Blockade of CD40-CD40 ligand protects against renal injury in chronic proteinuric renal disease

Blockade of CD40-CD40 ligand protects against renal injury in chronic proteinuric renal disease.BackgroundInteraction between CD40 and CD40 ligand (CD40L) is involved in both cognate and innate immune responses. Blockade of CD40-CD40L interactions reduces severity of renal injury in murine lupus nephritis and membranous nephropathy. We hypothesized that CD40-CD40L could contribute to renal injury in models that are not antibody-dependent, and that anti-CD40L could diminish inflammation and fibrosis in murine adriamycin nephropathy.MethodsMale BALB/c mice were divided into three groups (N = 6 per group): (1) saline-treated, age-matched control; (2) adriamycin only; and (3) MR1 + adriamycin. In group 3, mice were treated with intraperitoneal injections of anti-CD40L antibody (clone MR1, 0.4mg per mouse) after the onset of proteinuria at days 5, 7, 9, and 11 after adriamycin treatment. Animal subgroups were compared at 14 and 42 days after induction of adriamycin nephropathy. Functional and pathologic markers of disease severity, cellular components of interstitial inflammation, and the degree of CD40 expression were assessed. Relative cortical RNA expression of the chemokine monocyte-chemoattractant protein-1 (MCP-1) and regulated on activation normal T cell expressed and secreted (RANTES) was also compared between animal groups.ResultsCD40 was weakly expressed in tubules of normal mice but was expressed in tubules, interstitium, and glomeruli of mice with adriamycin nephropathy in a time-dependent manner. MR1 treatment resulted in a significant attenuation of the severity of adriamycin nephropathy at day 42 [e.g., glomerular sclerosis (%), group 3, 20.1 ± 4.7 vs. group 2, 30.2 ± 7.2, P < 0.001]. CD40L blockade significantly reduced tubulointerstitial injury as well [tubular diameter (μm), group 3, 42.5 ± 6.9 vs. group 2, 66.3 ± 13.7, P < 0.001; and group 1, 37.3 ± 5.7, P < 0.01; tubular cell height (μm), group 3, 16.3 ± 1.7 vs. group 2, 11 ± 1.8, P < 0.01; and group 1, 18.2 ± 1.9, P < 0.01; interstitial volume (%), group 3, 13.9 ± 5.1 vs. group 2, 26.2 ± 4.9, P < 0.001; and group 1, 1.3 ± 0.7, P < 0.001; proteinuria (mg/24 hours), group 3, 1.8 ± 0.6 vs. group 2, 4.3 ± 0.8, P < 0.001; and group 1, 0.7 ± 0.2, P < 0.05; and creatinine clearance (μL/min), group 3, 75 ± 4 vs. group 2, 35 ± 2, P < 0.001; and group 1, 82 ± 4, P < 0.01] were also improved by MR1. MR1 treatment also resulted in a significant reduction in the number of cortical macrophages at both 14 and 42 days after adriamycin (P < 0.01). Cortical expression of MCP-1 and RANTES was significantly reduced by MR1 treatment at 42 days after adriamycin (P < 0.01 and P < 0.05, respectively).ConclusionBlockade of CD40-CD40L interaction protects against renal structural and functional injury in this murine model of chronic proteinuric renal disease