Mesangial cells are specialized pericytes that reside within the mesangium of the renal glomerulus, comprising approximately 30–40% of all glomerular cells and originating from the metanephric mesenchyme.[1] These cells, along with their associated extracellular matrix, form the structural core of the glomerulus, embedding between capillary loops and connecting to the glomerular basement membrane via integrins.[1] Characterized as myofibroblast-like cells with contractile and phagocytic properties, they exhibit features similar to smooth muscle cells, enabling them to influence glomerular architecture and function.[2]In terms of function, mesangial cells provide essential structural support to the glomerular capillary network, regulating the surface area available for filtration by contracting in response to factors such as angiotensin II.[1] They also play a critical role in maintaining the filtration barrier through phagocytic clearance of macromolecules and debris, ensuring the permselectivity that allows passage of water and small solutes while restricting larger proteins.[1] Additionally, these cells produce and regulate the mesangial matrix, which includes components like collagen IV, laminin, fibronectin, and proteoglycans, modulated by cytokines such as transforming growth factor-beta (TGF-β).[1] Beyond structural roles, mesangial cells contribute to glomerular development by interacting with podocytes and endothelial cells to form a functional filtration unit.[3]Mesangial cells are also involved in immune responses, expressing major histocompatibility complex class II (MHC-II) and co-stimulatory molecules like CD40 and CD80 when activated, allowing them to process antigens and activate CD4+ T cells, which promotes Th1 differentiation and proinflammatory cytokine secretion (e.g., IL-6, IL-12).[4] In pathological contexts, such as glomerulonephritides including IgA nephropathy and diabetic nephropathy, mesangial cell proliferation and matrix expansion lead to sclerosis and impaired filtration, exacerbating kidney injury through inflammatory and fibrotic processes.[4][1]
Anatomy
Location and Types
Mesangial cells are specialized pericytes located within the renal corpuscle of the kidneyglomerulus, constituting approximately 30–40% of the total glomerular cellularity.[5] These cells are integral to the mesangium, a supportive structure in the glomerulus, and are classified into two main types based on their anatomical position: intraglomerular and extraglomerular mesangial cells.Intraglomerular mesangial cells reside between the capillary loops of the glomerular tuft, where they occupy the central mesangial region and contribute to the overall architecture of the filtration unit.[5] These cells extend slender cellular processes that anchor directly to the glomerular basement membrane (GBM), facilitating their spatial organization and interaction with surrounding glomerular components.Extraglomerular mesangial cells, also referred to as Goormaghtigh cells or lacis cells, are situated at the vascular pole of the glomerulus, specifically in the region between the afferent and efferent arterioles within the juxtaglomerular apparatus.[6] These cells form connections to the smooth muscle cells of the adjacent arterioles via gap junctions, enabling coordinated signaling in the renal vascular network.[7]
Morphology and Ultrastructure
Mesangial cells exhibit an irregular, stellate morphology characterized by a central cell body and multiple elongated cytoplasmic processes that extend toward the glomerular basement membrane (GBM) and make contact with adjacent mesangial cells and endothelial cells.[8] These processes extend between and support the glomerular capillaries, integrating the cells into the structural framework of the mesangium.[8] Ultrastructurally, the cells display a prominent rough endoplasmic reticulum, indicative of active protein synthesis, along with lysosomes that contribute to their intracellular processing capabilities.[9]Within the intraglomerular mesangial population, the majority exhibit a contractile phenotype, while up to 15% display a monocyte/macrophage-like phagocytic phenotype derived from bone marrow precursors.[10] The contractile cells contain bundles of actin filaments, myosin, and associated proteins such as tropomyosin, organized into a network that traverses the cytoplasmic extensions.[8] Intermediate filaments, including vimentin, provide additional cytoskeletal support, with desmin expression also observed in these cells.[8] Connections between mesangial cells and the overlying endothelium often occur through fenestrated regions, facilitating close apposition without direct membrane fusion.[9]The mesangial matrix surrounding these cells consists primarily of type IV collagen, laminin, fibronectin, and proteoglycans such as perlecan and agrin, forming a specialized non-cellular compartment that embeds and supports the mesangial cells.[11] This matrix integrates with the GBM at paramesangial angles, creating a cohesive structural unit within the glomerulus.[9]
Development
Embryonic Origin
Mesangial cells originate primarily from the stromal compartment of the metanephric mesenchyme, a derivative of the intermediate mesoderm that forms during early kidney development.[12] These stromal progenitors differentiate into mesangial cells, which exhibit characteristics of pericytes and vascular smooth muscle-like cells, providing structural support to the developing glomerular capillaries.[13] Some studies suggest a minor contribution from neural crest-derived stromal cells that integrate into the renal mesenchyme, though the predominant lineage remains mesenchymal.[13]During early nephrogenesis, mesangial cell precursors express key markers such as platelet-derived growth factor receptor beta (PDGFRβ), which is essential for their recruitment and differentiation, and alpha smooth muscle actin (α-SMA), indicative of their contractile properties.[14] PDGFRβ is detected in perivascular mesenchymal cells surrounding nascent glomerular structures, while α-SMA expression emerges in maturing mesangial cells within the glomerular tuft.[14]These precursors migrate into the developing glomerulus around embryonic day 13-15 in mice, guided by chemotactic signals including PDGF-B from endothelial cells[15] and vascular endothelial growth factor A (VEGFA).[16] This migration is critical for populating the S-shaped body stage of glomerular formation. Evidence from genetic studies supports this process; PDGF-B null mice exhibit a complete absence of mesangial cells, resulting in disorganized glomerular capillaries and formation of aneurysms due to failed recruitment of PDGFRβ-positive progenitors.[15]
Role in Glomerular Formation
During glomerular development, podocytes, derived from visceral epithelial precursors, secrete vascular endothelial growth factor (VEGF) to recruit endothelial precursors into the vascular cleft of the S-shaped nephron body, initiating the formation of primitive vascular loops.[17] These endothelial cells then produce platelet-derived growth factor B (PDGF-B), which acts in a paracrine manner on PDGF receptor β (PDGFRβ)-expressing mesangial progenitors—originating from perivascular cells surrounding the afferent and efferent arterioles—to recruit and direct their migration into the developing glomerular tuft.[15] This sequential recruitment establishes the foundational cellular architecture, with mesangial cells invading the cleft shortly after endothelial entry, typically around the comma- and S-shaped stages in mammalian models.[18]Mesangial cells play a pivotal role in branching morphogenesis by attaching to endothelial cells and exerting contractile forces that promote capillary looping and invagination, transforming the initial linear vascular structures into a complex, lobulated tuft.[18] Through these interactions, mesangial cells stabilize the nascent capillarynetwork against emerging hemodynamic pressures from blood flow, preventing collapse and ensuring structural integrity as the tuft expands.[9] Additionally, mesangial cells engage in paracrine signaling with endothelial cells, including the secretion of VEGF isoforms to support endothelial differentiation and network formation, while coordinating with podocytes via shared matrix components and growth factors to assemble the filtration barrier.[19]In human fetal kidney development, mesangial cell invasion precedes full capillary maturation, occurring prominently from the 8th to 12th gestational weeks as part of early nephrogenesis, with the glomerular tuft achieving a mature vascular configuration by approximately 20 weeks.[20] This timeline aligns with the transition from capillary loop stages to mature glomeruli, where mesangial cells integrate into the central mesangium to support ongoing tuft refinement.[21]
Function
Structural Support and Matrix Production
Mesangial cells contribute to the structural integrity of the glomerulus by providing tensile support to the capillary loops, which helps prevent their collapse under the high intraglomerular pressures encountered during filtration. The glomerular capillary hydrostatic pressure typically reaches approximately 60 mm Hg, generating significant biomechanical stress on the delicate capillary walls. Through their extensions and the intervening mesangial matrix, these cells anchor and stabilize the glomerular tuft, forming a biomechanical unit with the glomerular basement membrane that distributes wall tension and maintains capillary patency.[22][23]A key aspect of this support involves the synthesis and maintenance of the mesangial matrix, a specialized extracellular matrix that occupies roughly 10% of the glomerular volume in healthy kidneys and serves as the primary scaffold between mesangial cells and capillaries. Mesangial cells produce a balanced array of matrix components, including type IV collagen (predominantly α1·α1·α2 heterotrimers), fibronectin, and nidogen (also known as entactin), which assemble into a network that provides both rigidity and flexibility to withstand filtration forces. This matrix composition differs slightly from the glomerular basement membrane but complements it to ensure overall glomerular architecture. Type IV collagen forms the structural backbone, while fibronectin and nidogen facilitate adhesion and cross-linking among matrix elements and cell surfaces.[24][1][25]Mesangial cells also regulate the turnover of this matrix to preserve homeostasis, primarily through the production of matrix metalloproteinases (MMPs) such as MMP-2 and MMP-9, which degrade extracellular matrix proteins, and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs) like TIMP-1 and TIMP-2. This balanced enzymatic activity allows for dynamic remodeling in response to physiological demands, preventing excessive accumulation or degradation that could compromise glomerular structure. The secretion of these proteases and inhibitors by mesangial cells enables precise control over matrix degradation, ensuring long-term stability of the glomerular tuft.[26][27][28]In conditions of hemodynamic stress, such as systemic hypertension, mesangial cells respond by increasing matrix deposition to reinforce the glomerular structure against elevated pressures. This adaptive process involves upregulated synthesis of collagen IV and fibronectin, leading to mesangial expansion that helps mitigate capillary wall strain from sustained high glomerular hypertension. Such responses highlight the cells' role in buffering mechanical overload, though chronic activation can contribute to pathological changes if unresolved.[29][30][31]
Contractile Regulation of Glomerular Blood Flow
Mesangial cells play a critical role in dynamically regulating glomerular blood flow and filtration through their contractile properties, acting as smooth muscle-like pericytes that modulate the glomerular capillary surface area available for filtration.[8]Contraction of these cells reduces the ultrafiltration coefficient (K_f) by decreasing capillary lumen diameter and surface area, thereby attenuating glomerular filtration rate (GFR) without altering systemic blood pressure.[32] This regulation ensures fine-tuned control of renal hemodynamics in response to physiological demands.[33]Contraction is primarily mediated by vasoactive agonists binding to G-protein-coupled receptors on mesangial cells, triggering intracellular calcium signaling pathways. Angiotensin II, endothelin-1, and thromboxane A2 are key mediators; for instance, angiotensin II activates phospholipase C, leading to inositol trisphosphate (IP_3)-induced release of Ca²⁺ from intracellular stores, which activates voltage-gated Ca²⁺ channels and sustains contraction via actin-myosin interactions.[8] Similarly, endothelin-1 and thromboxane A2 elicit comparable Ca²⁺ mobilization and membrane depolarization through nonselective cation and chloride channels, resulting in reduced capillary surface area.[34] These processes involve cytoskeletal elements such as actin and myosin filaments, enabling the cells to exert mechanical force on adjacent capillaries.[8]Relaxation of mesangial cells counteracts contraction to increase K_f and GFR, primarily through cyclic GMP (cGMP)-dependent pathways activated by vasodilatory signals. Atrial natriuretic peptide (ANP) binds to natriuretic peptide receptors, elevating cGMP levels and activating protein kinase G, which hyperpolarizes the cell membrane via large-conductance Ca²⁺-activated K⁺ (BK_Ca) channels, thereby inhibiting Ca²⁺ influx and promoting relaxation.[8]Nitric oxide (NO), produced locally by endothelial or mesangial cells, similarly stimulates soluble guanylate cyclase to raise cGMP, enhancing BK_Ca activity and reducing contractile tone to expand the filtration surface.[9] These mechanisms provide a negative feedback loop to balance hemodynamic forces within the glomerulus.[8]Mesangial cells integrate with tubuloglomerular feedback (TGF) to maintain GFR homeostasis, particularly through extraglomerular mesangial cells positioned at the juxtaglomerular apparatus. These cells sense signals from the macula densa, such as increased NaCl delivery, and transmit them via gap junctions or paracrine factors to adjust afferent arteriole tone, modulating glomerular plasma flow in concert with intraglomerular mesangial contraction.[35] This coordination allows TGF to fine-tune filtration by altering both vascular resistance and capillary dynamics.[8]Quantitatively, mesangial contractions can alter GFR by 20-30% independently of changes in glomerular capillary pressure, as demonstrated in studies where agonist-induced responses reduced single-nephron GFR without systemic hemodynamic shifts.[33] For example, angiotensin II infusion in intact glomeruli decreases GFR by up to 61% in controls, with mesangial tone contributing substantially to this effect.[33] Such modulation underscores the cells' role in preventing glomerular hyperfiltration or hypofiltration under varying physiological conditions.[8]
Phagocytosis and Macromolecule Clearance
Mesangial cells serve as key phagocytes within the glomerulus, engulfing apoptotic endothelial and podocyte debris through receptor-mediated mechanisms involving integrins such as α_vβ_3 and thrombospondin, independent of CD36.[36] This process facilitates the resolution of inflammation by removing cellular remnants without triggering excessive immune responses, as demonstrated in models of self-limited mesangial proliferative glomerulonephritis where neighboring mesangial cells phagocytose apoptotic peers.[37] Additionally, mesangial cells employ pinocytosis and receptor-dependent endocytosis to internalize aggregated proteins and lipids, utilizing coated pits that direct particles to endosomes and subsequently to phagolysosomes for degradation.[9]In their role as scavengers, mesangial cells clear macromolecules such as IgG-containing immune complexes via Fcγ receptors, preventing their accumulation and subsequent inflammatory cascade in the glomerular mesangium.[38] Similarly, they internalize oxidized low-density lipoproteins (oxLDL) through scavenger receptors, mitigating potential oxidative stress and lipid-mediated glomerular injury under physiological conditions.[39] These clearance functions are essential for maintaining glomerular homeostasis, with uptake pathways like those involving β1,4-galactosyltransferase 1 specifically handling IgA1 complexes.[40]Certain mesangial cell populations exhibit monocyte-like characteristics, acquiring a macrophage phenotype upon stimulation, which enhances their phagocytic capacity.[41] These monocyte-like mesangial cells manage the engulfment of debris and macromolecules, and upon activation, they secrete pro-inflammatory cytokines including interleukin-6 (IL-6) to coordinate local immune responses.[41]The phagocytic capacity of mesangial cells is limited, and excessive macromolecular load, such as from persistent immune complexes, can overwhelm lysosomal processing, leading to phagolysosomal destabilization and cellular injury.[42] This overload disrupts lysosomal homeostasis, impairing degradation and contributing to mesangial dysfunction, as observed when complement activation induces lysosomal membrane permeabilization.[42] Lysosomal organelles, briefly referenced here, are central to this degradative pathway but can become sites of pathology under stress.[9]
Pathophysiology
Activation and Proliferation in Disease
Mesangial cells undergo activation in response to various pathological stimuli, including hyperglycemia, cytokines such as transforming growth factor-β (TGF-β), and mechanical stretch, which collectively induce phenotypic changes toward a dedifferentiated, myofibroblast-like state characterized by increased expression of smooth muscle α-actin (α-SMA).[43][9][44]Hyperglycemia promotes this activation by altering gene expression profiles, including upregulation of actin-regulatory proteins through oxidative stress and cytoskeletal disassembly, while TGF-β enhances glucose uptake and bioactivity in mesangial cells, amplifying the response.[45][46] Mechanical stretch, often resulting from altered glomerular hemodynamics, triggers signaling cascades like MAP kinase activation, which is further potentiated under high-glucose conditions, leading to inflammatory gene expression and loss of contractile properties.[47][48] This dedifferentiation enables mesangial cells to adopt reparative but potentially maladaptive roles in glomerular injury.[49]Proliferation of mesangial cells, or hyperplasia, is a key response to glomerular injury, primarily mediated by platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) signaling pathways, which drive DNA synthesis and increase cell numbers to address damage.[50][51] PDGF, released by injured mesangial cells and platelets, acts as a potent mitogen, with upregulated PDGF A and B chains and receptor expression observed in proliferative glomerulonephritis models, peaking during active injury phases.[52][53] EGF-family ligands similarly contribute by modulating growth and matrix responses, ensuring coordinated expansion in immune-mediated glomerular insults.[51] This proliferative response, while initially protective, can exacerbate sclerosis if unchecked.[54]In contrast to hyperplasia, mesangial cell hypertrophy—characterized by increased cell size without proliferation—predominates in metabolic stresses like hyperglycemia in diabetic nephropathy, often linked to cell cycle arrest mediated by proteins such as p27Kip1 and TGF-β signaling.[55][56] This hypertrophy contributes to early glomerular expansion without DNA replication, distinguishing it from the DNA synthesis-driven hyperplasia seen in immune-mediated damages like proliferative glomerulonephritis.[57][58] Recent single-cell RNA sequencing studies have elucidated mesangial-specific gene programs in early glomerular disease, revealing upregulated collagen genes (e.g., COL1A1) and extracellular matrix components in activated mesangial clusters, highlighting their role in initiating fibrotic pathways before overt proliferation.[59][60][61]
Role in Extracellular Matrix Expansion
In pathological states, mesangial cells exhibit dysregulated extracellular matrix (ECM) dynamics, characterized by an imbalance favoring synthesis over degradation, leading to pathological matrix accumulation. This involves upregulation of key ECM components such as fibronectin and collagens I and III, driven by stimuli like high glucose environments. Concurrently, degradation is impaired due to downregulation of matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, which normally break down ECM proteins.[57][62][63]A central mechanism underlying this expansion is the induction of ECM genes by transforming growth factor-β1 (TGF-β1), which activates signaling pathways promoting transcription of fibronectin, collagen I, and collagen III in mesangial cells. TGF-β1-mediated effects result in progressive mesangial expansion that can occupy 30% or more of the glomerular tuft volume in advanced disease stages, markedly altering glomerular architecture.[64][65][66]The consequences of this ECM expansion include mechanical compression of glomerular capillaries, which reduces the available filtration surface area and impairs glomerular filtration rate (GFR). This compression also contributes to local ischemia by restricting blood flow within the glomerular tuft, exacerbating renal dysfunction.[67][68]Recent findings highlight the role of microRNA-21 (miR-21) upregulation in promoting ECM deposition through inhibition of autophagy in mesangial cells. Under high-glucose conditions, elevated miR-21 suppresses PTEN expression, activating the Akt/mTOR pathway and thereby reducing autophagic degradation of cellular components, which indirectly enhances matrix accumulation.[69]Emerging research as of 2025 has identified additional molecular regulators, including the transcription factor GABP, which promotes mesangial cell proliferation and renal fibrosis in diabetic nephropathy via epigenetic modifications, and glycine decarboxylase (GLDC), which boosts mesangial proliferation in IgA nephropathy by enhancing glycolysis. These insights highlight evolving metabolic and transcriptional pathways in mesangial pathophysiology.[70][71]
Clinical Significance
Diabetic Kidney Disease
In diabetic kidney disease (DKD), chronic hyperglycemia profoundly impacts mesangial cells, primarily through the formation of advanced glycation end-products (AGEs), which accumulate and induce oxidative stress by disrupting cellular redoxhomeostasis and elevating reactive oxygen species (ROS) levels. This oxidative milieu upregulates transforming growth factor-beta (TGF-β), a key profibrotic cytokine that stimulates mesangial cell proliferation, hypertrophy, and excessive production of extracellular matrix components such as collagen IV and fibronectin, leading to mesangial expansion.[57][72] The hallmark pathological feature, Kimmelstiel-Wilson nodules, arises from this progressive matrix accumulation and mesangial cell hypertrophy, forming acellular, PAS-positive sclerotic nodules that compress glomerular capillaries and contribute to nodular glomerulosclerosis.[73][57]Mesangial cell hypercontractility further exacerbates glomerular hypertension in DKD, as hyperglycemia and mechanical strain from elevated intraglomerular pressure enhance contractility via vasoactive mediators like angiotensin II, reducing capillary surface area and intensifying hyperfiltration injury. This contractile dysfunction, coupled with ROS-mediated signaling, perpetuates a cycle of injury that impairs glomerular filtration and promotes proteinuria.[57][72]As DKD advances to sclerosis, mesangial cells undergo apoptosis driven by sustained oxidative stress and pathways such as PTEN/AKT dysregulation, leading to cell loss, irreversible fibrosis, and glomerular obsolescence; in patients with proteinuria, in type 1 diabetes the cumulative risk of progression to end-stage renal disease (ESRD) reaches approximately 50% within 10 years, while in type 2 diabetes the risk is lower, ranging from 3-11%.[74][75] Recent therapeutic advances include sodium-glucose cotransporter 2 (SGLT2) inhibitors like empagliflozin, which express in mesangial cells and mitigate fibrosis by blocking local glucose uptake, reducing ROS and inflammation, and attenuating TGF-β-driven matrix expansion, thereby slowing DKD progression independently of systemic glycemic control.[76][77]
IgA Nephropathy and Other Glomerular Diseases
In IgA nephropathy, the most common primary glomerulopathy worldwide, deposition of galactose-deficient IgA1-containing immune complexes in the mesangium activates mesangial cells, leading to their proliferation, cytokine release, and excessive extracellular matrix production.[78][79] This mesangial expansion impairs glomerular filtration and contributes to the hallmark clinical features of recurrent gross hematuria and persistent proteinuria, often progressing to chronic kidney disease if untreated.[80] A phase 3 clinical trial published in 2025 demonstrated that atacicept, a dual inhibitor of B-cell activating factors, significantly reduced proteinuria and hematuria in patients with IgA nephropathy by suppressing pathogenic IgA production and thereby attenuating mesangial inflammation.[81]Mesangial cells are also central to the pathology of other immune-mediated glomerular diseases. In lupus nephritis, particularly class II mesangial proliferative forms, immune complex deposition induces mesangial hypercellularity and matrix accumulation, exacerbating proteinuria and renal inflammation.[82][83]Membranoproliferative glomerulonephritis involves complement activation within the mesangium, often via the alternative pathway, which triggers mesangial proliferation and subendothelial deposits, leading to glomerular capillary wall thickening and hypocomplementemia.[84][85] In preeclampsia, maternal autoantibodies against the angiotensin II type 1 receptor (AT1-AA) bind to mesangial cells, stimulating secretion of interleukin-6 (IL-6) and plasminogen activator inhibitor-1 (PAI-1), which promote glomerular endotheliosis and systemic endothelial dysfunction.[86][87]Across these disorders, a shared mechanism involves overload of mesangial phagocytic capacity due to excessive immune complex uptake, resulting in oxidative stress, cytokine dysregulation, and direct cell injury that amplifies glomerular damage.[88][58] Additionally, extraglomerular mesangial cells, which interface with juxtaglomerular apparatus components, contribute to renin release dysregulation during inflammation, potentially exacerbating hypertension and renal hypoperfusion in these conditions.[89] Mesangial alterations, such as proliferation and matrix expansion, are observed in approximately 20-30% of primary glomerulopathies based on biopsy registries, underscoring their prevalence in non-diabetic glomerular injury.[90]