👤 Kosho Yamanouchi

Renal involvement in TAFRO syndrome usually is present as acute kidney injury with oligoproteinuria. Renal pathology is typically characterized by glomerular microangiopathy without immune deposits, and there have been no reports of membranous nephropathy. While idiopathic multicentric Castleman disease (iMCD), which shares a similar pathophysiology with TAFRO syndrome, has documented several cases of membranous nephropathy, the underlying mechanisms remain unclear. We present a case of TAFRO syndrome presenting with nephrotic syndrome, and kidney biopsy revealed exostosin 1/exostosin 2 (EXT1/EXT2)-associated membranous nephropathy. EXT1/EXT2 is considered a potential target antigen in autoimmune membranous nephropathy, suggesting their potential pathogenic role in this case. In iMCD cases with membranous nephropathy, IL-6 levels tend to be slightly low, while VEGF levels are significantly elevated, as seen in the present case. This cytokine profile may contribute to the differences in renal pathological findings and may also be involved in the response to treatment. This case may enhance our understanding of the pathophysiology of membranous nephropathy in TAFRO syndrome and iMCD. Show less

Subcutaneous transplantation of engineered hepatocyte/fibroblast sheets (EHFSs) is a low invasive and safe approach to construct vascularized subcutaneous human liver tissue (VSLT). However, the liver-specific structures and functionalities in the development process of VSLTs in mice remain poorly understood. Here, we describe time-dependent characteristics of the formation of the vascular network, cell-cell adhesions, liver transporters, liver-specific protein synthesis, and metabolizing activities. The EHFSs formed multilayered thick tissues by rapid neovascularization, which allows overcoming extremely difficult problems, such as the lack of oxygen supply on the formation of three-dimensional primary hepatocyte tissue under the skin. The blood vessels consisted of mouse-origin endothelial cells (ECs) (mVEGFR2) from the subcutaneous space at 1-7 days, and the following formation of the vascular network was performed by human-origin ECs (hVEGFR2). Many varieties of liver-specific gene expressions increased with the construction of the VSLTs: cell-cell adhesion molecules (CDH1, CLDN3, and CX32), transporters at basal (OATP1A1, OCT1, and NTCP) and apical membranes (MRP2, MDR1, and BSEP), blood coagulation factors (F8 and F9), urea synthesis (CPS1, OTC, and ARG1), and metabolism enzymes (CYP7A1, CYP1A2, CYP2B6, CYP3A4, and UGT1A1). Subacute hepatic failure model mice with VSLT were alive at least 7 weeks after liver damage. Thus, the ectopic liver organ offers the potential for a low invasive and safe treatment for liver diseases. Show less