Fibrosis and Immune Cell Infiltration Are Separate Events Regulated By
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BASIC RESEARCH www.jasn.org Fibrosis and Immune Cell Infiltration Are Separate Events Regulated by Cell-Specific Receptor Notch3 Expression Sabine Brandt,1,2 Tobias M. Ballhause ,1 Anja Bernhardt,1,2 Annika Becker,1 Delia Salaru,1 Hien Minh Le-Deffge,1 Alexander Fehr,1,2 Yan Fu,2,3 Lars Philipsen ,2,3 Sonja Djudjaj,4 Andreas J. Müller,2,3,5 Rafael Kramann ,6,7 Mahmoud Ibrahim,6 Robert Geffers,8 Chris Siebel,9 Berend Isermann,2,10 Florian H. Heidel,11,12,13 Jonathan A. Lindquist ,1,2 and Peter R. Mertens1,2 Due to the number of contributing authors, the affiliations are listed at the end of this article. ABSTRACT Background Kidney injuries that result in chronic inflammation initiate crosstalk between stressed resident cells and infiltrating immune cells. In animal models, whole-body receptor Notch3 deficiency protects from leukocyte infiltration and organ fibrosis. However, the relative contribution of Notch3 expression in tissue versus infiltrating immune cells is unknown. Methods Chimeric mice deficient for Notch3 in hematopoietic cells and/or resident tissue cells were generated, and kidney fibrosis and inflammation after unilateral ureteral obstruction (UUO) were analyzed. Adoptive transfer of labeled bone marrow–derived cells validated the results in a murine Leishmania ear infection model. In vitro adhesion assays, integrin activation, and extracellular matrix production were analyzed. Results Fibrosis follows UUO, but inflammatory cell infiltration mostly depends upon Notch3 expression in hematopoietic cells, which coincides with an enhanced proinflammatory milieu (e.g., CCL2 and CCL5 1 upregulation). Notch3 expression on CD45 leukocytes plays a prominent role in efficient cell transmi- gration. Functionally, leukocyte adhesion and integrin activation are abrogated in the absence of receptor Notch3. Chimeric animal models also reveal that tubulointerstitial fibrosis develops, even in the absence of prominent leukocyte infiltrates after ureteral obstruction. Deleting Notch3 receptors on resident cells blunts kidney fibrosis, ablates NF-kB signaling, and lessens matrix deposition. Conclusions Cell-specific receptor Notch3 signaling independently orchestrates leukocyte infiltration and organ fibrosis. Interference with Notch3 signaling may present a novel therapeutic approach in inflamma- tory as well as fibrotic diseases. JASN 31: ccc–ccc, 2020. doi: https://doi.org/10.1681/ASN.2019121289 Chronic inflammation of solid organs often results in destruction of organ architecture and perpetu- ated fibrosis, with functional deficits and ultimately Received December 13, 2019. Accepted July 12, 2020. organ failure.1,2 The list of injuries causing inflam- Published online ahead of print. Publication date available at mation includes acute and chronic infections, toxic www.jasn.org. agents, autoimmune diseases, and metabolic alter- Correspondence: Dr. Peter R. Mertens, Clinic of Nephrology and 3–6 ations (e.g., hyperglycemia and uremia). Key Hypertension, Diabetes and Endocrinology, Otto-von-Guericke events after primary insults are stress responses of University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, resident organ cells and leukocyte recruitment. The Germany. Email: [email protected] composition of the infiltrate depends on the timing Copyright © 2020 by the American Society of Nephrology JASN 31: ccc–ccc, 2020 ISSN : 1046-6673/3111-ccc 1 BASIC RESEARCH www.jasn.org and severity of the immune response, which encompasses de- Significance Statement fense mechanisms, such as complement activation, phagocy- tosis, and antigen presentation.7 Approximately 15% of adults In patients with CKD, receptor Notch3 is strongly upregulated. within the United States (37 million people) have CKD.8 De- Conversely, in experimental kidney disease models, Notch3 de- fi spite the enormity of this problem, therapeutic options are ciency protects from organ damage. To determine whether Notch3 on immune cells or tissue-resident cells participates in the scarce and mostly ineffective. Therefore, an improved under- inflammatory response, animals with bone marrow chimerism were standing of the cellular and molecular mechanisms leading to generated. These animal strains do not exhibit phenotypic differ- inflammation and renal fibrosis is essential to develop strate- ences in the absence of disease. However, after unilateral ureteral gies to combat these processes, because fibrosis-related organ obstruction, distinct alterations in the immune response and organ fi diseases account for almost 50% of all deaths.9–12 Currently, brosis become apparent. Notch3 receptors expressed by immune fi cells are of relevance for transmigration into tissue; the receptors established models of renal brosis propose that kidney injury expressed by resident kidney cells orchestrate organ fibrosis. These leads to immune cell infiltration, fibroblast activation, extra- events seem to be separable and distinct. cellular matrix (ECM) deposition, microvascular rarefaction, and tubular atrophy.9 Inflammation is considered the driving force in fibrotic diseases, with an intimate crosstalk between were housed and bred in the Central Animal Facility of the resident and infiltrating cells; therefore, targeting immune cell Otto-von-Guericke University Magdeburg Medical Faculty. fi infiltration is deemed to be a therapeutic option.13–15 How- The mice were kept under speci c pathogen-free conditions ever, it is not known whether immune cell recruitment is the in individual, ventilated cages (Techniplast, Buguggiate, Italy). culprit of organ fibrosis, or a bystander that modulates repar- All experiments and procedures were conducted in accor- ative processes.1 dance with the German National Guidelines for the Use of In CKD, the Notch receptor family plays a key role in both Experimental Animals (Animal Protection Act) and were ap- inflammatory responses and organ fibrosis.16–19 Animals proved by the state of Sachsen-Anhalt (Aktenzeichen UniMD deficient in receptors Notch1 and -3 demonstrate similar 42502-2-1135 and UniMD 42502-2-1253). All mouse strains fi protective effects on organ fibrosis. Notch3-deficient mice were con rmed by PCR genotyping that was performed as 18 fl exhibit significantly reduced kidney fibrosis (.50%), fewer previously described. Brie y, the mouse tail was lysed with m m myofibroblasts (approximately 50%), and fewer infiltrating 200 l direct PCR tail lysis buffer and 50 g of proteinase immune cells (approximately 30% of total leukocytes) com- K. PCR was performed using primer pairs for WT (forward, pared with wild-type (WT) mice after ureteral obstruc- CCATGAGGATGCTATCTGTGAC; reverse, CACATTGGC tion.18 The inflammatory chemokines CCL2 and CCL5 are ACAAGAATGAGCC) and Notch3 knockout (forward, TCG reduced by .50% in Notch3-deficient mice.18 Similar find- CCTTCTTGACGAGTTCT; reverse, GCGATGCAATTTCCT ings are reported in Notch3-deficient animals undergoing CATTT). The PCR cycler performed 35 cycles at 94°C, 60°C, nephrotoxic serum nephritis and ischemia reperfusion. and 72°C (each for 60 seconds). Products were separated on Thus, genetic ablation of receptor Notch3 protects mice 1% agarose/ethidium bromide gels. from kidney damage.18–20 However, it is not clear whether this protection is mediated Leishmania major Infection by Notch3 deficiency on immune cells or by a lack of Notch3 Leishmania major inoculation was performed as described.23 expression on tissue-resident cells. Here, we use bone marrow Briefly, dsRed-expressing parasites were grown at 26°C, for a (BM) chimeras to clarify cell type–specific roles of receptor maximum of five passages, in M119 medium supplemented Notch3 and discover that Notch3 receptors are not only rele- with 10% heat-inactivated FBS, 0.1 mM adenine, 1 mg/ml biotin, vant for leukocyte transmigration, but are also key molecules 5mg/mlhemin,and2mg/ml biopterin (all from Sigma-Aldrich, 5 for the fibrogenic niche. Unexpectedly, organ fibrosis is not Darmstadt, Germany). For infection, 10 stationary-phase pro- reduced in the absence of prominent leukocyte infiltration and mastigotes were resuspended in 10 ml PBS and injected into the vice versa. ear dermis. Experimental Kidney Disease METHODS Unilateral ureter obstruction (UUO) was performed with sex- matched, 12- to 16-week-old mice. The right ureters of WT Animals and knockout mice were ligated for 5 and 14 days. Both kid- Studies were performed using Notch3-knockout animals and neys were collected for preparation of cortical RNA, protein their WT littermates in a C57BL/6J (CD45.2) background lysates, immunohistochemistry, and flow cytometry (FACS). (kindly provided by Dr. Anne Joutel, Institut National de la Blood sampling by heart puncture was subjected to complete Santé et de la Recherche Médicale).21,22 The commercially blood cell counting (ADVIA 120; Bayer Diagnostics Munich, available CD45.1 mice are C57BL/6J background. The health Germany) and plasma specimens were stored at 280°C until of the mice corresponded to the Federation of European Lab- further analysis. Contralateral kidneys were harvested for oratory Animal Science Association guidelines. The animals comparative analyses. 2 JASN JASN 31: ccc–ccc,2020 www.jasn.org BASIC RESEARCH Table 1. List of primary antibodies Primary Antibodies Catalog No. Dilution Company Dye Immunhistochemistry and immunofluorescence Gli1 (IF) AF3455 1:200 R&D Systems Notch3 (IHC) ab23426 1:200 Abcam F4/80 (IHC) MON3099 1:100 Monosan Western blotting Notch3 sc-5539 1:500 Santa Cruz TNC ab108930 1:500 Abcam Tubulin T5168 1:1000 Sigma Phospho–NF-kB–p65 (S536) 3033 1:1000 Cell Signaling Phospho-IkBa