The activities of cell cycle regulatory proteins have been reported to be associated with the development of pathological lesions in glomerulonephritis. To assess the cellular mechanisms underlying the mesangial cell proliferation and glomerulosclerosis in progressive human IgA nephropathy (IgAN), we examined the expression of E2F1, Rb, c-Myc, proliferating cell nuclear antigen (PCNA), cyclins (D1, E and A), cyclindependent kinase 2 (CDK2) and CDK inhibitors (p21 waf1 , p27 kip1 , 57 kip2 and p16 ink4a ) by immunohistochemistry in renal biopsy specimens. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) was also performed to detect the presence of apoptosis. In total, 51 cases of IgAN were categorized into four subgroups according to histological severity. A dramatic upregulation of E2F1 expression in mesangial cells was identified in proliferating glomeruli, which correlated well with the proliferation index. High endogenous expression of p27 kip1 and p57 kip2 by podocytes in normal glomeruli and glomeruli with minor lesions was observed to decrease in proliferating and sclerosing glomeruli; this pattern displayed a strong inverse correlation with the mean glomerulosclerosis score and the index of glomerular lesion. Increased apoptotic activity was identified in progressive glomerular lesions of advanced IgAN, which correlated with the proliferative activity in these lesions as assessed by total expression levels of PCNA and CDK2 in glomeruli, E2F1 expression levels in the mesangium, cyclin D1 expression levels in endothelium and the c-Myc glomerular staining score. Our results suggest that the onset and magnitude of mesangial cell proliferation and glomerulosclerosis is associated with the upregulation of E2F1 by mesangial cells and the downregulation of p27 kip1 and p57 kip2 by glomerular epithelial cells. The cell type-specific and coordinated regulation of proliferative and proapoptotic activities of cell cycle regulatory proteins may play an important role in mediating progressive glomerular injury in human IgAN. Laboratory Investigation (2004) 84, 1112-1125, advance online publication, 21 June 2004 doi:10.1038/labinvest.3700144 Keywords: IgA nephropathy; cell cycle regulatory protein; mesangial cell proliferation; glomerulosclerosis; apoptosis Cell cycle regulatory proteins (CCPs) govern not only cellular hypertrophy and proliferation, but also cellular apoptosis and differentiation. Mounting evidence has emerged that indicates a close link between cell cycle regulation and the development of histopathological lesions in glomerular diseases. 1,2 In the experimental model of mesangial proliferative anti-Thy1.1 nephritis, increased expression of cyclins A, D1 and cyclin-dependent kinase 2 (CDK2) by mesangial cells in association with decreased high endogenous levels of CDK inhibitor (CKI) p27 kip1 by glomerular epithelial cells (GECs), were required for mesangial cell proliferation. [3][4][5] The increased glomerular activity of CDK2 could be inhibited by the CDK antagonist r...