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J Nephrol ; 28(1): 51-8, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24756968

RESUMEN

The benefits of tonsillectomy in IgA nephropathy (IgAN) are still debated. Tonsillectomy may remove pathogen sources and reduce the mucosal associated lymphoid tissue (MALT), limiting degalactosylated IgA1 (deGal-IgA1) production, which is considered to be the initiating pathogenetic event leading to IgA glomerular deposition. In the European network VALIGA, 62/1147 IgAN patients underwent tonsillectomy (TxIgAN). In a cross-sectional study 15 of these patients were tested and compared to 45 non-tonsillectomized IgAN (no-TxIgAN) and healthy controls (HC) regarding levels of deGal-IgA1, and markers of innate immunity and oxidative stress, including toll-like receptors (TLR)2, 3, 4 and 9 mRNAs, proteasome (PS) and immunoproteasome (iPS) mRNAs in peripheral blood mononuclear cells (PBMC), and advanced oxidation protein products (AOPP). Levels of deGal-IgA1 were lower in TxIgAN than in no-TxIgAN (p = 0.015), but higher than in HC (p = 0.003). TLR mRNAs were more expressed in TxIgAN than in HC (TLR4, p = 0.021; TLR9, p = 0.027), and higher in TxIgAN than in no-TxIgAN (p ≤ 0.001 for TLR2, 4, 9). A switch from PS to iPS was detected in PBMC of TxIgAN in comparison to HC and it was higher than in no-TxIgAN [large multifunctional peptidase (LMP)2/ß1, p = 0.039; LPM7/ß5, p < 0.0001]. The levels of AOPP were significantly higher in TxIgAN than HC (p < 0.001) and no-TxIgAN (p = 0.033). In conclusion, the activation of innate immunity via TLRs and ubiquitin-proteasome pathways and the pro-oxidative milieu were not affected by tonsillectomy, even though the levels of aberrantly galactosylated IgA1 were lower in patients with IgAN who had tonsillectomy. The residual hyperactivation of innate immunity in tonsillectomized patients may result from extra-tonsillar MALT.


Asunto(s)
Inmunidad Adaptativa , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/cirugía , Inmunidad Innata , Tonsilectomía , Adolescente , Adulto , Productos Avanzados de Oxidación de Proteínas/sangre , Estudios de Casos y Controles , Estudios Transversales , Cisteína Endopeptidasas/genética , Femenino , Galactosa/metabolismo , Expresión Génica , Glomerulonefritis por IGA/patología , Voluntarios Sanos , Humanos , Inmunoglobulina A/sangre , Masculino , Persona de Mediana Edad , Complejo de la Endopetidasa Proteasomal/genética , ARN Mensajero/sangre , Receptor Toll-Like 2/genética , Receptor Toll-Like 3/genética , Receptor Toll-Like 4/genética , Receptor Toll-Like 9/genética , Receptores Toll-Like/genética , Adulto Joven
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