Kidney Expression of Trefoil Factor 3 Is Not Associated with Kidney Survival in Immunoglobulin A Nephropathy: A Preliminary Study

Background: Trefoil factor 3 (TFF-3) is a peptide that restores the epithelium as protection against injury. Recently, TFF-3 was shown to be expressed in kidney tubular cells and was associated with fibrosis. We aimed to determine whether TFF-3 is associated with kidney outcomes.

Methods: We evaluated TFF-3 expression and its relationship with mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis and crescents (MEST-C) score, tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), and transforming growth factor-beta (TGF-β) expression in the kidney. We included 28 immunoglobulin A (IgA) patients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73m2 and proteinuria ≥0.5 g/day. Kidney biopsies were scored using MEST-C and were stained for TFF-3, IL10, TGF-β, and TNF-α.

Results: Mean patient age was 37.0 ± 13.8 years and eGFR was 74.6 ± 41.2 mL/min/1.73 m2 . Patients were followed for 9.1 ± 3.6 years. Trefoil factor 3 was positive in 67.9% of patients exclusively in tubular cells. Tumor growth factor-β was also observed only in tubular cells in 71.4% of patients and was higher in TFF-3-positive patients (89.5% vs. 22.2%, P < .05). When patients with and without TFF-3 staining were compared, there was no difference in age, eGFR, albumin, or proteinuria. Yearly eGFR change was also similar (−0.5 ± 2.3 vs. −1.3 ± 2.4 mL/min/1.73 m2 , P = .44). Trefoil factor 3 was not associated with kidney survival. The MEST-C score was not correlated with TFF-3. Trefoil factor 3 staining showed correlation with TGF-β but was not associated with kidney survival in IgA patients.

Conclusion: Findings of the study imply TFF-3 is not a marker of permanent damage but might simply be a marker of the repair of ongoing tubular injury.

Cite this article as: Aşıcıoğlu E, Oztas D, Barutcu Atas D, et al. Kidney expression of trefoil factor 3 is not associated with kidney survival in IgA nephropathy: A preliminary study. Turk J Nephrol. 2024;33(2):188-193.