1.Mechanism of transforming growth factor- β1 induce renal fibrosis based on transcriptome sequencing analysis.
Huanan LI ; Peifen LI ; Shanyi LI ; Xueying ZHANG ; Xinru DONG ; Ming YANG ; Weigan SHEN
Journal of Zhejiang University. Medical sciences 2023;52(5):594-604
OBJECTIVES:
To explore the mechanism of transforming growth factor-β1 (TGF-β1) induce renal fibrosis.
METHODS:
Renal fibroblast NRK-49F cells treated with and without TGF-β1 were subjected to RNA-seq analysis. DESeq2 was used for analysis. Differentially expressed genes were screened with the criteria of false discovery rate<0.05 and l o g 2 F C >1. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed for differentially expressed genes. Genes encoding transcription factors were further screened for differential expression genes. Then, the expression of these genes during renal fibrosis was verified using unilateral ureteral obstruction (UUO)-induced mouse renal fibrosis model and a public gene expression dataset (GSE104954).
RESULTS:
After TGF-β1 treatment for 6, 12 and 24 h, 552, 1209 and 1028 differentially expressed genes were identified, respectively. GO analysis indicated that these genes were significantly enriched in development, cell death, and cell migration. KEGG pathway analysis showed that in the early stage of TGF-β1 induction (TGF-β1 treatment for 6 h), the changes in Hippo, TGF-β and Wnt signaling pathways were observed, while in the late stage of TGF-β1 induction (TGF-β1 treatment for 24 h), the changes of extracellular matrix-receptor interaction, focal adhesion and adherens junction were mainly enriched. Among the 291 up-regulated differentially expressed genes treated with TGF-β1 for 6 h, 13 genes (Snai1, Irf8, Bhlhe40, Junb, Arid5a, Vdr, Lef1, Ahr, Foxo1, Myc, Tcf7, Foxc2, Glis1) encoded transcription factors. Validation in a cell model showed that TGF-β1 induced expression of 9 transcription factors (encoded by Snai1, Irf8, Bhlhe40, Junb, Arid5a, Vdr, Lef1, Myc, Tcf7), while the expression levels of the other 4 genes did not significantly change after TGF-β1 treatment. Validation results in UUO-induced mouse renal fibrosis model showed that Snai1, Irf8, Bhlhe40, Junb, Arid5a, Myc and Tcf7 were up-regulated after UUO, Vdr was down-regulated and there was no significant change in Lef1. Validation based on the GSE104954 dataset showed that IRF8 was significantly overexpressed in the renal tubulointerstitium of patients with diabetic nephropathy or IgA nephropathy, MYC was highly expressed in diabetic nephropathy, and the expressions of the other 7 genes were not significantly different compared with the control group.
CONCLUSIONS
TGF-β1 induces differentially expressed genes in renal fibroblasts, among which Irf8 and Myc were identified as potential targets of chronic kidney disease and renal fibrosis.
Mice
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Animals
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Humans
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Transforming Growth Factor beta1/metabolism*
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Diabetic Nephropathies/pathology*
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Transcriptome
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Signal Transduction
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Kidney
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Ureteral Obstruction/pathology*
;
Fibrosis
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Interferon Regulatory Factors
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Transforming Growth Factor beta/metabolism*
;
DNA-Binding Proteins/metabolism*
;
Transcription Factors/metabolism*
2.Effect of telmisartan on expression of metadherin in the kidney of mice with unilateral ureter obstruction.
Fenfen PENG ; Hongyu LI ; Bohui YIN ; Yuxian WANG ; Yihua CHEN ; Zhaozhong XU ; Chongwei LUO ; Haibo LONG
Journal of Southern Medical University 2019;39(2):156-161
OBJECTIVE:
To explore the effect of telmisartan on the expression of metadherin in the kidney of mice with unilateral ureter obstruction.
METHODS:
Eighteen male C57 mice were randomized into sham-operated group, model group and telmisartan treatment group. In the latter two groups, renal interstitial fibrosis as the result of unilateral ureter obstruction (UUO) was induced by unilateral ureteral ligation with or without telmisartan intervention. Renal pathological changes of the mice were assessed using Masson staining, and immunohistochemistry and Western blotting were used to detect the expression of extracellular matrix proteins and metadherin in the kidney of the mice. In the experiment, cultured mouse renal tubular epithelial cells (mTECs) were stimulated with transforming growth factor-β1 (TGF-β1) and transfected with a siRNA targeting metadherin, and the changes in the expressions of extracellular matrix proteins and metadherin were detected using Western blotting.
RESULTS:
The expressions of extracellular matrix proteins and metadherin increased significantly in the kidney of mice with UUO ( < 0.05). Intervention with telmisartan significantly lowered the expressions of extracellular matrix proteins and metadherin and alleviated the pathology of renal fibrosis in mice with UUO ( < 0.05). In cultured mTECs, siRNA-mediated knockdown of metadherin obviously reversed TGF-β1-induced increase in the expressions of extracellular matrix proteins and metadherin.
CONCLUSIONS
Telmisartan can suppress the production of extracellular matrix proteins and the expression of metadhein to attenuate UUO-induced renal fibrosis in mice.
Angiotensin II Type 1 Receptor Blockers
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Animals
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Antihypertensive Agents
;
Extracellular Matrix Proteins
;
metabolism
;
Fibrosis
;
Kidney
;
drug effects
;
metabolism
;
pathology
;
Male
;
Membrane Proteins
;
genetics
;
metabolism
;
Mice
;
Mice, Inbred C57BL
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RNA, Small Interfering
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Random Allocation
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Telmisartan
;
pharmacology
;
Transforming Growth Factor beta1
;
pharmacology
;
Ureteral Obstruction
;
complications
;
metabolism
3.Concomitant inhibition of renin angiotensin system and Toll-like receptor 2 attenuates renal injury in unilateral ureteral obstructed mice.
Sarah CHUNG ; Jin Young JEONG ; Yoon Kyung CHANG ; Dae Eun CHOI ; Ki Ryang NA ; Beom Jin LIM ; Kang Wook LEE
The Korean Journal of Internal Medicine 2016;31(2):323-334
BACKGROUND/AIMS: There has been controversy about the role of Toll-like receptor 2 (TLR2) in renal injury following ureteric obstruction. Although inhibition of the renin angiotensin system (RAS) reduces TLR2 expression in mice, the exact relationship between TLR2 and RAS is not known. The aim of this study was to determine whether the RAS modulates TLR2. METHODS: We used 8-week-old male wild type (WT) and TLR2-knockout (KO) mice on a C57Bl/6 background. Unilateral ureteral obstruction (UUO) was induced by complete ligation of the left ureter. Angiotensin (Ang) II (1,000 ng/kg/min) and the direct renin inhibitor aliskiren (25 mg/kg/day) were administrated to mice using an osmotic minipump. Molecular and histologic evaluations were performed. RESULTS: Ang II infusion increased mRNA expression of TLR2 in WT mouse kidneys (p < 0.05). The expression of renin mRNA in TLR2-KO UUO kidneys was significantly higher than that in WT UUO kidneys (p < 0.05). There were no differences in tissue injury score or mRNA expression of monocyte chemotactic protein 1 (MCP-1), osteopontin (OPN), or transforming growth factor beta (TGF-beta) between TLR2-KO UUO and WT UUO kidneys. However, aliskiren decreased the tissue injury score and mRNA expression of TLR2, MCP-1, OPN, and TGF-beta in WT UUO kidneys (p < 0.05). Aliskiren-treated TLR2-KO UUO kidneys showed less kidney injury than aliskiren-treated WT UUO kidneys. CONCLUSIONS: TLR2 deletion induced activation of the RAS in UUO kidneys. Moreover, inhibition of both RAS and TLR2 had an additive ameliorative effect on UUO injury of the kidney.
Amides/*pharmacology
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Angiotensin II/pharmacology
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Animals
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Disease Models, Animal
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Fibrosis
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Fumarates/*pharmacology
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Kidney/*drug effects/metabolism/pathology
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Male
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Mice, Inbred C57BL
;
Mice, Knockout
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Nephritis, Interstitial/genetics/metabolism/pathology/*prevention & control
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RNA, Messenger/genetics/metabolism
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Renin/*antagonists & inhibitors/metabolism
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Renin-Angiotensin System/*drug effects
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Toll-Like Receptor 2/deficiency/drug effects/genetics/*metabolism
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Ureteral Obstruction/*drug therapy/genetics/metabolism/pathology
4.BM-MSCs from Wuzhishan mini-pigs delay the progress of renal fibrosis induced by chronic kidney disease through autocrine hepatocyte growth factor in vitro.
Yang XIANG ; Jiale LONG ; Jiansheng XING ; Yuanhui GAO ; Qing CHENG ; Yong CAI ; Zhenxiang LIU ; Shufang ZHANG ; Lie CHEN ; Chao YANG ; Zhiming BAI
Journal of Central South University(Medical Sciences) 2016;41(12):1260-1269
To isolate bone marrow mesenchymal stem cells (BM-MSCs) and establish the model of chronic kidney disease (CKD) of Wuzhishan (WZS) mini-pig, and to study the repairment effect of BM-MSCs on CKD-induced renal fibrosis in vitro.
Methods: Density gradient method was used to isolate and culture BM-MSCs. The cells were verified by morphology, phenotype, differentiation and so on. The left partial ureteral obstruction (LPUUO) was used to establish the CKD model, which was evaluated by B-ultrasound, single-photon emission computed tomography (SPECT), HE and Masson staining. The cells were divided into 3 groups, the tissue plus BM-MSCs group, the tissue group, and the BM-MSCs group, respectively. Seven days later, the supernatants were collected to observe the changes of hepatocyte growth factor (HGF) cumulative release. HE and Masson staining was used to observe the changes of renal tissue.
Results: The isolated BM-MSCs possessed the features as follow: fibroblast-like adherent growth; positive in CD29 and CD90 expression while negative in CD45 expression; osteogenic induction and alizarin red staining were positive; alcian blue staining were positive after chondrogenic induction. Twelve weeks after the operation of LPUUO, B-ultrasound showed the thin renal cortical with pelvis effusion; SPETCT showed the left kidney delayed filling and renal impairment. The accumulation of HGF in the tissue plus BM-MSCs group was significantly higher than that in the tissue alone group at the 1st, 5th, 6th, 7th day, respectively (P<0.05). HE staining showed the different degree of renal lesions between the tissue plus BM-MSCs+CKD group and the tissue alone group, which was aggravated with the time going. Masson staining showed that the cumulative optical density of blue-stained collagen fibers in tissue plus BM-MSCs group was significantly lower than that in the tissue group at the 5th to 7th day (P<0.05).
Conclusion: BM-MSCs from WZS mini-pig can inhibit or delay the progress of CKD-induced renal fibrosis through autocrine HGF in vitro.
Animals
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Autocrine Communication
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physiology
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Bone Marrow Cells
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Cells, Cultured
;
Fibrosis
;
physiopathology
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prevention & control
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Hepatocyte Growth Factor
;
metabolism
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Kidney
;
drug effects
;
pathology
;
physiopathology
;
Mesenchymal Stem Cells
;
drug effects
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Renal Insufficiency, Chronic
;
complications
;
physiopathology
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Swine
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Swine, Miniature
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Ureteral Obstruction
;
complications
5.Conditional Knockout of Src Homology 2 Domain-containing Protein Tyrosine Phosphatase-2 in Myeloid Cells Attenuates Renal Fibrosis after Unilateral Ureter Obstruction.
Jing-Fei TENG ; Kai WANG ; Yao LI ; Fa-Jun QU ; Qing YUAN ; Xin-Gang CUI ; Quan-Xing WANG ; Dan-Feng XU
Chinese Medical Journal 2015;128(9):1196-1201
BACKGROUNDSrc homology 2 domain-containing protein tyrosine phosphatase-2 (SHP-2) is a kind of intracellular protein tyrosine phosphatase. Studies have revealed its roles in various disease, however, whether SHP-2 involves in renal fibrosis remains unclear. The aim of this study was to explore the roles of myeloid cells SHP-2 in renal interstitial fibrosis.
METHODSMyeloid cells SHP-2 gene was conditionally knocked-out (CKO) in mice using loxP-Cre system, and renal interstitial fibrosis was induced by unilateral ureter obstruction (UUO). The total collagen deposition in the renal interstitium was assessed using picrosirius red stain. F4/80 immunostaing was used to evaluate macrophage infiltration in renal tubular interstitium. Quantitative real-time polymerase chain reaction and enzyme linked immunosorbent assay were used to analyze the production of cytokines in the kidney. Transferase-mediated dUTP nick-end labeling stain was used to assess the apoptotic renal tubular epithelial cells.
RESULTSSrc homology 2 domain-containing protein tyrosine phosphatase-2 gene CKO in myeloid cells significantly reduced collagen deposition in the renal interstitium after UUO. Macrophage infiltration was evidently decreased in renal tubular interstitium of SHP-2 CKO mice. Meanwhile, the production of pro-inflammatory cytokines was significantly suppressed in SHP-2 CKO mice. However, no significant difference was observed in the number of apoptotic renal tubular epithelial cells between wild-type and SHP-2 CKO mice.
CONCLUSIONSOur observations suggested that SHP-2 in myeloid cells plays a pivotal role in the pathogenesis of renal fibrosis, and that silencing of SHP-2 gene in myeloid cells may protect renal from inflammatory damage and prevent renal fibrosis after renal injury.
Animals ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrosis ; enzymology ; pathology ; Immunohistochemistry ; Kidney Diseases ; enzymology ; pathology ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Myeloid Cells ; metabolism ; Protein Tyrosine Phosphatase, Non-Receptor Type 11 ; genetics ; metabolism ; Ureteral Obstruction ; enzymology ; pathology
6.Tempol Attenuates Renal Fibrosis in Mice with Unilateral Ureteral Obstruction: The Role of PI3K-Akt-FoxO3a Signaling.
Hye Eun YOON ; Soo Jeong KIM ; Sung Jun KIM ; Sungjin CHUNG ; Seok Joon SHIN
Journal of Korean Medical Science 2014;29(2):230-237
This study investigated whether tempol, an anti-oxidant, protects against renal injury by modulating phosphatidylinositol 3-kinase (PI3K)-Akt-Forkhead homeobox O (FoxO) signaling. Mice received unilateral ureteral obstruction (UUO) surgery with or without administration of tempol. We evaluated renal damage, oxidative stress and the expression of PI3K, Akt, FoxO3a and their target molecules including manganese superoxide dismutase (MnSOD), catalase, Bax, and Bcl-2 on day 3 and day 7 after UUO. Tubulointerstitial fibrosis, collagen deposition, alpha-smooth muscle actin-positive area, and F4/80-positive macrophage infiltration were significantly lower in tempol-treated mice compared with control mice. The expression of PI3K, phosphorylated Akt, and phosphorylated FoxO3a markedly decreased in tempol-treated mice compared with control mice. Tempol prominently increased the expressions of MnSOD and catalase, and decreased the production of hydrogen peroxide and lipid peroxidation in the obstructed kidneys. Significantly less apoptosis, a lower ratio of Bax to Bcl-2 expression and fewer apoptotic cells in TUNEL staining, and decreased expression of transforming growth factor-beta1 were observed in the obstructed kidneys from tempol-treated mice compared with those from control mice. Tempol attenuates oxidative stress, inflammation, and fibrosis in the obstructed kidneys of UUO mice, and the modulation of PI3K-Akt-FoxO3a signaling may be involved in this pathogenesis.
Animals
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Antioxidants/pharmacology/therapeutic use
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Collagen/metabolism
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Cyclic N-Oxides/*pharmacology/therapeutic use
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Fibrosis
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Forkhead Transcription Factors/*metabolism
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Hydrogen Peroxide/metabolism
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Kidney Diseases/drug therapy/metabolism/pathology
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Lipid Peroxidation
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Male
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Mice
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Mice, Inbred C57BL
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Oxidative Stress/drug effects
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Phosphatidylinositol 3-Kinases/*metabolism
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Phosphorylation/drug effects
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Proto-Oncogene Proteins c-akt/*metabolism
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Severity of Illness Index
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Signal Transduction/*drug effects
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Spin Labels
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Superoxide Dismutase/metabolism
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Ureteral Obstruction/complications/drug therapy/*metabolism/pathology
7.Effects of astaxanthin on renal fibrosis and cell apoptosis induced by partial unilateral ureteral obstruction in rats.
Chaoxin XIE ; Meng MENG ; Xianfeng YIN ; Fengling HE ; Hanshen YE ; Dong XIE
Journal of Southern Medical University 2013;33(2):305-308
OBJECTIVETo study the effects of astaxanthin on renal fibrosis and apoptosis induced by partial unilateral ureteral obstruction (UUO) in rats.
METHODSNinety-six male adult SD rats were randomized into 6 equal groups, namely the blank control group, sham-operated group, UUO group, and astaxanthin group at high, medium, and low doses. Left ureteral ligation was performed in UUO and astaxanthin groups, and two days before the operation, the rats in astaxanthin groups were lavaged with 25, 50, or 100 mg/kg astaxanthin daily for 14 days, while the same volume of saline was given to rats in UUO group and sham-operated group. Renal pathological in the rats was observed with HE staining, and the expression levels of TGF-β1, SGK1, and CTGF in the left kidney were detected immunohistochemically; the expression level of Bcl-2 and Bax were detected using Bcl-2 and Bax detection kits.
RESULTSCompared to UUO group, high- and medium-dose astaxanthin groups showed obviously ameliorated renal pathologies and reduced expressions of TGF-β1, SGK1, and CTGF in the left kidney with lessened renal cell apoptosis.
CONCLUSIONAstaxanthin can reduce UUO-induced renal fibrosis and renal cell apoptosis, demonstrating the renoprotective effect of astaxanthin against renal fibrosis.
Animals ; Apoptosis ; drug effects ; Connective Tissue Growth Factor ; metabolism ; Fibrosis ; Immediate-Early Proteins ; metabolism ; Kidney ; drug effects ; metabolism ; pathology ; Kidney Diseases ; metabolism ; pathology ; Male ; Protein-Serine-Threonine Kinases ; metabolism ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism ; Ureteral Obstruction ; metabolism ; pathology ; Xanthophylls ; pharmacology ; bcl-2-Associated X Protein ; metabolism
8.Effects of bicyclol on renal PAI-1 expression in rats with uniliteral ureteral obstruction.
Chinese Journal of Contemporary Pediatrics 2011;13(6):509-513
OBJECTIVETo explore the protective effects of bicyclol against renal interstitial fibrosis and possible mechanisms of the protection.
METHODSEighty-one Sprague-Dawley (SD) rats were randomly assigned to a sham-operated group and UUO groups with and without bicyclol treatment. A rat model of renal interstitial fibrosis was prepared by unilateral ureteral obstruction (UUO). Renal tissues were examined by hematoxylin & eosin and Masson staining on 7, 14 and 21 days. Immunhistochemistry was used for determining plasminogen activator inhibitor-1(PAI-1) expression in the renal interstitium. PAI-1 mRNA expression in renal tissues was semi-quantitatively determined by reverse transcription-polymerase chain reaction (RT-PCR).
RESULTSThe relative areas of renal interstitial fibrosis in the bicyclol-treated UUO group 7, 14 and 21 days after operation were (9.6 ± 0.6)%, (16.8 ± 0.8)% and (33.6 ± 1.6)% respectively, which were significantly lower than those in the untreated UUO group [13.0 ± 0.7)%, (25.8 ± 1.5)% and (53.2 ± 2.5)% respectively] (P<0.05). The levels of protein and mRNA expression of PAI-1 in the bicyclol-treated UUO group decreased significantly compared with those in the untreated UUO group 7, 14 and 21 days after operation (P<0.05).
CONCLUSIONSBicyclol can alleviate renal interstitial injury and renal interstitial fibrosis caused by UUO in rats, possibly through a downregulation of renal PAI-1 expression.
Animals ; Biphenyl Compounds ; pharmacology ; therapeutic use ; Fibrosis ; Kidney ; chemistry ; drug effects ; metabolism ; pathology ; Male ; Plasminogen Activator Inhibitor 1 ; analysis ; genetics ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Ureteral Obstruction ; drug therapy ; metabolism ; pathology
9.Effect of losartan on renal expression of monocyte chemoattractant protein-1 and transforming growth factor-β(1) in rats after unilateral ureteral obstruction.
Yu-Yu HUANG ; An-Ping XU ; Shan-Shan ZHOU ; Jun-Zhou FU ; Hong DU
Journal of Southern Medical University 2011;31(8):1405-1410
OBJECTIVETo investigate the effect of losartan on the expression of monocyte chemoattractant protein-1 (MCP1) and transforming growth factor-β(1) (TGF-β(1)) in the kidney of rats with unilateral urethral obstruction (UUO) and evaluate protective effect of losartan against reanal interstitial fibrosis.
METHODSRat models of UUO were treated with losartan at the routine dose, high dose, and very high dose (50, 200, and 500 mg/kg daily, respectively), and saline was given to UUO model rats and rats with sham operation. At 7, 14, and 21 days, the tail cuff blood pressure (TCP), 24-h urine protein (Upro), serum Scr, BUN, K(+), percentage of renal damage and renal interstitial fibrosis (%INT) were measured in the rats. MCP1 protein in the renal tissues was detected using immunohistochemistry, and MCP1 and TGF-β(1) mRNA expressions were assayed using RT-PCR.
RESULTSAs the UUO prolonged, Upro, TCP, tubular damage, %INT, and MCP1 and TGF-β(1) mRNA expressions all increased significantly (P<0.05). High and very high doses of losartan, compared with the routine dose, obviously reversed these changes.
CONCLUSIONHigh-dose losartan can effectively control blood pressure, reduce renal damage and fibrosis, and inhibit MCP1 and TGF-β(1) expression in rats with UUO, and at a very high dose, losartan can more effectively reduce 24-h Upro than the high-dose group. High and very high doses of losartan offer better protective effect on the kidney in rats with UUO.
Animals ; Chemokine CCL2 ; metabolism ; Fibrosis ; etiology ; prevention & control ; Kidney ; metabolism ; pathology ; Losartan ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism ; Ureteral Obstruction ; complications ; drug therapy
10.PPARgamma Agonist and Angiotensin II Receptor Antagonist Ameliorate Renal Tubulointerstitial Fibrosis.
Jee Young HAN ; Ye Ji KIM ; Lucia KIM ; Suk Jin CHOI ; In Suh PARK ; Joon Mee KIM ; Young Chae CHU ; Dae Ryong CHA
Journal of Korean Medical Science 2010;25(1):35-41
The peroxisome proliferator activated receptor (PPAR)gamma agonist is used as antidiabetic agent with antihyperglycemic and antihyperinsulinemic actions. Beyond these actions, antifibrotic effects have been reported. We examined antifibrotic effects of PPARgamma agonist and interaction with angiotensin receptor antagonist in the unilateral ureteral obstruction (UUO) model. After UUO, mice were divided to four groups: no treatment (CONT), pioglitazone treatment, L158809 treatment, and L158809+ pioglitazone treatment. On day 14, CONT mice showed severe fibrosis and all treated mice showed decreased fibrosis. The immunohistochmistry of PAI-1, F4/80 and p-Smad2 demonstrated that their expressions were increased in CONT group and decreased in the all treated groups compared to CONT. PAI-1 and p-Smad2 determined from Western blotting, among treated groups, was decreased compared to CONT group. The expression of TGF-beta1 from real time RT PCR showed markedly increased in the CONT group and decreased in all treated groups compared to CONT. These data suggest the pioglitazone inhibited tubulointerstitial fibrosis, however, the synergism between pioglitazone and L158809 is not clear. Considering decreased expression of PAI-1 and TGF-beta/Smad2 in the treated groups, PAI-1 and TGF-beta are likely linked to the decreased renal tubulointerstitial fibrosis. According to these results, the PPARgamma agonist might be used in the treatment of renal fibrotic disease.
*Angiotensin Receptor Antagonists
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Animals
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Antigens, Differentiation/metabolism
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Disease Models, Animal
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Fibrosis
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Hypoglycemic Agents/pharmacology
;
Kidney/metabolism/*pathology
;
Male
;
Mice
;
Mice, Inbred C57BL
;
PPAR gamma/*agonists
;
Plasminogen Activator Inhibitor 1/metabolism
;
Smad2 Protein/metabolism
;
Thiazolidinediones/pharmacology
;
Transforming Growth Factor beta1/genetics/metabolism
;
Ureteral Obstruction/metabolism/pathology

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