Title Izražaj receptora za D vitamin, 25-hidroksivitamin D 1α–hidroksilaze i vitamin D3 24-hidroksilaze u bubrezima pacijenata s IgA nefropatijom
Title (english) Expression of renal vitamin D receptors and metabolizing enzymes in IgA Nephropathy
Author Adela Arapović
Mentor Natalija Filipović (mentor)
Committee member Sandra Zekić Tomaš (predsjednik povjerenstva)
Committee member Krešimir Galešić (član povjerenstva)
Committee member Iris Jerončić Tomić (član povjerenstva)
Granter University of Split School of Medicine Split
Defense date and country 2022-01-28, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Pediatrics
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract Perkutana biopsija bubrega izvodi se u KBC-u Split kontinuirano od 1994. Stroge
indikacije za invazivni zahvat obuhvaćaju poznate bubrežne sindrome. Bubrežno tkivo se
nakon postavljanja dijagnoze može naknadno analizirati radi novih biljega, važnih u
patogenezi bubrežnih bolesti. Bubreg je mjesto aktivacije vitamina D koji ima pleiotropni
povoljni učinak na organizam. Zbog bubrežne bolesti kompleksni mehanizam regulacije
vitamina D može biti poremećen. Istražili smo izražaj receptora za vitamin D (VDR) te
enzima aktivacje (1α-OHaza) i razgradnje (CYP24A1) vitamina D u bioptatima bubrega
bolesnika s IgA nefropatijom (IgAN) i usporedili s kontrolnim tkivima.
Za epidemiološku analizu prikupljeni su klinički i patološki padaci o 54 bolesnika
bioptirana na Klinici za dječje bolesti od 2008. do 2017. Za eksperimentalnu analizu
prikupljeni su arhivirani parafinski blokovi bubrežnog tkiva 12 bolesnika s IgAN-om (šestero
djece i šestero odraslih). Izrezani su preparati debljine 5 µm, standardno priređeni za
indirektno imunohistokemijsko bojenje protutijelima na VDR, 1α-OHazu i CYP24A1,
analizirani na imunofluoroscencijskom mikroskopu, fotografirani i kvantificirani uporabom
ImageJ računalnog programa. U statističkoj analizi je značajnim smatran P < 0,05.
U epidemiološkoj analizi, od 54 ispitanika, 29 je bilo muškog i 25 ženskog spola,
srednja dob 9,84 ± 5,4 godine. Polovina indikacija za biopsiju otpada na nefrotski sindrom
(NS; 25,93%) i ne-nefrotsku proteinuriju s hematurijom (22,22%). Najčešće je
dijagnosticirana IgAN, a potom bolest minimalnih promjena (MCD), Henoch-Schönlein
nefritis (HSPN), fokalna segmentalna glomeruloskleroza (FSGS) i Alportov sindrom (AS).
Spektar dijagnoza se promijenio u odnosu na prethodno analizirano razdoblje 1995 – 2005. jer
je mali postotak prethodno često dijagnosticiranog mezangioproliferativnog
glomerulonefritisa (MesPGN). Na promjene u indikacijama i veći broj bioptiranih s IH-om i
ne-nefrotskom proteinurijom s hematurijom utjecale su nove klasifikacije i mogućnost boljeg
dijagnosticiranja hereditarnih bolesti glomerularne bazalne membrane (GBM). U
eksperimentalnoj analizi, izražaj VDR-a u bubrežnom tkivu je značajno veći u bolesnika s
IgAN-om nego u kontroli (P = 0,037), a izražaj 1α-OHaze značajno manji nego u kontroli (P
< 0,001). Izražaj CYP24A1 i postotak jezgara imunoreaktivnih na CYP24A1 u glomerulima i
epitelu distalnih kanalića je značajno veći u bolesnika s IgAN-om nego u kontrolnim tkivima
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(P < 0,001). Postotak nuklearnog izražaja CYP24A1 u epitelu proksimalnih kanalića pokazuje
negativnu korelaciju s eGFR (P = 0,034).
Raspodjela indikacija i patoloških nalaza slična je podacima iz većine drugih studija.
Razlika u izražaju VDR-a i enzima povezanih s aktivacijom i degradacijom vitamina D
upućuje na smanjenu proizvodnju kalcitriola i povećanu razgradnju vitamina D u bubregu
bolesnika s IgAN-om.
Abstract (english) Percutaneous kidney biopsy has been performed at University Hospital of Split
continuously since 1994. Strict indications for invasive procedure include well- known renal
syndromes. After diagnosis, renal tissue can be subsequently analyzed for new markers,
important in the pathogenesis of renal disease. The kidney is the site of activation of vitamin
D, which has a pleiotropic beneficial effect on the body. Due to kidney disease, the complex
mechanism of vitamin D regulation can be disrupted. We investigated the expression of
vitamin D receptor (VDR) and the enzymes of activation (1α-OHase) and degradation
(CYP24A1) of vitamin D in kidney biopsies of patients with IgA nephropathy (IgAN) and
compared it with control.
For epidemiological analysis, clinical and pathological data were collected on 54
patients biopsied in the Clinic for Children´s Diseases from 2008 to 2017. For experimental
analysis, archived paraffin blocks of renal tissue of 12 patients with IgAN (6 children and 6
adults) were collected. Five µm thick slides, standardly prepared for indirect
immunohistochemical staining with antibodies to VDR, 1α-OHase and CYP24A1, were
analyzed on an immunofluorescence microscope, photographed and quantified using an
Image J computer program. In the statistical analysis, P < 0.05 was considered significant.
In the epidemiological analysis, out of the 54 patients, 29 were male and 25 female;
mean age 9.84 ± 5.4 years. Half of the biopsyindications are nephrotic syndrome (NS;
25.93%) and non-nephrotic proteinuria with hematuria, 22.22%. IgAN was most commonly
diagnosed, followed by minimal change disease (MCD), Henoch-Schönlein purpura nephritis
(HSPN), focal segmental glomerulosclerosis (FSGS), and Alport syndrome (AS). The
spectrum of diagnoses changed compared to the previously analyzed period 1995 – 2005
because a small percentage of previously frequently diagnosed mesangioproliferative
glomerulonephritis (MesPGN). Changes in indications were influenced by new classifications
and the possibility of better diagnosis of hereditary disease of the glomerular basement
membrane (GBM). In the experimental analysis, the expression of VDR in renal tissue was
higher in patients with IgAN (P = 0.037), and the expression of 1α-OHase was significantly
lower than in control (P <0.001). CYP24A1 expression in renal tissue, as well as the
percentage of positive nuclei int he glomeruli and epithelium of distal tubules were higher in
patients with IgAN than in control (P <0.001). The percentage of nuclear CYP24A1
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expression in the epithelium of the proximal tubules shows a negative correlation with the
estimated glomerular filtration (eGFR; P = 0.034).
The distribution of indications and pathological findings is similar to that of most
other studies. The difference in the expression of VDR and enzymes associated with vitamin
D activation and degradation suggests decreased calcitriol production and increased renal
degradation of vitamin D in patients with IgAN.
Keywords
receptori za vitamin D
IgA nefropatija
CYP24A1
CY P27B1
25-hidroksivitamin D 1α-hidroksilaza
Vitamin D3 24-hidroksilaza
Keywords (english)
vitamin D receptors
IgA nephropathy
CYP24A1
CY P27B1
25-hydroxyvitamin D 1α-hydroxylase
Vitamin D3 24-hydroxylase
Language croatian
URN:NBN urn:nbn:hr:171:277603
Promotion 2022
Study programme Title: Biology of Neoplasms Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2022-02-02 14:55:56