TNF ligand superfamily member 12, also known as TNF-related weak inducer of apoptosis (TWEAK), acts through its receptor, fibroblast growth factor-inducible 14 (Fn14), to mediate several key pathologic processes involved in tissue injury relating to lupus nephritis. To explore the potential for renal protection in lupus nephritis by targeting this pathway, we introduced the Fn14 null allele into the MRL-lpr/lpr lupus mouse strain. At 26-38 weeks of age, female Fn14-knockout MRL-lpr/lpr mice had significantly lower levels of proteinuria compared with female wild-type MRL-lpr/lpr mice. Furthermore, Fn14-knockout mice had significantly improved renal histopathology accompanied by attenuated glomerular and tubulointerstitial inflammation. There was a significant reduction in glomerular Ig deposition in Fn14-knockout mice, despite no detectable differences in either serum levels of antibodies or splenic immune cell subsets. Notably, we found that the Fn14-knockout mice displayed substantial preservation of podocytes in glomeruli and that TWEAK signaling directly damaged barrier function and increased filtration through podocyte and glomerular endothelial cell monolayers. Our results show that deficiency of the Fn14 receptor significantly improves renal disease in a spontaneous lupus nephritis model through prevention of the direct injurious effects of TWEAK on the filtration barrier and/or modulation of cytokine production by resident kidney cells. Thus, blocking the TWEAK/Fn14 axis may be a novel therapeutic intervention in immune-mediated proliferative GN.

IFN-α is a potent activator of innate and adaptive immunity, and its administration to preautoimmune (NZB×NZW)F1 mice promotes virulent systemic lupus erythematosus (SLE) disease. Given the known contributions of B cells and BAFF to SLE, we evaluated the ability of IFN-α administration to induce disease in wild-type (WT), B cell-deficient, and BAFF-deficient NZM 2328 mice. Whereas WT mice rapidly developed proliferative glomerulonephritis, marked proteinuria, and increased mortality in response to IFN-α administration, B cell-deficient mice developed neither renal pathology nor clinical disease. Moreover, BAFF-deficient mice, despite developing limited glomerular IgG and C3 deposition, also remained free of histological glomerulonephritis and clinical disease. Strikingly, similar T cell expansion and serum IgG responses were observed in adenovirus (Adv)-IFN–treated WT and BAFF-deficient mice despite their disparate pathological and clinical responses, whereas numbers of activated B cells increased in WT mice but not in BAFF-deficient mice. Nonetheless, B cell, plasma cell, and T cell infiltration of the kidneys in Adv-IFN–treated WT mice was similar to that in WT mice treated with Adv-control. Its ability to promote SLE disease in WT mice notwithstanding, IFN-α administration failed to drive the preferential expansion of CD4+ memory T cells that occurs during the natural course of disease, and glomerular infiltration of macrophages failed to associate with development of disease. These results collectively suggest that therapeutic targeting in SLE of BAFF and/or B cells in SLE could be successful even in states of IFN-α overexpression. Moreover, our results document important biological differences between IFN-α–driven and spontaneous natural SLE disease.

Objective The mechanism by which anti-DNA antibodies mediate lupus nephritis has yet to be conclusively determined. Previously, we found that treatment of mesangial cells with anti-DNA antibodies induced high expression of Neutrophil Gelatinase Associated Lipocalin (NGAL), an iron-binding protein upregulated in response to kidney injury. However, whether NGAL is instrumental in pathogenesis, induced as part of repair, or irrelevant to damage/repair pathways, is not known. Methods To investigate the role of NGAL in antibody-mediated nephritis, we induced nephrotoxic nephritis by passive antibody transfer to B6 or 129 mice. To determine if NGAL upregulation is instrumental, we compared the severity of renal damage in NGAL wild-type and knock-out mice following induction of nephrotoxic nephritis. Results We found that kidney NGAL expression, as well as urinary NGAL levels, were significantly increased in nephrotoxic nephritis as compared to control injected mice. Tight correlations were observed between NGAL expression, renal histopathology, and urinary NGAL excretion. NGAL knock-out mice had attenuated proteinuria and improved renal histopathology as compared to wild-type mice. Similarly, following nephritis induction, NGAL injection significantly exacerbated nephritis and decreased survival. NGAL induces apoptosis via caspase-3 activation, and upregulates inflammatory gene expression in kidney cells in vitro and when injected in vivo. Conclusion We conclude that kidney binding of pathogenic antibodies stimulates local expression of NGAL, which plays a crucial role in the pathogenesis of nephritis via promotion of inflammation and apoptosis. NGAL blockade may be a novel therapeutic approach for the treatment of nephritis mediated by pathogenic antibodies, including anti-GBM disease and lupus nephritis.

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Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multi-organ damage mediated by immune complexes and autoantibodies. It often presents with patients being non-specifically unwell and there is a wide range of differential diagnoses, one of which includes chronic infections such as Tuberculosis (TB). Exudative pericarditis is a relatively common feature in SLE and is present in up to 62% of patients on autopsy, although only a quarter of patients are symptomatic; constrictive pericarditis is a very rare feature of SLE. We report a 49 year old gentleman who was diagnosed with SLE which presented with features of constrictive pericarditis following an extensive period of investigations for TB.

The TNF superfamily member TWEAK acts through its receptor, Fn14, to mediate several key pathological processes known to be involved in lupus nephritis. To explore the potential for renal protection by targeting this pathway, we introduced the Fn14 null allele into the MRL/lpr lupus mouse strain. At 26 to 38 weeks of age, female MRL/lpr Fn14 knockout (KO) mice (backcross #8) had significantly lower levels of proteinuria, BUN, and creatinine as compared to Fn14 wild type (WT) mice. Furthermore, Fn14KO mice had significantly improved renal pathology, accompanied by attenuated glomerular and tubulointerstitial inflammation and less glomerular immune deposits. There were no detectable differences between the strains in either serum autoantibody levels or in splenic immune cell subsets, although less lymphadenopathy was observed in Fn14KO mice. Importantly, Fn14KO mice displayed substantial preservation of podocytes in kidney glomeruli. Moreover, we demonstrated that TWEAK signaling via Fn14 directly damaged the integrity of the glomerular filtration barrier through effects on both podocytes and glomerular endothelial cells. Inhibition of TWEAK signaling due to deficiency of the Fn14 receptor significantly improves renal disease in a spontaneous lupus nephritis model, likely through prevention of the direct injurious effects of TWEAK on the filtration barrier. Thus, blocking the TWEAK/Fn14 axis is a novel therapeutic target in immune-mediated proliferative glomerulonephritis.

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