Michael S. Balzer @balzer-lab.org · Jan 8 Then came the immune system. Those CTSD⁺ distal cells were talking — loudly — to a specific macrophage population: TREM2⁺ resident macrophages. These macrophages were inflammatory, expanded in DKD, and shrank with enalapril treatment. This was epithelial–immune crosstalk, not collateral damage.
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Spatial transcriptomics sealed it. In human DKD kidneys, CTSD⁺ connecting tubules and TREM2⁺ macrophages sit next to each other. Not metaphorically. Physically. When disease is present, their neighborhood expands. When RAAS signaling is suppressed, that neighborhood quiets down. Context matters.