The EGF Receptor promotes glomerular injury in. M. FLAMANT G. BOLLEE PL. THARAUX Actualités néphrologiques 24 Avril 2012
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1 The EGF Receptor promotes glomerular injury in necrotizing crescentic glomerulonephritis. M. FLAMANT G. BOLLEE PL. THARAUX Actualités néphrologiques 24 Avril 2012
2 Glomerulonephritis 12% of ESRD Registre R.E.I.N, 2008 IgAN Vasculitis / ANCA SLE Goodpasture / anti-gbm post infectious GN Cryoglobulinemia... pauci-immunes RPGN Activation of neutrophils In response to ANCA anti-gbm Glomerulonepritis anti-α3nc1 / α5nc1 antibodies Autoreactive T Lymphocytes Epitope spreading immune complexes RPGN 25% Auto-antibodies Complement activation Common mechanisms? Glomerular epithelial cells
3 Podocytes in NCGN Up to 50% of the crescentic cells Transformation of their phenotype: - loss of differenciation markers - Migration and proliferation Proliferation of podocytes induced by the deletion of the vhl gene is sufficient to develop a NCGN Ding, Nat Med, 2006
4 Glomerular parietal epithelial cells in NCGN PEC-rtTA/LC1/R26R mice Smeets, J Am Soc Nephrol, 2009 involvement of the GPEC in human and murine crescentic glomerulonephritis up to 80% of the crescentic cells Progenitor cells: - CD24 and CD133 expression (human) - podocytes regeneration
5 ANCA vasculitis anti-gbm antibodies Immune complexes Immunosuppressants? Inflammation injury rupture of the glomerular filtration barrier leakage of plasma proteins Local factors? Proliferation and migration of glomerular epithelial cells HB-EGF EGFR Proliferation Migration Inflammation?
6 Heparin-binding EGF-like growth factor (HB-EGF) - Growth Factor of the EGF family EGF TGFα Amphireguline Epigen HB-EGF Epireguline Betacelluline Neuregulins - Ligand of the ErbB family (EGFR, ErBb4) Ligand binding EGFR/ErbB1 ErbB2 ErbB3 ErbB4 Hetero or homodimer formation Autophosphorylation P P P P Recruitment of intracellular signaling pathways PI3K Ras STAT3, STAT5 MAPK
7 PI3K HB-EGF expression pattern: - Epithelial cells - Vascular SMC - endothelial cells - Mesangial cells - T lymphocytes - Macrophages - Cancer cells Juxtacrine and paracrine activity Proliferation Migration Involvement in NCGN? Adapted from Flamant et al, Med Science, 2005
8 Glomerular expression of HB-EGF - Diabetes - FSGS (Puromycin model) - NTS anti GBM (early induction) Paizis Kidney Int Feng, JCI 2000 Mesangial expression - anti Thy1.1 GN - human GN (IgAN, MPGN, SLE) Takemura J Pathol 1999 Physiological function of EGFR signaling pathways: Mg reabsorption (TRMP6) Tubular regeneration Groenestege, Terzi, J Clin Invest, 2007 Zhuang, Am J Physiol Renal Physiol, 2004 EGFR pathway in renal diseases: Fibrosis Polycystic kidney disease Terzi, J Clin Invest, 2000 Richards, J Clin Invest, 1998
9 Anti GBM nephropathy PBMC Expression HB-EGF Resident cells. Early and transient induction of HB-EGF. Early HB-EGF dependant hemodynamic modifications ( SNGFR prevented with an anti-hbegf antibody) JC Invest Feng et al.
10 Nephrotoxic Serum (NTS) Sheep IgG (preimmunization) IgG from sheep NTS sacrifice J-5 J1, 2, 3 J10 anti-mbg Glomerulonephritis accelerated model
11 mrna of HBEGF is induced in the anti-gbm GN RT-qPCR in isolated podocytes Bollée & Flamant et al. Nat Med 2011
12 crescentic glomeruli (%) *** # 0 CT (+/+) (-/-) Albuminuria Blood Urea Nitrogen Survival rate (%) Hbegf (+/+) Hbegf (-/-) P<0.01 ine g/mmol of creatini *** mg/dl ** * # # 20 # # days 0 CT (+/+) (-/-) 0 CT (+/+) (-/-) Histological lesions and functional impact of anti-gbm GN is reduced in HB-EGF deficient mice Bollée & Flamant et al. Nat Med 2011
13 HB-EGF deficiency prevents structural modifications of podocytes in the anti-gbm nephropathy Bollée & Flamant et al. Nat Med 2011
14 HB-EGF deficiency restricted to hematopoietic cells does not protect against lesions of anti-gbm GN HB-EGF can be produced by hematopoïetic cells : macrophages lymphocytes T HB-EGF (+/+) Higashiyama, Science, 1991 Blotnick, Proc Natl Acad Sci USA, 1994 HB-EGF (-/-) HB-EGF (+/+) Crescentic glomeruli (%) Albuminuria (g/mol creatinine) CT Hbegf (+/+) BM Hbegf (-/-) BM 0 CT Hbegf (+/+) BM Hbegf (-/-) BM Bollée & Flamant et al. Nat Med 2011
15 EGFR phosphorylation in glomerulus during anti-gbm GN in mice G G (+/+)CT T G (+/+)0 (+/+)v (+/+)NTS (-/-)NTS G (+/+)AG (+/+)NTS (+/+)AG (+/+)NTS+AG1478 Crescentic glomeruli (%) Infilt G pegfr/egfr signal ratio (AU) Bollée & Flamant et al. Nat Med 2011
16 EGFR inhibition (AG1478) decreases the severity of anti-gbm GN CT vehicle Cr AG1478 % glomeruli Crescentic glomeruli *** *## CT vehicle AG1478 Ascites score (1-4) Albuminuria Blood Urea Nitrogen ** g/mmol of creatinine *** *## mg/dl ** *# 0 CT vehicle AG CT vehicle AG1478 CT vehicle AG1478 Bollée & Flamant et al. Nat Med 2011
17 HB-EGF deficiency and AG1478 treatment reduces lymphocyte T infiltration in the kidney CT vehicle AG1478 Tc Cr Area (% total area) CD3+ Area in Renal Cortex *** ### CT vehicle AG1478 CT baseline Hbegf (+/+) Hbegf (-/-) Cr G Tc G G Bollée & Flamant et al. Nat Med 2011
18 Erlotinib infused 4 days after NTS injection prevented anti-gbm GN NTS+erlotinib NTS+vehicle Ne G Infilt Cr G Tc G Infilt G Tc G NTS+erlotinib NTS+vehicle days 4-14 Bollée & Flamant et al. Nat Med 2011
19 Epiregulin (KO) or TGF-alpha (wa1) deficient mice are not protected from glomerular lesions or functional alterations in the antigbm GN model epiregulin (human) TGF-α (mouse) Lack of epiregulin or TGF-α induction in NCGN Crescentic glomeruli (%) Albuminuria (g/mol creatinine) 0 wt CT wa1/wa1 Ereg (-/-) wt NTS wa1/wa1 NTS Ereg (-/-) NTS wt CT wa1/wa1 Ereg (-/-) wt NTS wa1/wa1 NTS Ereg (-/-) NTS Bollée & Flamant et al. Nat Med 2011
20 Inducible deletion of Egfr in podocytes Pod-Tet on-cre Egfr loxp/loxp Podocin-rtTA TetO Cre x + Doxycycline EGFR Synaptopodin Merge Pod-Tet on-cre Egfr wt/wt Pod-Tet on-cre Egfr loxp/loxp Bollée & Flamant et al. Nat Med 2011
21 Specific deletion of EGFR in podocytes attenuates anti-gbm GN in mice Pod-Tet on-cre Egfr wt/wt Pod-Tet on-cre Egfr loxp/loxp Survival (%) Pod-Tet on-cre Egfr wt/wt Pod-Tet on-cre Egfr loxp/loxp * days Bollée & Flamant et al. Nat Med 2011
22 EGF TGFα Amphiregulin Epigen HB-EGF Epiregulin Betacellulin Neuregulins EGFR/ErbB1 ErbB2 ErbB3 ErbB4 Role of ErbB4 in the RPGN? Podocin Cre x Constitutive invalidation of ErbB4 in podocytes
23 Contrôle perbb4 ErbB4 inhibition in podocytes does not modify renal damage and functional alteration of anti-gbm GN
24 Mouse Harvest kidney Sieving Ø 100µm Ø 40µm 7 days Decapsulated Glomeruli (90% of total) Capsulated Glomeruli (10% of total) Transfer into plates Expand podocytes from glomeruli 4 days Proliferation assay Podocyte outgrowth measurement
25 Role of HB-EGF in the proliferation and migration of podocytes in vitro +/+ +/+ + AG +/+ -/- -/- -/- + HB-EGF Outgrowth area, mm 2 * * + AG + HB-EGF Bollée & Flamant et al. Nat Med 2011
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27 Induction of HB-EGF expression in human crescentic GN pauci-immune endocarditis pauci-immune pauci-immune pauci-immune pauci-immune
28 Summary
29
30
31 Perspectives Flamant M et al., Nephrol Dial Transplant 2012
32 INSERM Guillaume Bollée (U790 PARCC) Pierre-Louis Tharaux (U790 PARCC) Cécile Fligny (U790 PARCC) Marine Milon(U790 PARCC) Jean-Claude Dussaule (U702) Sophie Vandermeersch (U702) Laurent Mesnard (U702) Martin Flamant (U699) Collège de France Stéphane Germain Samuel Lunenfeld Institute, Toronto Susan Quaggin Service de pathologie, Hôpital Tenon, Paris Patrice Callard Anita Rodenas Service de néphrologie, Montreuil Xavier Bellenfant Université de Greifswald, Allemagne Karlhans Endlich Nicole Endlich Sandra Schordan
33 CD31 pegfr NTS NTS + erlotinib LPS LPS + erlotinib pegfr EGFR Contro l Erlotinib EGFR phopshorylation in glomeruli is not induced after LPS infusion
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