Expression of endothelial protein C receptor in cortical peritubular capillaries associates with a poor clinical response in lupus nephritis.

Published

Journal Article

OBJECTIVE: To study the membrane expression of endothelial protein C receptor (mEPCR) in the renal microvasculature in lupus nephritis (LN) as a potential marker of injury and/or prognostic indicator for response to therapy. METHODS: mEPCR expression was analysed by immunohistochemistry in normal kidney and in 59 biopsies from 49 patients with LN. Clinical parameters were assessed at baseline, 6 months and 1 year. RESULTS: mEPCR was expressed in the medulla, arterial endothelium and cortical peritubular capillaries (PTCs) in all biopsies with LN but not in the cortical PTCs of normal kidney. Positive mEPCR staining in >25% of the PTCs was observed in 16/59 biopsies and associated with poor response to therapy. Eleven (84.6%) of 13 patients with positive staining for mEPCR in >25% of the PTCs and follow-up at 6 months did not respond to therapy, compared with 8/28 (28.6%) with mEPCR staining in < or =25% PTCs, P = 0.0018. At 1 year, 10 (83.3%) of 12 patients with positive mEPCR staining in >25% of the PTCs did not respond to therapy (with two progressing to end-stage renal disease) compared with 8/24 (33.3%) with positive staining in < or =25% of the PTCs, P = 0.0116. Although tubulo-interstitial damage (TID) was always accompanied by mEPCR, this endothelial marker was extensively expressed in the absence of TID suggesting that poor response could not be attributed solely to increased TID. mEPCR expression was independent of International Society of Nephrology/Renal Pathology Society class, activity and chronicity indices. CONCLUSION: Increased mEPCR expression in PTCs may represent a novel marker of poor response to therapy for LN.

Full Text

Duke Authors

Cited Authors

  • Izmirly, PM; Barisoni, L; Buyon, JP; Kim, MY; Rivera, TL; Schwartzman, JS; Weisstuch, JM; Liu, DT; Bernstein, S; Tseng, C-E; Belmont, HM; Esmon, CT; Merrill, JT; Askanase, AD; Thomas, DB; Clancy, RM

Published Date

  • May 2009

Published In

Volume / Issue

  • 48 / 5

Start / End Page

  • 513 - 519

PubMed ID

  • 19286697

Pubmed Central ID

  • 19286697

Electronic International Standard Serial Number (EISSN)

  • 1462-0332

Digital Object Identifier (DOI)

  • 10.1093/rheumatology/kep034

Language

  • eng

Conference Location

  • England