Tubular basement membrane immune complex deposition is associated with activity and progression of lupus nephritis: a large multicenter Chinese study.

Tubulointerstitial injury is found frequently in lupus nephritis. Immune complex deposits can occur in the tubular basement membranes (TBMs), although its significance in lupus nephritis patients remains unclear. This study assessed the clinical and prognostic features of lupus nephritis patients with TBM deposits in a large Chinese multicenter cohort. Complete data were collected from 195 patients with renal biopsy-proven lupus nephritis diagnosed in the Peking University First Hospital as the discovery cohort. A total of 102 lupus nephritis patients were enrolled from another four centers as the validation cohort. The status of TBM deposits was retrospectively assessed using electron microscopy, and the associations of the deposits with clinical data, pathological characteristics and renal outcomes were further analyzed. The percentage of positive TBM deposits was nearly 30% in the lupus nephritis patients. Using immuno-gold labeling, we found that 10/10 patients were positive for IgG, 7/10 were C3d positive, 6/10 were C1q positive, and 1/10 were C4d positive. Patients with TBM deposits presented with more active features, including a higher SLEDAI score (SLE Disease Activity Index) ( p < 0.001), higher serum creatinine level ( p = 0.001) and lower serum C3 level ( p < 0.001). These patients also presented with higher scores for most renal pathological indices, including the total activity indices score ( p < 0.001) and total chronicity indices score ( p = 0.001). TBM deposits affected renal outcomes in the univariate Cox hazards regression analysis (HR = 4.2, 95% CI = 1.3-14.3, p = 0.02). In conclusion, TBM deposits were common in lupus nephritis patients and correlated closely with the clinical disease activity and renal outcome.

Predictors of survival in Chinese patients with lupus nephritis.

The current study was to determine the predictors of survival in 491 Chinese patients with lupus nephritis (LN). All patients were evaluated and consecutively followed up from 2003 to 2010. The female: male ratio was 9.5:1, with a median age of 31.1 ± 12 years. Forty-nine (10.0%) patients were lost to follow-up and 47 (10.3%) patients died. The overall cumulative probability of survival at 5, 10, 15 and 20 years by Kaplan-Meier analysis was 88%, 77%, 53% and 45%, respectively. The log-rank test showed that the probability of survival was significantly decreased in the late-onset patients (≥50 years) (P = 0.036), patients with hypoproteinaemia (≤35 g/l) (P = 0.014), patients with increased creatinine (≥1.5 mg/dl) (P = 0.002) and patients with massive proteinuria (≥3.5 g/24 h) (P = 0.009). However, the probability of survival was significantly higher in patients treated with hydroxychloroquine (HCQ) (P = 0.003) than those not treated with it. Based on a multivariate model, increased creatinine (hazard ratio (HR) = 2.041; P = 0.017) and proteinuria ≥3.5 g/24hours (HR=1.716; P = 0.016) were independent risk factors. Glucocorticoid (HR = 0.457; P = 0.01) and HCQ (HR=0.197; P = 0.026) were independent protective factors. Our findings suggest that renal dysfunction and massive proteinuria are independent risk factors for mortality. HCQ could improve the survival of patients with LN.

SOX9 regulated proliferation and apoptosis of human lung carcinoma cells by the Wnt/ß-catenin signaling pathway.

OBJECTIVE: Sex-determining region Y-box 9 (SOX9) is a transcription factor linked to stem cell maintenance and commonly over-expressed in solid cancers. In the present study, the effects of SOX9 on proliferation and apoptosis of human lung carcinoma cells and its mechanisms were investigated. MATERIALS AND METHODS: Following over-expression or knock-down of SOX9 in human lung carcinoma cell line A549, cell viability was evaluated using XTT method, and cell apoptosis was measured by Flow cytometry. Caspase-3, Caspase-8, Caspase-9 and SOX9 expression was measured by RT-PCR, and Wnt, phosphorylated Wnt (p-Wnt) and ß-catenin expression was detected by Western Blot. RESULTS: Results showed that SOX9 expression was elevated in human lung carcinoma cells. Knocking down cellular SOX9 by short hairpin RNA (shRNA) decreased cell proliferation while promoted apoptosis of A549 cells. Furthermore, down-regulation of p-Wnt and ß-catenin expression levels was detected in A549 cells lack of SOX9. However, over-expression of SOX9 played the opposite roles in proliferation and apoptosis of human lung carcinoma cells. To further demonstrate the functions of the Wnt/ß-catenin signaling pathway in SOX9 regulated-cell functions, the inhibitor IWP-2 was used to block the activation of Wnt/ß-catenin signal. No significant differences between IWP-2-treated cells and SOX9 plus IWP-2-treated cells suggested the existence of a regulatory role for SOX9 through targeting the Wnt/ß-catenin pathway. CONCLUSIONS: These findings establish the significance of SOX9 in lung cancer pathobiology and heterogeneity, with implications for targeting the Wnt/ß-catenin-SOX9 signaling pathway as a rational therapeutic strategy.