Constituents of the extracellular matrices in diabetic glomerulosclerosis.

This study was undertaken to elucidate the distributions of laminin, fibronectin, type I, III, IV, V and VI collagen and heparan sulfate proteoglycan (HSPG) in diabetic nephropathy, using immunohistochemical procedures. The pathological features of diabetic glomerulosclerosis were characterized as diffuse and nodular lesions, showing an expanded mesangial matrix associated with a thickened glomerular basement membrane (GBM). In the thickened GBM, laminin was present throughout the whole membrane, type IV collagen occurred along the subendothelial side, and HSPG was present with no change in its amount. On the other hand, the components detected in the slightly expanded mesangial matrix were type IV, V and VI collagen, fibronectin and HSPG, but not laminin. When the matrix was expanded markedly, collagenous components were increased over the other components. In the typical Kimmelstiel-Wilson nodules, the mesangial matrix was occupied mainly by type V and VI collagen with a relative decrease in type IV collagen. When a nodular lesion adhered to Bowman's capsule, type I and III collagen occurred not only in Bowman's space but also within the lesion itself. Furthermore, laminin and HSPG became detectable on the outside of the lesion, but not within it. These results suggested that there was a difference in the distribution and proportion of extracellular matrix components between diffuse and nodular lesions. It appeared that the nodular lesion was not simply an advanced form of the diffuse lesion.