While these differences

in tissue microRNA expression are interesting, defining whether changes are disease-specific or fundamental to disease Atezolizumab cost pathogenesis remains a major challenge. Transition of epithelial to mesenchymal cells is recognized as a substantial contributor to the development of kidney fibrosis.63 Epithelial mesenchymal transition (EMT) describes a reversible series of events during which epithelial cells undergo morphological changes and acquire mesenchymal characteristics. These events involve epithelial cells losing cell–cell contacts, apical-basal polarity and epithelial-specific junctional proteins such as E-cadherin while acquiring mesenchymal markers including vimentin and N-cadherin.64 The end result is that immobile epithelial cells revert to an immature undifferentiated phenotype with enhanced migratory ability reminiscent of an earlier development stage and can embed in interstitium.

EMT is known to be involved in implantation, embryogenesis and organ development. It also has been shown to associate with cancer progression and metastasis.65 EMT has been suggested to contribute to kidney fibrosis, which is defined as an excessive deposition of extracellular matrix, mediated predominantly by fibroblasts and mesenchymal cells, click here leading to structural destruction and renal failure. The possible sources of fibroblasts and mesenchymal cells in kidney fibrosis include de novo proliferation of resident tissue fibroblasts, circulating fibrocytes from bone marrow or perivascular smooth muscle cell expansion (myofibroblasts). It has been demonstrated recently that a

large proportion of interstitial fibroblasts actually originate from tubular epithelial cells via EMT in diseased kidney.66–68 Several studies have now found that EMT is regulated by miRNAs, notably the miR-200 family and miR-205.69–72 These miRNAs have been implicated in the EMT process occurring in cancer development.72 The miR-200 family and miR-205 are downregulated in Madin Darby canine kidney cells undergoing TGFβ-induced EMT.69 Their decrease with TGF-β exposure is linked to the EMT response. Evidence has recently emerged that the miR-200 Fludarabine family and miR-205 are elevated in patients with hypertensive nephrosclerosis.58 Recently, Yamaguchi et al. have proposed an important mechanism for podocyte dehiscence and loss through EMT.73 In other disease processes, particular miRNAs were found to be substantially altered during EMT.65 Future work is required to determine the significance of miRNA involvement in EMT during the development of diabetic nephropathy. Renal transplantation is the treatment of choice for patients with end-stage kidney disease because of superior survival and quality of life when compared with patients on maintenance dialysis. Despite improvements in immunosuppression, acute rejection (AR) and chronic allograft nephropathy remain major challenges.