Expresión linfocitaria y niveles de IL-2 en el síndrome nefrótico corticorresistente por glomeruloesclerosis focal y segmentaria: implicaciones en la respuesta a los inhibidores de calcineurina

IF 2.1 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2026-01-01 Epub Date: 2025-08-13 DOI:10.1016/j.nefro.2025.501402

Maria Planella-Cornudella , Neus Roca-Saladrigues , Victor Lopez-Baez , Elias Jatem-Escalante , Eduard Sole-Mir , Xavier Gomez-Arbones , Alvaro Madrid-Aris , Alfons Segarra-Medrano

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引用次数: 0

Abstract

Background and objective

Calcineurin inhibitors (CNI) are the first-line treatment for steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS), though response rates vary. This study analyzed lymphocyte activation through IL-2 receptor expression on T lymphocytes and serum IL-2Rα (soluble CD25) levels in these patients to evaluate their relationship with response to CNI therapy.

Materials and methods

A multicenter case-control study was conducted with 39 patients with steroid-resistant FSGS, diagnosed via renal biopsy, and 23 healthy controls. Clinical, biochemical, and immunological variables were assessed. Soluble CD25 levels were measured using ELISA, and lymphocyte activation was analyzed by flow cytometry. Treatment criteria and response evaluation followed KDIGO guidelines. Diagnostic performance was assessed using ROC curves for soluble CD25.

Results

The 48.7% of patients responded to CNI treatment. Soluble CD25 levels and IL-2 expression on CD3 T lymphocytes were significantly associated with CNI response (P<.01): responders had higher CD25 levels (477 ± 84.47 pg/ml) compared to non-responders (290.28 ± 85.98 pg/ml). Responders showed a significant reduction in soluble CD25 (−35.8%) and CD3-IL2⁺ cells after remission, alongside increases in CD8 DR⁺ cells and regulatory T cells. ROC analysis identified a soluble CD25 cutoff of 324 pg/ml, with 94% sensitivity and 75% specificity for predicting response to CNI.

Conclusions

Elevated soluble CD25 levels and T cell activation were associated with better CNI response. Soluble CD25 could be a predictive biomarker to identify patients with higher likelihood of response, optimizing therapeutic decisions and avoiding unnecessary treatments in steroid-resistant FSGS.

查看原文本刊更多论文

局灶性和节段性肾小球硬化引起的皮质耐药肾病综合征的淋巴细胞表达和IL-2水平：对钙化素抑制剂反应的影响

背景和目的钙调神经蛋白抑制剂（CNI）是由局灶节段性肾小球硬化（FSGS）引起的类固醇抵抗性肾病综合征（SRNS）的一线治疗药物，但疗效各不相同。本研究通过T淋巴细胞上IL-2受体的表达和血清IL-2Rα（可溶性CD25）水平分析了这些患者的淋巴细胞活化情况，以评估它们与CNI治疗反应的关系。材料与方法对39例经肾活检确诊的类固醇抵抗性FSGS患者和23例健康对照进行了一项多中心病例对照研究。评估临床、生化和免疫学变量。ELISA法检测可溶性CD25水平，流式细胞术检测淋巴细胞活化情况。治疗标准和疗效评价遵循KDIGO指南。采用可溶性CD25的ROC曲线评估诊断效果。结果48.7%的患者对CNI治疗有应答。可溶性CD25水平和CD3 T淋巴细胞上IL-2的表达与CNI应答显著相关（P< 0.01）：应答者CD25水平（477±84.47 pg/ml）高于无应答者（290.28±85.98 pg/ml）。缓解后，应答者显示可溶性CD25（- 35.8%）和CD3-IL2+细胞显著减少，同时CD8 DR+细胞和调节性T细胞增加。ROC分析发现可溶性CD25截止值为324 pg/ml，预测CNI应答的灵敏度为94%，特异性为75%。结论可溶性CD25水平升高和T细胞活化与较好的CNI反应相关。可溶性CD25可能是一种预测性生物标志物，用于识别有更高应答可能性的患者，优化治疗决策，避免类固醇抵抗性FSGS的不必要治疗。

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.