflammatory/anti-fibrotic intervention. The model used was anti-thy1-induced chronic-progressive glomerulosclerosis (cGS) in the rat, where a brief anti-thy1-induced glomerular injury progresses spontaneously toward tubulointerstitial fibrosis and renal insufficiency. cGS was induced by injection of anti-thy1 antibody into uninephrectomized Wistar rats. One week after disease induction, animals were randomly assigned to the following groups: cGS, cGS plus MMF (20 mg.kg body wt(-1).day(-1)), cGS plus high-dose enalapril (12 mg.kg body wt(-1).day(-1)), and cGS plus both. At week 16 after disease induction, MMF or enalapril alone reduced signs of chronic renal disease significantly and similarly compared with the untreated cGS group. Variables measured included proteinuria, blood pressure, tubulointerstitial and glomerular matrix accumulation, expression of transforming growth factor-beta(1), fibronectin, and plasminogen activator inhibitor-1, infiltration of lymphocytes and macrophages, plasma creatinine and urea levels, and glomerular filtration rate. Combined MMF and enalapril treatment was not superior to single therapy. In conclusion, MMF slows the progression of chronic renal fibrosis and renal insufficiency as effectively as high-dose enalapril in the anti-thy1-induced chronic-progressive glomerulosclerosis model. The dual anti-inflammatory/anti-fibrotic intervention does not yield additive renoprotective effects, indicating that MMF and enalapril interfere with similar or very closely related pathways involved in progression of renal disease.
authors.affiliation: Department of Nephrology, Charité University Medicine Berlin, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Krämer
authors.forename: Tanja
authors.initials: T
authors.lastname: Loof
authors.forename: Sebastian
authors.initials: S
authors.lastname: Martini
authors.forename: Matthias
authors.initials: M
authors.lastname: Rückert
authors.forename: Yingrui
authors.initials: Y
authors.lastname: Wang
authors.forename: Torsten
authors.initials: T
authors.lastname: Böhler
authors.forename: Fuijo
authors.initials: F
authors.lastname: Shimizu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawachi
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Harm
authors.initials: H
authors.lastname: Peters
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D001772:Blood Cell Count; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D018450:Disease Progression; D004347:Drug Interactions; D004435:Eating / Q000502:physiology; D004656:Enalapril / Q000627:therapeutic use*; D005353:Fibronectins / Q000378:metabolism; D005355:Fibrosis; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000473:pathology; D007677:Kidney Function Tests; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology*; D009392:Nephrectomy; D017395:Plasminogen Activator Inhibitor 1 / Q000096:biosynthesis; D011507:Proteinuria / Q000188:drug therapy; D051381:Rats; D017208:Rats, Wistar; D018800:Thy-1 Antigens / Q000276:immunology*; D016212:Transforming Growth Factor beta / Q000378:metabolism; D053773:Transforming Growth Factor beta1
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005353:Fibronectins; D007166:Immunosuppressive Agents; D017395:Plasminogen Activator Inhibitor 1; C508962:Tgfb1 protein, rat; D018800:Thy-1 Antigens; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1; D004656:Enalapril; D009173:Mycophenolic Acid