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Tettevi EJ, Kuevi DNO, Sumabe BK, Simpong DL, Maina MB, Dongdem JT, Osei-Atweneboana MY, Ocloo A. In Silico Identification of a Potential TNF-Alpha Binder Using a Structural Similarity: A Potential Drug Repurposing Approach to the Management of Alzheimer's Disease. BIOMED RESEARCH INTERNATIONAL 2024; 2024:9985719. [PMID: 38221912 PMCID: PMC10787656 DOI: 10.1155/2024/9985719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/25/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
Introduction Alzheimer's disease (AD) is a neurodegenerative disorder with no conclusive remedy. Yohimbine, found in Rauwolfia vomitoria, may reduce brain inflammation by targeting tumour necrosis factor-alpha (TNFα), implicated in AD pathogenesis. Metoserpate, a synthetic compound, may inhibit TNFα. The study is aimed at assessing the potential utility of repurposing metoserpate for TNFα inhibition to reduce neuronal damage and inflammation in AD. The development of safe and effective treatments for AD is crucial to address the growing burden of the disease, which is projected to double over the next two decades. Methods Our study repurposed an FDA-approved drug as TNFα inhibitor for AD management using structural similarity studies, molecular docking, and molecular dynamics simulations. Yohimbine was used as a reference compound. Molecular docking used SeeSAR, and molecular dynamics simulation used GROMACS. Results Metoserpate was selected from 10 compounds similar to yohimbine based on pharmacokinetic properties and FDA approval status. Molecular docking and simulation studies showed a stable interaction between metoserpate and TNFα over 100 ns (100000 ps). This suggests a reliable and robust interaction between the protein and ligand, supporting the potential utility of repurposing metoserpate for TNFα inhibition in AD treatment. Conclusion Our study has identified metoserpate, a previously FDA-approved antihypertensive agent, as a promising candidate for inhibiting TNFα in the management of AD.
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Affiliation(s)
- Edward Jenner Tettevi
- Department of Biochemistry, Cell and Molecular Biology, School of Biological Science, University of Ghana, Legon, Accra, P.O. Box LG 25, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, School of Biological Science, University of Ghana, Legon, Accra, P.O. Box LG 25, Ghana
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra, P.O. Box M 32, Ghana
| | - Deryl Nii Okantey Kuevi
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra, P.O. Box M 32, Ghana
| | - Balagra Kasim Sumabe
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra, P.O. Box M 32, Ghana
| | - David Larbi Simpong
- Department of Medical Laboratory Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Mahmoud B. Maina
- Serpell Laboratory, Sussex Neuroscience, School of Life Sciences, University of Sussex, UK
- Biomedical Science Research and Training Centre, College of Medical Sciences, Yobe State University, Damaturu, Nigeria
| | - Julius T. Dongdem
- Department of Biochemistry and Molecular Medicine, School of Medicine, University for Development Studies, Tamale Campus, Ghana
| | - Mike Y. Osei-Atweneboana
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra, P.O. Box M 32, Ghana
- CSIR-College of Science and Technology, 2nd CSIR Close, Airport Residential Area, Behind Golden Tulip Hotel, Greater Accra Region, Ghana
| | - Augustine Ocloo
- Department of Biochemistry, Cell and Molecular Biology, School of Biological Science, University of Ghana, Legon, Accra, P.O. Box LG 25, Ghana
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Veronesi G, Guglielmo A, Gardini A, Sacchelli L, Loi C, Patrizi A, Bardazzi F. Biological therapy in patients with psoriasis: What we know about the effects on renal function. Dermatol Ther 2021; 35:e15202. [PMID: 34773435 DOI: 10.1111/dth.15202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 01/02/2023]
Abstract
Psoriasis is a chronic inflammatory dermatosis affecting 2%-3% of the general population. The link between psoriasis and renal dysfunction has been investigated, demonstrating a common pro-inflammatory pathogenesis. This study is aimed at evaluating renal function in patients with moderate-to-severe chronic plaque psoriasis treated with biological therapy. We analyzed 92 patients, correlating PASI and serum creatinine levels at baseline, after 6 months and after 1 year of continuous treatment with biological therapy. Data were analyzed using paired t-test and the linear mixed model for PASI and serum creatinine levels correlation, whereas the analysis of variances (ANOVA) was used for creatinine levels assessment between the baseline, the 6-months and, 1-year later evaluation. We observed a significant mean decrease in comparing serum creatinine levels after 1 year of biological therapy (p < 0.001). Interestingly, PASI reduction is correlated with creatinine decrease, and the renal function improvement is greater when complete psoriasis remission is attained. Our data suggest that a drop in systemic inflammation, secondary to biological therapy administration, might improve renal function. Future research is needed to confirm and expand our findings.
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Affiliation(s)
- Giulia Veronesi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alba Guglielmo
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aldo Gardini
- Department of Statistical Sciences 'P. Fortunati', University of Bologna, Bologna, Italy
| | - Lidia Sacchelli
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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3
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Angeletti A, Arrigo S, Madeo A, Molteni M, Vietti E, Arcuri L, Coccia MC, Gandullia P, Ghiggeri GM. Different renal manifestations associated with very early onset pediatric inflammatory bowel disease: case report and review of literature. BMC Nephrol 2021; 22:146. [PMID: 33888087 PMCID: PMC8061217 DOI: 10.1186/s12882-021-02358-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
Background Inflammatory bowel diseases are characterized by chronic inflammation of the gastrointestinal tract. In particular, Crohn disease and ulcerative colitis represent the two most common types of clinical manifestations. Extraintestinal manifestations of inflammatory bowel diseases represent a common complications, probably reflecting the systemic inflammation. Renal involvement is reported in 4–23% of cases. However, available data are limited to few case series and retrospective analysis, therefore the real impact of renal involvement is not well defined. Case presentation We report the case of a 10-years old male affected by very early onset unclassified-Inflammatory bowel diseases since he was 1-year old, presenting with a flare of inflammatory bowel diseases associated with acute kidney injury due to granulomatous interstitial nephritis. Of interest, at 7-year-old, he was treated for IgA nephropathy. To our knowledge, no previous reports have described a relapse of renal manifestation in inflammatory bowel diseases, characterized by two different clinical and histological phenotypes. Conclusions The link between the onset of kidney injuries with flares of intestinal inflammation suggest that nephritis maybe considered an extra-intestinal manifestation correlated with active inflammatory bowel disease. However, if granulomatous interstitial nephritis represents a cell-mediated hypersensitivity reaction than a true extraintestinal manifestation of inflammatory bowel diseases is still not clarified. We suggest as these renal manifestations here described may be interpreted as extraintestinal disorder and also considered as systemic signal of under treatment of the intestinal disease.
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Affiliation(s)
- A Angeletti
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - S Arrigo
- Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Madeo
- Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Molteni
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - E Vietti
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Arcuri
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M C Coccia
- Department of Pathology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - P Gandullia
- Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G M Ghiggeri
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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4
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Kim YN, Jung Y. [Renal and Urinary Manifestations of Inflammatory Bowel Disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:260-268. [PMID: 31132832 DOI: 10.4166/kjg.2019.73.5.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/03/2022]
Abstract
The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4-23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.
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Affiliation(s)
- Ye Na Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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5
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Morita K, Shibano T, Maekawa K, Hattori M, Hida N, Nakamura S, Takeshima Y. Crohn's disease following rituximab treatment in a patient with refractory nephrotic syndrome. CEN Case Rep 2019; 8:55-60. [PMID: 30251194 PMCID: PMC6361080 DOI: 10.1007/s13730-018-0364-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
Rituximab (RTX) is increasingly used for the treatment of refractory nephrotic syndrome due to its inhibitory effect on B cells which extends the period of remission, while lowering the dose of steroids needed for disease management. However, RTX can lead to various side effects, including Crohn's disease. Herein, we describe a case of a 15-year-old boy with refractory nephrotic syndrome diagnosed at age 9 years who developed Crohn's disease following RTX treatment. RTX was initiated in this patient at the age of 13 years 6 months due to occurrence of 12 relapses of nephrotic syndrome over a 4-year period, despite treatment using cyclosporine, steroid pulse therapy, and mycophenolate mofetil. The patient received 4 doses of RTX over a 2-year period (dose, 375 mg/m2). Although the treatment was effective in extending the disease-free duration up to 6 months, at the age of 15 years 9 months, the patient developed abdominal pain, associated with frequent watery stools and rapid weight loss. Based on clinical and endoscopic findings, he was diagnosed with Crohn's disease and treated using infliximab. Remission of Crohn's disease was achieved with this treatment, with no further relapse of nephrotic syndrome. Infliximab is thought to extend the remission period of nephrotic syndrome. In this case, we propose that Crohn's disease was caused by an abnormal immune tolerance, secondary to the use of RTX, although the exact underlying mechanism remains to be clarified. Therefore, inflammatory bowel disease should be considered if severe abdominal symptoms with weight loss following RTX administration are observed.
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Affiliation(s)
- Keishi Morita
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Takayuki Shibano
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kohei Maekawa
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masuji Hattori
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Hida
- Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shiro Nakamura
- Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
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Yarkan Tuğsal H, Zengin B, Kenar G, Can G, Ünlü M, Önen F, Birlik M. Infliximab-associated focal segmental glomerulosclerosis in a patient with ankylosing spondylitis. Rheumatol Int 2019; 39:561-567. [PMID: 30673815 DOI: 10.1007/s00296-019-04241-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 12/26/2022]
Abstract
The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of spondyloarthritis (SpA). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects ranging from common ones including infections to uncommon renal complications. This report describes a case of infliximab-induced focal segmental glomerulosclerosis (FSGS) in a 40-year-old female patient with ankylosing spondylitis (AS) who presented with asymptomatic proteinuria and microscopic hematuria. To the best of our knowledge, this is the second reported case of FSGS attributed to infliximab (IFX). A review of the English literature was conducted for cases of possible IFX-associated renal disorders in patients with SpA and SpA spectrum diseases. In this respect, the reported renal pathologies were IgA nephropathy, crescentic glomerulonephritis, acute renal artery occlusion, acute tubulointerstitial nephritis (ATIN), FSGS, and membranous glomerulopathy. Furthermore, partial or complete resolution was reported after cessation of therapy. In conclusion, although renal complications of TNF inhibitors (TNFi) are uncommon, spot urine evaluation may be recommended in the follow-up of patients treated with TNFi.
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Affiliation(s)
- Handan Yarkan Tuğsal
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - Berrin Zengin
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gökçe Kenar
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gerçek Can
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehtat Ünlü
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Fatoş Önen
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
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8
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Havmose M, Thomsen SF. Development of paradoxical inflammatory disorders during treatment of psoriasis with TNF inhibitors: a review of published cases. Int J Dermatol 2017; 56:1087-1102. [DOI: 10.1111/ijd.13691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/18/2017] [Accepted: 05/22/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Martin Havmose
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - Simon Francis Thomsen
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
- Department of Biomedical Sciences; University of Copenhagen; Copenhagen Denmark
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9
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Abstract
The prevalence of extraintestinal manifestations in inflammatory bowel diseases varies from 6% to 46%. The aetiology of extraintestinal manifestations remains unclear. There are theories based on an immunological response influenced by genetic factors. Extraintestinal manifestations can involve almost every organ system. They may originate from the same pathophysiological mechanism of intestinal disease, or as secondary complications of inflammatory bowel diseases, or autoimmune diseases susceptibility. The most frequently involved organs are the joints, skin, eyes, liver and biliary tract. Renal involvement has been considered as an extraintestinal manifestation and has been described in both Crohn's disease and ulcerative colitis. The most frequent renal involvements in patients with inflammatory bowel disease are nephrolithiasis, tubulointerstitial nephritis, glomerulonephritis and amyloidosis. The aim of this review is to evaluate and report the most important data in the literature on renal involvement in patients with inflammatory bowel disease. Bibliographical searches were performed of the MEDLINE electronic database from January 1998 to January 2015 with the following key words (all fields): (inflammatory bowel disease OR Crohn's disease OR ulcerative colitis) AND (kidney OR renal OR nephrotoxicity OR renal function OR kidney disease OR renal disease OR glomerulonephritis OR interstitial nephritis OR amyloidosis OR kidney failure OR renal failure) AND (5-aminosalicylic acid OR aminosalicylate OR mesalazine OR TNF-α inhibitors OR cyclosporine OR azathioprine OR drugs OR pediatric).
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Affiliation(s)
- Domenico Corica
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Claudio Romano
- Department of Pediatrics, University of Messina, Messina, Italy
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10
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Visconti L, Leonardi G, Buemi M, Santoro D, Cernaro V, Ricciardi CA, Lacquaniti A, Coppolino G. Kidney disease and psoriasis: novel evidences beyond old concepts. Clin Rheumatol 2015; 35:297-302. [DOI: 10.1007/s10067-015-3126-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
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Kaneko K, Tsuji S, Kimata T, Kitao T, Yamanouchi S, Kato S. Pathogenesis of childhood idiopathic nephrotic syndrome: a paradigm shift from T-cells to podocytes. World J Pediatr 2015; 11:21-8. [PMID: 25822700 DOI: 10.1007/s12519-015-0003-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nephrotic syndrome is the most common cause of kidney disease in children, but its pathogenesis remains unclear. This article reviews the novel aspects of the mechanisms underlying massive proteinuria in minimal-change disease, which is the most common form of childhood nephrotic syndrome. DATA SOURCES This article integrates the findings of a PubMed database search for English language articles published in the past 40 years (from September 1974 to February 2014) using the key words "pathogenesis", "minimal change nephrotic syndrome" or "idiopathic nephrotic syndrome". RESULTS Unknown humoral factors associated with T-cell dysfunction have been thought to play an important role in the pathogenesis of minimal-change disease. However, recent findings are changing this paradigm, i.e., visceral glomerular epithelial cells (podocytes) may be involved via expression of molecules such as CD80 and angiopoietin-like 4. CONCLUSIONS Recent evidence suggests that minimal-change disease results from interactions between humoral factors and dysfunctional podocytes. In addition to immunosuppressant drugs that target lymphocytes, a biological agent such as an antibody against the abnormal molecule(s) expressed by podocytes may provide novel drug treatment for minimal-change disease.
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Affiliation(s)
- Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan,
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12
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Yoo YJ, Chung SY, Gu DH, Ko GJ, Pyo HJ, Kwon YJ, Bak YT, Won NH. A Case of Late Onset-Acute Tubulointerstitial Nephritis with Infliximab and Mesalazine Treatment in a Patient with Crohn's Disease. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:308-12. [DOI: 10.4166/kjg.2014.63.5.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yang Jae Yoo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Yoon Chung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Hoe Gu
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Heui Jung Pyo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Tae Bak
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hee Won
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
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13
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Melgaço SSC, da Silva GB, Dantas AMM, Vasconcelos AMA, de Siqueira VR, Vieira APF, Daher EDF. Evaluation of renal function in patients with psoriasis using immunobiologicals. An Bras Dermatol 2013; 88:667-9. [PMID: 24068151 PMCID: PMC3760955 DOI: 10.1590/abd1806-4841.20132035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 08/17/2012] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate renal function in patients with psoriasis using immunobiologicals. A prospective study was conducted with 15 patients with confirmed diagnosis of psoriasis who were starting to use immunobiologicals. The mean age was 41 ± 11 years, with 60% females. The mean time of disease was 11 ± 6.6 years. Significant changes in creatinine and creatinine clearance were not observed in the course of the study. There was an increase in transaminases and a decrease in magnesium levels.
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Affiliation(s)
| | - Geraldo Bezerra da Silva
- Master's Degree in Medical Sciences at the Federal University of Ceará, Assistant Professor, University of Fortaleza - Fortaleza (CE), Brazil
| | | | - Ana Mirella Arcanjo Vasconcelos
- Medical Doctor, Dermatology Resident at the Walter Cantídio University Hospital, Federal University of Ceará - Fortaleza (CE),
Brazil
| | - Verônica Riquet de Siqueira
- Medical Doctor, Dermatology Resident at the Walter Cantídio University Hospital, Federal University of Ceará - Fortaleza (CE),
Brazil
| | | | - Elizabeth de Francesco Daher
- Doctorate in Nephrology from the University of São Paulo, Associate Professor, Department of Internal Medicine, Federal University of Ceará - Fortaleza (CE), Brazil
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Koya M, Pichler R, Jefferson JA. Minimal-change disease secondary to etanercept. Clin Kidney J 2012; 5:420-3. [PMID: 26019819 PMCID: PMC4432405 DOI: 10.1093/ckj/sfs081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 06/18/2012] [Indexed: 01/15/2023] Open
Abstract
Etanercept is a soluble tumor necrosis factor alpha (TNFα) receptor which is widely used in the treatment of rheumatoid arthritis, psoriasis and other autoimmune inflammatory disorders. It is known for its relative lack of nephrotoxicity; however, there are reports on the development of nephrotic syndrome associated with the treatment with TNFα antagonists. Here, we describe a patient with psoriasis who developed biopsy-proven minimal-change disease (MCD) shortly after initiating etanercept. Our case is unique in that the MCD resolved after discontinuation of this medication, notably without the use of corticosteroids, strongly suggesting a drug-related phenomenon.
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Affiliation(s)
- Mariko Koya
- Department of Internal Medicine , University of Washington , Seattle, WA , USA
| | - Raimund Pichler
- Department of Nephrology , University of Washington , Seattle, WA , USA
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Gordon J, Kopp JB. Off the beaten renin-angiotensin-aldosterone system pathway: new perspectives on antiproteinuric therapy. Adv Chronic Kidney Dis 2011; 18:300-11. [PMID: 21782136 DOI: 10.1053/j.ackd.2011.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/31/2011] [Accepted: 06/01/2011] [Indexed: 01/23/2023]
Abstract
CKD is a major public health problem in the developed and the developing world. The degree of proteinuria associated with renal failure is a generally well accepted marker of disease severity. Agents with direct antiproteinuric effects are highly desirable therapeutic strategies for slowing, or even halting, progressive loss of kidney function. We review progress on therapies acting further downstream of the renin-angiotensin-aldosterone system pathway (e.g., transforming growth factor-beta antagonism, endothelin antagonism) and on those acting independent of the renin-angiotensin-aldosterone system pathway. In all, we discuss 26 therapeutic targets or compounds and 2 lifestyle changes (dietary modification and weight loss) that have been used clinically for diabetic or nondiabetic kidney disease. These therapies include endogenous molecules (estrogens, isotretinoin), biologic antagonists (monoclonal antibodies, soluble receptors), and small molecules. Where mechanistic data are available, these therapies have been shown to exert favorable effects on glomerular cell phenotype. In some cases, recent work has indicated surprising new molecular pathways for some therapies, such as direct effects on the podocyte by glucocorticoids, rituximab, and erythropoietin. It is hoped that recent advances in the basic science of kidney injury will prompt development of more effective pharmaceutical and biologic therapies for proteinuria.
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16
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Oikonomou KA, Kapsoritakis AN, Stefanidis I, Potamianos SP. Drug-induced nephrotoxicity in inflammatory bowel disease. Nephron Clin Pract 2011; 119:c89-94; discussion c96. [PMID: 21677443 DOI: 10.1159/000326682] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Conservative management of inflammatory bowel disease (IBD) is based on a combination of drugs, including aminosalicylates (ASAs), steroids, antibiotics, immunosuppressives and biologic agents. Although various side effects have been related to treatment regimens, drug-induced nephrotoxicity is rather uncommon. Furthermore, it is often underestimated since renal function deterioration may be attributed to the underlying disease. The nephrotoxicity of ASAs and cyclosporine A seems well established, but recent data have suggested a possible role of biologic agents such as infliximab and adalimubab in renal impairment. The aim of this review is to summarize the nephrotoxic effects of medical treatment as well as to express possible caveats in the administration of novel agents in IBD.
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Oikonomou K, Kapsoritakis A, Eleftheriadis T, Stefanidis I, Potamianos S. Renal manifestations and complications of inflammatory bowel disease. Inflamm Bowel Dis 2011; 17:1034-45. [PMID: 20842645 DOI: 10.1002/ibd.21468] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 12/11/2022]
Abstract
Renal manifestations and complications are not rare in patients with inflammatory bowel disease (IBD) and may present as nephrolithiasis, amyloidosis, tubulointerstitial nephritis, and glomerulonephritis. Symptoms of renal impairment are not always specific and since the underlying bowel disease is preponderant, renal function deterioration may be underestimated. Additionally, medical treatment of patients with IBD such as aminosalicylates, cyclosporine, and tumor necrosis factor-α inhibitors can cause renal complications, although direct correlation to bowel disease is not always clear. The well-documented renal manifestations and complications of IBD, as well as the possible renal side effects of new drugs, emphasize the need for periodic evaluation of renal function. New markers of renal function may facilitate early diagnosis and unravel the complex mechanisms responsible for kidney damage. The purpose of this review is to summarize the renal manifestations and complications as well as the markers of renal function utilized in IBD, attempting to shed more light on the pathophysiology of renal damage in IBD.
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Affiliation(s)
- Konstantinos Oikonomou
- Department of Gastroenterology, University of Thessaly, School of Medicine, Larissa, Greece.
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Long-term remission of nephrotic syndrome with etanercept for concomitant juvenile idiopathic arthritis. Pediatr Nephrol 2010; 25:2175-7. [PMID: 20532801 DOI: 10.1007/s00467-010-1571-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/16/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
Etanercept is a tumor necrosis factor (TNF)-alpha inhibitor that has been applied beneficially for juvenile idiopathic arthritis (JIA). We experienced long-term remission of nephrotic syndrome (NS) in a boy treated with etanercept, which was initially used for concomitant JIA. He developed NS at age 3 years 7 months and had mostly been treated with cyclosporine because of steroid dependency and frequent relapses. Cyclosporine was halted at 10 years 7 months because of nephrotoxicity, and he was subsequently treated with mizoribine. However, he had three relapses in the first year and developed JIA at 11 years 7 months. He was treated with sulfasalazine, methotrexate, and prednisolone, but his arthritis persisted. Etanercept was started at 12 years 3 months. Thereafter, his arthritis went into complete remission. Surprisingly, he has remained relapse-free for both NS and JIA for more than 3 years with etanercept and mizoribine. It is difficult to know whether the NS remission after initiating etanercept was coincidental. However, there are many reports of increased TNF-alpha or soluble TNF-alpha receptor in NS relapse. To date, there are two reports of the efficacy of TNF-alpha inhibitors against NS. It is possible that TNF-alpha inhibitors may have potential as therapeutic agents for NS.
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Saougou I, Papagoras C, Markatseli TE, Voulgari PV, Drosos AA. A case report of a psoriatic arthritis patient on hemodialysis treated with tumor necrosis factor blocking agent and a literature review. Clin Rheumatol 2010; 29:1455-9. [DOI: 10.1007/s10067-010-1485-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 11/28/2022]
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A case report of nephrotic syndrome due to intake of certolizumab pegol in a patient with Crohn's disease. Am J Gastroenterol 2010; 105:234. [PMID: 20054326 DOI: 10.1038/ajg.2009.500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Joy MS, Gipson DS, Powell L, MacHardy J, Jennette JC, Vento S, Pan C, Savin V, Eddy A, Fogo AB, Kopp JB, Cattran D, Trachtman H. Phase 1 trial of adalimumab in Focal Segmental Glomerulosclerosis (FSGS): II. Report of the FONT (Novel Therapies for Resistant FSGS) study group. Am J Kidney Dis 2009; 55:50-60. [PMID: 19932542 DOI: 10.1053/j.ajkd.2009.08.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 08/17/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with primary focal segmental glomerulosclerosis (FSGS) resistant to current treatment regimens are at high risk of progression to end-stage kidney disease. Antifibrotic agents, such as tumor necrosis factor alpha antagonists, are a promising strategy to slow or halt the decline in renal function, based on preclinical and clinical data. STUDY DESIGN Phase 1 clinical trial to assess the pharmacokinetics, tolerability, and safety of adalimumab, a human monoclonal antibody to tumor necrosis factor alpha. SETTING & PARTICIPANTS 10 patients (4 male and 6 female) aged 16.8 +/- 9.0 years with an estimated glomerular filtration rate of 105 +/- 50 mL/min/1.73 m(2) were studied. INTERVENTION Adalimumab, 24 mg/m(2), every 14 days for 16 weeks (total, 9 doses). OUTCOMES Pharmacokinetic assessment, tolerability, and safety. MEASUREMENTS Estimated glomerular filtration rate, proteinuria, and pharmacokinetic assessment after initial dosing and steady state. RESULTS Pharmacokinetic evaluation indicated that the area under the curve was decreased by 54% (P < 0.001) and clearance was increased by 160% (P < 0.01) in patients with resistant FSGS compared with healthy controls and patients with rheumatoid arthritis. Adalimumab was well tolerated with no serious adverse events or infectious complications attributable to the drug. Proteinuria decreased by > or = 50% in 4 of 10 treated patients. LIMITATIONS Insufficient power to assess the safety or efficacy of adalimumab therapy for patients with resistant FSGS. CONCLUSIONS Pharmacokinetic assessment showed increased clearance of adalimumab in patients with resistant primary FSGS and validated the need to evaluate the disposition of novel therapies for this disease to define appropriate dosing regimens. The study provides a rationale to evaluate the efficacy of adalimumab as an antifibrotic agent for resistant FSGS in phase 2/3 clinical trials.
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Affiliation(s)
- Melanie S Joy
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Takeuchi T, Takegawa M, Ito Y, Kishi F, Miyamoto M, Minakata T. [Minimal change nephrotic syndrome developing in a rheumatoid arthritis patient under etanercept treatment]. ACTA ACUST UNITED AC 2008; 31:178-82. [PMID: 18587229 DOI: 10.2177/jsci.31.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 67-year-old female patient with rheumatoid arthritis (RA) developed minimal change nephrotic syndrome (MCNS) while under treatment with etanercept (ETN). Histopathological examination of renal biopsy specimens showed minimal-change nephropathy. Almost complete resolution of the MCNS was achieved by discontinuation of ETN and initiation of steroid therapy. There have been no reports from Japan of the occurrence of MCNS caused by ETN administration in RA patients, and only very few cases have been reported from around the world. Therefore, this case was considered to be very uncommon and worthy of reporting, and herein is a report of our patient.
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Affiliation(s)
- Takao Takeuchi
- Department of Clinical Immunology and Rheumatology, Osaka Red Cross Hospital, Japan
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Kuroda T, Otaki Y, Sato H, Fujimura T, Nakatsue T, Murakami S, Sakatsume M, Nakano M, Gejyo F. A case of AA amyloidosis associated with rheumatoid arthritis effectively treated with Infliximab. Rheumatol Int 2008; 28:1155-9. [PMID: 18496698 DOI: 10.1007/s00296-008-0590-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 05/03/2008] [Indexed: 11/25/2022]
Abstract
We report the case of a 55-year-old Japanese woman with reactive AA amyloidosis associated with rheumatoid arthritis, in which inflammatory disease was completely suppressed with infliximab. Nephrotic syndrome was observed and renal biopsy specimens revealed amyloidosis deposits. Treatment with infliximab normalized the serum amyloid A (SAA) protein level, and subsequently nephritic syndrome disappeared and her creatinine clearance improved. Serial gastrointestinal biopsy specimens showed marked lasting regression of amyloid deposits. Thus treatment with infliximab represents an important therapeutic strategy for AA amyloidosis associated with RA.
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Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata City 951-8510, Japan.
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Immunomodulators: interleukins, interferons, and IV immunoglobulin. CLINICAL NEPHROTOXINS 2008. [PMCID: PMC7120840 DOI: 10.1007/978-0-387-84843-3_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The outstanding progress in immunology and the development of new technologies have resulted in the introduction of new immunotherapies, the so-called “immunomodulators”, for autoimmune diseases, inflammatory disorders, allograft rejection, and cancer. These immunomodulators comprise recombinant cytokines and specific blocking or depleting antibodies. Many of these therapies achieve their effect by stimulating the release of cytokines. The term cytokines includes interleukins (IL-), chemokines, growth factors, interferons (IFN), colony stimulating factors (CSF), and tumor necrosis factors (TNF). These molecules are involved in inflammation, cell proliferation and apoptosis, tissue injury and repair. These new therapeutic tools can be associated with side effects among which nephrotoxicity. The most common immunomodulators associated with nephrotoxicity are described in Table 1. The nephrotoxic side effects of immunomodulators can be roughly divided into (ischemic) tubular necrosis, thrombotic microangiopathy, serum sickness, and autoimmune disorders.
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Hueber AJ, Tunc A, Schett G, Manger B. Anti-tumour necrosis factor alpha therapy in patients with impaired renal function. Ann Rheum Dis 2007; 66:981-2. [PMID: 17337474 PMCID: PMC1955094 DOI: 10.1136/ard.2006.069211] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Karie S, Launay-Vacher V, Izzedine H, Deray G. Néphrotoxicité des médicaments: veille bibliographique janvier 2003–décembre 2005. Nephrol Ther 2006; 2:368-78. [PMID: 17081959 DOI: 10.1016/j.nephro.2006.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Accepted: 07/20/2006] [Indexed: 01/19/2023]
Abstract
Drug-induced kidney injury is a major side effect in clinical practice. Renal injury associated with drugs may involve several components of the kidney: glomerulus, tubules, interstitium, and blood vessels. Acute renal failure may occur as a major reaction to many drugs. Moreover, therapeutic agents may induce an allergic reaction leading to interstitial inflammation and tubular damage. In this article, we present an updated version of the bibliography containing the case reports of nephrotoxicity published in the international literature from January 2003 to December 2005.
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Affiliation(s)
- Svetlana Karie
- ICAR, service de néphrologie, groupe hospitalier de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75015 Paris, France.
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