The Adaptive Immune System in DKD

Patients with diabetes mellitus commonly develop diabetic kidney disease (DKD), the leading cause of end-stage kidney disease. A key driver of progression to DKD is inflammation. Activation of the immune system is associated with a pro-inflammatory environment, leading to renal fibrosis and a progressive loss or renal function.

The role of the innate immune system in DKD has been well characterized; however, there are few data available on the potential contribution of the adaptive immune system. In a recent online article in the Journal of Diabetes Investigation [], Lingyun Kong, PhD, and colleagues provided a of the role of the adaptive immune system, and associated cytokines, in the development of DKD.

Data from experimental models of DKD indicate an increase in the number of T cells in the circulation and in the kidney cortex, in turn triggering secretion of inflammatory mediators such as IFN-y and TNT-a, as well as activation of cells in innate immune response. In human studies, the number of T cells residing in the interstitial region of the kidney correlates with the degree of albuminuria in individuals with type 2 diabetes.

In the journal article, the authors also discuss the potential therapeutic benefits of targeting the adaptive immune system as a means of preventing the progression of DKD.