Pathogenesis Of FSGS Research Articles

#5466 CSF-1R SYSTEM ACTIVATES PARIETAL EPITHELIAL CELLS LEADING TO FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS)

Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS) is the most common glomerular cause leading to end-stage kidney disease. Actual treatment of primary FSGS by immunosuppressive agents presents inconsistent results. Thus, new innovative strategies different from those used to date by taking into consideration podocyte renewal and maintenance or even strategies complementary to immunosuppression are needed. In FSGS, parietal epithelial cells (PECs) switch to an activated phenotype (aPECs) in response to podocyte damage promoting glomerulosclerosis. Colony-stimulating factor (CSF-1) is a hematopoietic growth factor that acts via its specific receptor, the tyrosine kinase receptor CSF-1R. CSF-1 has been detected in sera and renal biopsies from patients with different renal complications, including FSGS, attributing their role and presence to macrophage but not to glomerular cells. The potential cellular and molecular mechanisms involved are also unknown. In this work, we evaluated the implication of CSF-1/CSF-1R axis in the pathogenesis of FSGS and its potential as new pharmacological target point by using specific CSF-1R inhibitors. Specifically, we focused on the modulation of PECS activation by de novo production of CD44 and the preservation of podocyte loss. Method We evaluated the role of the CSF-1/CSF-1R axis as a driver of glomerular damage in FSGS in adriamycin-induced nephropathy (ADR) in mice, the main experimental model to study human FSGS. To this end, we treated or not ADR-animals with CSF-1R specific inhibitors, GW2580 or Ki20227 (n = 5-7 group). We determined the expression and localization of CSF-1R in the glomerulus in tissue by triple immunofluorescence (WT-1, SSeCks and CSF-1R) and their relevance in glomerulosclerosis (PAS and pro-fibrotic genes), the determination of de novo CD44 formation and its correlation with ERK1/2 pathway by immunohistochemistry (IH). We detected podocyte in the glomerulus by WT-1 IH and the localization of aPECS in the glomerular tuff by Claudin-1 and SSeCkS markers. Finally, we used isolated human kidney progenitor cells with and without CSF-1 treatment (n = 6/group) to identify potential key interactors of CSF-1 by RNAseq. We validated genes of interest in the FSGS experimental model. Results We observed a constitutively expression of CSF-1R in the glomerulus of control mice that significantly increased in ADR-treated mice, specifically in podocytes (WT1) and PECs (SSeCks), confirmed with mRNA expression. ADR-treated mice showed important events of sclerotic glomerulus and pro-fibrotic genes as collagen that was significantly reversed by the treatment with CSF-1R inhibitors (p<0.001). Results reflected a CSF-1R inhibitor-dependent renal function recovery with the use of the inhibitors with a reduction of proteinuria and an increase of glomerular filtration rate (p<0.001). We found a positive CD44 staining both in Bowman's capsule and inner the tuff of ADR-treated mice, accompanied by an increase of ERK1/2 activation. CSF-1R inhibitors significantly reduced the percentage of glomeruli with de novo CD44 production. Remarkably, podocyte depletion was also preserved with very similar levels to non-treated animals (p<0.001). For RNAseq results, 227 differentially expressed genes (considering a criterion of a probability of differential expression >0.9 and a |M| > 1) were subjected to enrichment analysis. The top significant gene ontology terms were mainly involved with interferon-induced genes. Genes involved in this pathway were validated in the FSGS model, showing an increase in mice treated with ADR compared to controls and alleviated with CSF-1R inhibitors (p<0.001). Conclusion In this study we propose a novel therapeutic strategy to FSGS-associated pathology based on the inhibition of CSF1-R activity having an impact on reducing aPECs, glomerulosclerosis, proteinuria, improving renal function and preserving the podocyte-progenitor phenotype, thus, in podocyte preservation against damage.

Tenascin-C Promotes Migration and Proliferation of Parietal Epithelial Cells and Participates in the Pathogenesis of FSGS

Tenascin-C Promotes Migration and Proliferation of Parietal Epithelial Cells and Participates in the Pathogenesis of FSGS

POS-378 Blocking Ribosomal Protein S6 Phosphorylation Inhibits Podocyte Hypertrophy and Focal Segmental Glomerulosclerosis

Ribosomal protein S6 (rpS6) phosphorylation mediates the hypertrophic growth of renal proximal tubule cells. However, the role of rpS6 phosphorylation in podocyte hypertrophy and podocyte loss during the pathogenesis of FSGS remains undefined.

NPHS2 gene polymorphism aggravates renal damage caused by focal segmental glomerulosclerosis with COL4A3 mutation.

Focal segmental glomerulosclerosis (FSGS), a type of primary glomerular disease, is the leading cause of end-stage renal disease (ESRD). Several studies have revealed that certain single-gene mutations are involved in the pathogenesis of FSGS; however, the main cause of FSGS has not been fully elucidated. Homozygous mutations in the glomerular basement membrane gene can lead to early renal failure, while heterozygous carriers develop renal failure symptoms late. Here, molecular genetic analysis of clinical information collected from clinical reports and medical records was performed. Results revealed that nephrosis 2 (NPHS2) gene polymorphism aggravated renal damage in three FSGS families with heterozygous COL4A3 mutation, leading to early renal failure in index patients. Our findings suggest that COL4A3 and NPHS2 may have a synergistic effect on renal injury caused by FSGS. Further analysis of the glomerular filtration barrier could help assess the cause of kidney damage. Moreover, a detailed analysis of the glomerular basement membrane-related genes and podocyte structural proteins may help us better understand FSGS pathogenesis and provide insights into the prognosis and treatment of hereditary glomerulonephropathy.

Elevated plasma free sialic acid levels in individuals with reduced glomerular filtration rates.

N-acetylneuraminic acid (Neu5Ac, sialic acid) is a negatively charged monosaccharide, and the predominant form of sialic acid in human cells (1). Sialic acid is typically found as the terminal monosaccharide on glycoconjugates, where it plays a role in various physiologic and pathologic interactions (1). Sialylated glycoconjugates are critical contributors to the polyanionic component of the glomerular glycocalyx, contributing to size and charge selectivity for plasma macromolecules (1,2). Podocyte foot process morphology is maintained by the anionic charged sialic acid residues on glycoconjugates in podocyte membranes (2). Free sialic acid is filtered but not reabsorbed by the human kidney, in a fashion similar to that for creatinine (3), but in contrast to the handling of other monosaccharides such as glucose, mannose, galactose, and fructose that are reabsorbed by tubular cells (4). Circulating sialic acid levels, both unbound and bound to glycoconjugates, have only been sporadically studied in different conditions, including some renal disorders (3,5−9); a possible causative link to reduced eGFRs has been seldom discussed or investigated. We designed this study to establish a correlation between eGFR and plasma free sialic acid across a range of subjects with glomerular disorders. This would not only emphasize this often-overlooked aspect of renal filtering of free sialic acid, but also inform our developmental program for glomerular diseases using the sialic acid precursor, N-acetylmannosamine (ManNAc) (10), which was expected to significantly increase plasma free sialic acid levels in subjects with reduced eGFR. Peripheral blood was obtained from eight subjects enrolled in National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) natural history study 94-DK-0127 (ClinicalTrials.gov identifier, NT1392), “Pathogenesis of FSGS,” and from eight subjects enrolled in NIDDK study 16-DK-0036 (ClinicalTrials.gov identifier, NCT02639260), “A Phase 1 Multiple Ascending Dose Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of …

P1808INHIBITION OF MIR-155 IMPROVES PROGNOSIS IN AN EXPERIMENTAL FSGS MOUSE MODEL BY REGULATING AUTOPHAGY

Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS), a podocytopathy, is one of the most common primary glomerular diseases causing end-stage renal disease in children. Its mechanisms remain unclear and the effective treatment lacks. MiR-155 is a typical multifunctional miRNA, which serves a crucial role in the regulation of numerous vessel cells. The present study aimed to investigate the role of miR-155 in the pathogenesis of FSGS. Method A FSGS model was establishe by injection of adriamycin in miR-155 knockout mice. Renal pathological changes were observed by Periodic Schiff-Methenamine Silver staining and Masson trichrome staining. Podocyte morphology and autophagosomes were examined with electron microscopy. Podocyte density was estimated by the Weibel-Gomez method. Expression of autophagy markers and apoptosis-associated proteins were analyzed by Western blotting analysis. Results Silencing of miR-155 significantly decreased urinary protein excretion and ameliorated glomerulosclerosis in adriamycin-induced FSGS mice. We found that adriamycin treatment led to fusion of podocyte foot processes, swelling of the podocyte body, dilated mitochondria, and podocyte loss. Inhibition of miR-155 improved podocyte depletion and the above cytopathies induced by adriamycin. In addition, the results also demonstrated that in miR-155 KO mice, the expression of LC3 and ATG5 was increased and the expression of P62 was decreased. Conclusion These suggest that modulated miR-155 can prevent podocyte damage, by regulating the level of autophagy. The present study provides a novel insight into microRNAs as potential therapeutics for the treatment of podocytopathy.

MO009NEUTRALIZATION OF UPAR WITH AN ANTI-UPAR ANTIBODY AMELIORATES RECURRENT FSGS SERA INDUCED PODOCYTE INJURY

Abstract Background and Aims The role of suPAR as a biomarker and/or causative factor in the pathogenesis of recurrent FSGS remains unclear (Harel E., et al. Transplantation 2020; 104:54-60). While anti-suPAR antibodies have been shown to block suPAR induced podocyte injury in mouse models of FSGS, this beneficial effect has not yet been demonstrated in FSGS patients. We report here the inhibitor effects of 2G10, a fully human anti-suPAR antibody that blocks the interaction of suPAR with the B3 integrin on podocytes. Method The immortalized podocyte cell line was developed by transfection with the temperature sensitive SV40 T gene. These cells proliferate at the “permissive” temperature (33°C) and are considered undifferentiated. After transferring to the “nonpermissive” temperature (37°C), they enter growth arrest and by day 10-14 express markers of differentiated podocytes in vivo, such as nephrin, podocin, CD2 associated protein (CD2AP), synaptopodin, and known molecules of the slit diaphragm ZO-1, α, β, and γ-catenin, and P-cadherin. The podocytes were cultured in RPMI medium supplemented with insulin, transferrin, selenium, sodium pyruvate (ITS-A, Gibco #513000), 10% FBS and penicillin/streptomycin. After differentiation for 14 days, cells were serum starved for 1h. Serum from rFSGS patients or from a control patient was added (4% final) and cells were cultured for an additional 24h. After fixation in PFA/sucrose. actin cytoskeleton was visualized by labeling with rhodamine-conjugated phalloidin. DAPI was used for nuclei staining. Cells were imaged by confocal microscopy at 40X magnification and the number of cells with intact stress fibers were counted. For rescue of stress fibers, podocytes were cultured in the presence of a fully humanized anti uPAR antibody (2G10, 1 ug/ml; Duriseti S, J Biol Chem, 2010, 285:26878-88) or an isotype IgG control antibody (1 ug/ml). Results Sera from three patients with recurrence of FSGS after transplant were used in the study. Podocyte culture in the presence of sera from all three patients caused significant depolarization of stress fibers as determined by number of stress fiber positive cells (30%, 59% and 49% reduction with respect to untreated podocytes respectively). Treatment of podocytes with control sera did not cause any significant changes (data not shown). Culture of podocytes with patient sera in the presence of 2G10 antibody against uPAR rescued stress fibers (Fig 1A and 1B). On the other hand, a control human IgG was unable to rescue the loss of stress fibers induced by sera from recurrent FSGS patients. Conclusion The therapeutic potential of a human anti-suPAR antibody in samples from patients with recurrent FSGS has not been previously demonstrated. The in vitro findings of 2G10 antibody on preserving the stress fibers in human podocytes from the disrupting effect of the sera of patients with recurrent FSGS suggest that antibodies that block suPAR could be effective in preventing recurrence of FSGS.

A comprehensive analysis of NPHS1 gene mutations in patients with sporadic focal segmental glomerulosclerosis

BackgroundFocal segmental glomerulosclerosis (FSGS) is still one of the common causes of refractory nephrotic syndrome. Nephrin, encoded by podocyte-specific NPHS1 gene, participated in the pathogenesis of FSGS. The sites of NPHS1 mutations in FSGS is not clarified very well. In this study, we investigated the specific mutations of NPHS1 gene in Chinese patients with sporadic FSGS.MethodsA total of 309 patients with sporadic FSGS were collected and screened for NPHS1 mutations by second-generation sequencing. The variants were compared with those extracted from 2504 healthy controls in the 1000 Genomes Project. The possible pathogenic roles of missense variants were predicted by three different software. We also compared these candidate causal mutations with those summarized from the previous studies.ResultsThirty-two genetic mutations of NPHS1 gene were identified in FSGS patients, including 12 synonymous mutations, 17 missense mutations, 1 splicing mutation, and 2 intron mutations, of which c.G3315A (p.S1105S) was the most common variant (261/309). A novel missense mutation c.G2638 T (p.V880F) and a novel splicing mutation 35830957 C > T were identified in FSGS patients. The frequencies of the four synonymous mutations (c.C294T [p.I98I], c.C2223T [p.T741 T], c.C2289T [p.V763 V], c.G3315A [p.S1105S]) were much higher in FSGS patients than in controls. The frequencies of the four missense mutations (c.G349A [p.E117K], c.G1339A [p.E447K], c.G1802C [p.G601A], c.C2398T [p.R800C]) were much higher and one (c.A3230G [p.N1077S]) was lower in FSGS patients than in controls. Five missense mutations, c.C616A (p.P206T), c.G1802C (p.G601A), c.C2309T (p.P770L), c.G2869C (p.V957 L), and c.C3274T (p.R1092C), were predicted to be pathogenic mutations by software analysis.ConclusionsNPHS1 gene mutations were quite common in sporadic FSGS patients. We strongly recommend mutation analysis of the NPHS1 gene in the clinical management of FSGS patients.

T and B cells immunophenotypes in blood and urine of patients with focal segmental glomerulosclerosis in relation to disease severity

Background: Disordered immune system is responsible for the pathogenesis in most of the glomerulonephritis (GN) including FSGS. Elucidation of involvement of immune cells is important to avoid invasive procedures for monitoring of disease progression. Methods: We analyzed the frequencies of CD25, CD122 and CD5 on CD4+, CD8+ and CD19+ T and B cells in blood and urine samples of 50 individuals including FSGS, other GN, pathological controls (PC)) and healthy controls (HC)). Data was analyzed using spss software. Results: The ratio of CD4+25+to CD4+122+ was found significantly low in blood of FSGS patients compared to HC and PC (37.6 ± 44.1% vs. 100% in HC and PC, P = 0.000). The ratio of CD19+25+ to CD19+122+ cells were also significantly low in FSGS compared to HC (21.6 ± 20.6% vs.9.4 ± 7.7%, P =0.021) . Overall, the percentages CD4+ 25+ 122+, CD8+25+ 122+and CD19+25+ 122+ cells were more in the urine of FSGS patients compared to controls. CD19+5+ B cells were significantly high in blood and urine of FSGS compared to controls. These cells were also significantly more in the blood of steroid dependent and resistant FSGS patients compared to steroid responsive and in urine of patients with renal dysfunction compared to normal renal functions. Conclusions: Our results show that T and B cells have a definite role in the pathogenesis of FSGS. A low expression of CD25 found on T and B cells in FSGS found in this study indicate down regulation of Treg and Breg cells in these patients. A high expression of CD5+B in blood and urine of FSGS may be responsible for disease severity. The results of this study are important as it may help in avoiding unnecessary invasive procedure for patient monitoring. However there is a need to do further studies to validate these results.

FSGS: Diagnosis and Diagnostic Work-Up.

Focal segmental glomerulosclerosis is a histologic lesion, rather than a clinical disease. FSGS is common cause of nephrotic syndrome in both adults and children worldwide. In the United States it is the most common primary glomerular disease resulting in end-stage renal disease and recent reports have suggested that its incidence might be on the rise. Currently the incidence is estimated to be 7 per million. The podocyte is the cellular target cell in FSGS and in recent years substantial insight in the pathogenesis and genetics of FSGS have accumulated. Furthermore the discovery of potential novel biomarkers to diagnose FSGS and monitor disease activity has renewed interest in this disease. In this review article we will focus on the clinical presentation and diagnosis of FSGS.

Absence in T1/ST2 receptor results in a more severe experimental nephropathy (CCR5P.208)

Abstract Focal segmental glomerulosclerosis (FSGS) is a major cause of chronic kidney disease. Several studies suggest an association between Th2 and the pathogenesis of FSGS. Immune system molecules are widely associated with Th1/Th2 balance. In light of this, we chose the shaft IL-33/ST2, Th2 immune responses and kidney damage as the object of study, both related to. We used BALB/c WT and ST2-/- animals, intravenously injected with a single dose of 10mg/kg of adriamycin. Since ST2-deficient animals exhibit more severe kidney damage when induced by adriamycin, the absence of this receptor signaling is intimately related to induced loss of renal function. Observing the changes of these animals, as increase in serum creatinine levels and elevated protein/creatinine curve, more severe tissue damage and decreased expression of nephrin protein, STAT3 and Smad2/3. In addition, there was an increase in PAI-1 and nephrin phosphorylation, Prha, pTyr. Serum levels of IL-33 are also higher in ST2-/- animals. In the cellular context, we observed an increase in the percentage of TCD4pos splenic cells in these ST2-/- animals. However, CD4pos / FOXp3pos cells are less present when compared to wild type animals and similar to control animals. We also observed that the effect found in ST2-/- animals was mitigated by the transfer of TCD4pos wildtype lymphocytes. Considering all results, we can conclude so far that cytokine IL-33 plays an important role in the development and control of FSGS.

Administration of recombinant soluble urokinase receptor per se is not sufficient to induce podocyte alterations and proteinuria in mice.

Circulating levels of soluble forms of urokinase-type plasminogen activator receptor (suPAR) are generally elevated in sera from children and adults with FSGS compared with levels in healthy persons or those with other types of kidney disease. In mice lacking the gene encoding uPAR, forced increases in suPAR concentration result in FSGS-like glomerular lesions and proteinuria. However, whether overexpression of suPAR, per se, contributes to the pathogenesis of FSGS in humans remains controversial. We conducted an independent set of animal experiments in which two different and well characterized forms of recombinant suPAR produced by eukaryotic cells were administered over the short or long term to wild-type (WT) mice. In accordance with the previous study, the delivered suPARs are deposited in the glomeruli. However, such deposition of either form of suPAR in the kidney did not result in increased glomerular proteinuria or altered podocyte architecture. Our findings suggest that glomerular deposits of suPAR caused by elevated plasma levels are not sufficient to engender albuminuria.

Pathophysiology and treatment of focal segmental glomerulosclerosis: the role of animal models

Focal segmental glomerulosclerosis (FSGS) is a kidney disease with progressive glomerular scarring and a clinical presentation of nephrotic syndrome. FSGS is a common primary glomerular disorder that causes renal dysfunction which progresses slowly over time to end-stage renal disease. Most cases of FSGS are idiopathic Although kidney transplantation is a potentially curative treatment, 40% of patients have recurrence of FSGS after transplantation. In this review a brief summary of the pathogenesis causing FSGS in humans is given, and a variety of animal models used to study FSGS is discussed. These animal models include the reduction of renal mass by resecting 5/6 of the kidney, reduction of renal mass due to systemic diseases such as hypertension, hyperlipidemia or SLE, drug-induced FSGS using adriamycin, puromycin or streptozotocin, virus-induced FSGS, genetically-induced FSGS such as via Mpv-17 inactivation and α-actinin 4 and podocin knockouts, and a model for circulating permeability factors. In addition, an animal model that spontaneously develops FSGS is discussed. To date, there is no exact understanding of the pathogenesis of idiopathic FSGS, and there is no definite curative treatment. One requirement facilitating FSGS research is an animal model that resembles human FSGS. Most animal models induce secondary forms of FSGS in an acute manner. The ideal animal model for primary FSGS, however, should mimic the human primary form in that it develops spontaneously and has a slow chronic progression. Such models are currently not available. We conclude that there is a need for a better animal model to investigate the pathogenesis and potential treatment options of FSGS.

Circulating suPAR in Two Cohorts of Primary FSGS

Overexpression of soluble urokinase receptor (suPAR) causes pathology in animal models similar to primary FSGS, and one recent study demonstrated elevated levels of serum suPAR in patients with the disease. Here, we analyzed circulating suPAR levels in two cohorts of children and adults with biopsy-proven primary FSGS: 70 patients from the North America-based FSGS clinical trial (CT) and 94 patients from PodoNet, the Europe-based consortium studying steroid-resistant nephrotic syndrome. Circulating suPAR levels were elevated in 84.3% and 55.3% of patients with FSGS patients in the CT and PodoNet cohorts, respectively, compared with 6% of controls (P<0.0001); inflammation did not account for this difference. Multiple regression analysis suggested that lower suPAR levels associated with higher estimated GFR, male sex, and treatment with mycophenolate mofetil. In the CT cohort, there was a positive association between the relative reduction of suPAR after 26 weeks of treatment and reduction of proteinuria, with higher odds for complete remission (P=0.04). In the PodoNet cohort, patients with an NPHS2 mutation had higher suPAR levels than those without a mutation. In conclusion, suPAR levels are elevated in geographically and ethnically diverse patients with FSGS and do not reflect a nonspecific proinflammatory milieu. The associations between a change in circulating suPAR with different therapeutic regimens and with remission support the role of suPAR in the pathogenesis of FSGS.

Activation of NFAT Signaling in Podocytes Causes Glomerulosclerosis

Mutant forms of TRPC6 can activate NFAT-dependent transcription in vitro via calcium influx and activation of calcineurin. The same TRPC6 mutants can cause FSGS, but whether this involves an NFAT-dependent mechanism is unknown. Here, we generated mice that allow conditional induction of NFATc1. Mice with NFAT activation in nascent podocytes in utero developed proteinuria and glomerulosclerosis postnatally, resembling FSGS. NFAT activation in adult mice also caused progressive proteinuria and FSGS. Ultrastructural studies revealed podocyte foot process effacement and deposition of extracellular matrix. NFAT activation did not initially affect expression of podocin, synaptopodin, and nephrin but reduced their expression as glomerular injury progressed. In contrast, we observed upregulation of Wnt6 and Fzd9 in the mutant glomeruli before the onset of significant proteinuria, suggesting a potential role for Wnt signaling in the pathogenesis of NFAT-induced podocyte injury and FSGS. These results provide in vivo evidence for the involvement of NFAT signaling in podocytes, proteinuria, and glomerulosclerosis. Furthermore, this study suggests that NFAT activation may be a key intermediate step in the pathogenesis of mutant TRPC6-mediated FSGS and that suppression of NFAT activity may contribute to the antiproteinuric effects of calcineurin inhibitors.

A New Approach to Idiopathic Nephrotic Syndrome

Minimal-change disease (MCD) and primary FSGS are important causes of idiopathic nephrotic syndrome (INS) and, in the case of FSGS, end-stage renal failure. Intriguing features of these diseases include their frequent response to steroids, their association with immune abnormalities, the existence

Recessive NPHS2 (Podocin) Mutations Are Rare in Adult-Onset Idiopathic Focal Segmental Glomerulosclerosis

Recessive NPHS2 (podocin) mutations account for up to approximately 30% of steroid-resistant idiopathic FSGS in children and are associated with a reduced risk for disease recurrence after renal transplantation. R229Q, a missense variant that is present in 3.6% of the white population, has been implicated as a common disease-causing mutation. Given these clinical implications, we examined the role of NPHS2 mutations in a cohort of patients with adult-onset FSGS. We used denaturing HPLC to screen for heterozygous and homozygous gene variants in PCR-amplified DNA fragments that contained all exons and splice junctions of NPHS2. Bidirectional sequencing was performed to define all of the gene variants detected. With the use of the denaturing HPLC in a single-blind pilot study, 40 of 43 known NPHS2 mutations were detected from 22 pediatric patients with FSGS to establish a test sensitivity of 93%. This screen then was applied to 87 adult patients with idiopathic FSGS (15 steroid-sensitive, 63 steroid-resistant, and nine familial cases). In this latter cohort, compound heterozygous mutations were detected only in one patient with steroid-sensitive FSGS (R229Q and Q285fsX302) and no homozygous mutations. Overall, R229Q accounted for eight (80%) of ten of the putative mutant alleles that were detected in the study cohort. Contrary to the pediatric experience, recessive NPHS2 mutations are rare in this study population, suggesting that the pathogenesis of FSGS in adults may differ from that in children. These data do not support R229Q as a disease-causing mutation for steroid-resistant FSGS.

Bacteriological examination of pus from abscesses of the central nervous system.

The methods used successfully to examine pus from abscesses of the central nervous system are described. The association between direct inoculation of intracranial pus into a liquid anaerobic culture medium and the isolation of viable bacteria is emphasised. Cultural methods for the recognition of the streptococci associated with brain abscess and methods for the assay of antimicrobial drugs in pus are presented. The role of gas liquid chromatography is discussed.