title: Activated renal macrophages are markers of disease onset and disease remission in lupus nephritis.
abstract: Costimulatory blockade with CTLA4Ig and anti-CD40L along with a single dose of cyclophosphamide induces remission of systemic lupus erythematosus nephritis in NZB/W F(1) mice. To understand the mechanisms for remission and for impending relapse, we examined the expression profiles of 61 inflammatory molecules in the perfused kidneys of treated mice and untreated mice at different stages of disease. Further studies using flow cytometry and immunohistochemistry allowed us to determine the cellular origins of several key markers. We show that only a limited set of inflammatory mediators is expressed in the kidney following glomerular immune complex deposition but before the onset of proteinuria. Formation of a lymphoid aggregate in the renal pelvis precedes the invasion of the kidney by inflammatory cells. Regulatory molecules are expressed early in the disease process and during remission but do not prevent the inevitable progression of active inflammation. Onset of proliferative glomerulonephritis and proteinuria is associated with activation of the renal endothelium, expression of chemokines that mediate glomerular cell infiltration, and infiltration by activated dendritic cells and macrophages that migrate to different topographical areas of the kidney but express a similar profile of inflammatory cytokines. Increasing interstitial infiltration by macrophages and progressive tubular damage, manifested by production of lipocalin-2, occur later in the disease process. Studies of treated mice identify a type II (M2b)-activated macrophage as a marker of remission induction and impending relapse and suggest that therapy for systemic lupus erythematosus nephritis should include strategies that prevent both activation of monocytes and their migration to the kidney.
authors.affiliation: Autoimmunity Center, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
authors.forename: Lena
authors.initials: L
authors.lastname: Schiffer
authors.forename: Ramalingam
authors.initials: R
authors.lastname: Bethunaickan
authors.forename: Meera
authors.initials: M
authors.lastname: Ramanujam
authors.forename: Weiqing
authors.initials: W
authors.lastname: Huang
authors.forename: Mario
authors.initials: M
authors.lastname: Schiffer
authors.forename: Haiou
authors.initials: H
authors.lastname: Tao
authors.forename: Michael P
authors.initials: MP
authors.lastname: Madaio
authors.forename: Michael M
authors.initials: MM
authors.lastname: Madaio
authors.forename: Erwin P
authors.initials: EP
authors.lastname: Bottinger
authors.forename: Anne
authors.initials: A
authors.lastname: Davidson
mesh_terms: D000069594:Abatacept; D000818:Animals; D015415:Biomarkers / Q000032:analysis; D023201:CD40 Ligand / Q000037:antagonists & inhibitors; D018450:Disease Progression; D005260:Female; D005434:Flow Cytometry; D020869:Gene Expression Profiling; D018796:Immunoconjugates / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007249:Inflammation / Q000235:genetics; D007668:Kidney / Q000276:immunology* / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D008214:Lymphocytes / Q000276:immunology; D008262:Macrophage Activation / Q000235:genetics*; D008264:Macrophages / Q000276:immunology*; D051379:Mice; D008814:Mice, Inbred NZB; D011507:Proteinuria / Q000235:genetics; D012074:Remission Induction
chemical_list: D015415:Biomarkers; D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D023201:CD40 Ligand; D000069594:Abatacept