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Diaz Garcia JD. Diagnostic Usefulness of Antibodies Against M-type Phospholipase A2 Receptor (aPLA2R) in Primary Membranous Nephropathy in the Mexican Population. Cureus 2023; 15:e43588. [PMID: 37719622 PMCID: PMC10503780 DOI: 10.7759/cureus.43588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE This study aimed to determine the frequency and diagnostic performance of antibodies against M-type phospholipase A2 receptors (aPLA2R) in subjects with idiopathic membranous nephropathy (IMN). MATERIALS AND METHODS A diagnostic test study was conducted in a cohort of 160 patients from the nephrology outpatient clinic over a period of eight years. Serum samples were taken and analyzed from patients with a histological diagnosis of IMN with proteinuria greater than and less than 1 g in 24 hours and other glomerular diseases other than IMN with aPLA2R measurement by enzyme-linked immunosorbent assay (ELISA) (Euroimmun, Luebeck, Germany). RESULTS In 22 of 160 patients, an aPLA2R concentration >9 RU/mL was found, and all these cases had IMN. The prevalence of seropositivity in cases with active IMN was 78% (21/27). All these correlations were statistically significant with a p<0.001. The area under the receiver operating characteristic (ROC) curve (AB-ROC) of aPLA2R was 0.87 (95%, CI: 78-0.96). CONCLUSIONS The aPLA2R has adequate diagnostic usefulness to diagnose IMN in the selected population, especially in subjects with proteinuria greater than 1 gr/day, with a sensitivity of 78% and a specificity of 99%.
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Perna A, Ruggiero B, Podestà MA, Perico L, Orisio S, Debiec H, Remuzzi G, Ruggenenti P. Sexual dimorphic response to rituximab treatment: A longitudinal observational study in a large cohort of patients with primary membranous nephropathy and persistent nephrotic syndrome. Front Pharmacol 2022; 13:958136. [PMID: 36120314 PMCID: PMC9479107 DOI: 10.3389/fphar.2022.958136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Rituximab is one of the first-line therapies for patients with membranous nephropathy (MN) at high risk of progression towards kidney failure. We investigated whether the response to Rituximab was affected by sex and anti-PLA2R antibody levels in 204 consecutive patients (148 males and 56 females) with biopsy-proven MN who were referred to the Nephrology Unit of the Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII from March 2001 to October 2016 and managed conservatively for at least 6 months. The primary outcome was a combined endpoint of complete (proteinuria <0.3 g/24 h) or partial (proteinuria <3.0 g/24 h and >50% reduction vs. baseline) remission. Patients gave written informed consent to Rituximab treatment. The study was internally funded. No pharmaceutical company was involved. Anti-PLA2R antibodies were detectable in 125 patients (61.3%). At multivariable analyses, female gender (p = 0.0198) and lower serum creatinine levels (p = 0.0108) emerged as independent predictors of better outcome (p = 0.0198). The predictive value of proteinuria (p = 0.054) and anti-PLA2R titer (p = 0.0766) was borderline significant. Over a median (IQR) of 24.8 (12.0–36.0) months, 40 females (71.4%) progressed to the combined endpoint compared with 73 males (49.3%). Anti-PLA2R titers at baseline [127.6 (35.7-310.8) vs. 110.1 (39.9–226.7) RU/ml] and after Rituximab treatment were similar between the sexes. However, the event rate was significantly higher in females than in males [HR (95%): 2.12 (1.44–3.12), p = 0.0001]. Forty-five of the 62 patients (72.3%) with anti-PLA2R titer below the median progressed to the combined endpoint versus 35 of the 63 (55.6%) with higher titer [HR (95%): 1.97 (1.26–3.07), p < 0.0029]. The highest probability of progressing to the combined endpoint was observed in females with anti-PLA2R antibody titer below the median (86.7%), followed by females with anti-PLA2R antibody titer above the median (83.3%), males with titer below the median (68.1%), and males with titer above the median (44.4%). This trend was statistically significant (p = 0.0023). Similar findings were observed for complete remission (proteinuria <0.3 g/24 h) and after analysis adjustments for baseline serum creatinine. Thus, despite similar immunological features, females were more resilient to renal injury following Rituximab therapy. These findings will hopefully open new avenues to identify the molecular pathways underlying sex-related nephroprotective effects.
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Affiliation(s)
- Annalisa Perna
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Barbara Ruggiero
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Manuel Alfredo Podestà
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy
| | - Luca Perico
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Silvia Orisio
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Hanna Debiec
- Sorbonne Université and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, Paris, France
| | - Giuseppe Remuzzi
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
- *Correspondence: Giuseppe Remuzzi,
| | - Piero Ruggenenti
- Department of Renal Medicine, Centro di Ricerche Cliniche Aldo e Cale Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
- Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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Bobart SA, Han H, Tehranian S, De Vriese AS, Roman JCL, Sethi S, Zand L, Andrades Gomez C, Giesen CD, Soler MJ, Bomback AS, Fervenza FC. Noninvasive Diagnosis of PLA2R-Associated Membranous Nephropathy: A Validation Study. Clin J Am Soc Nephrol 2021; 16:1833-1839. [PMID: 34782349 PMCID: PMC8729491 DOI: 10.2215/cjn.05480421] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidney biopsy is the current gold standard to diagnose membranous nephropathy. Approximately 70%-80% of patients with primary membranous nephropathy have circulating anti-phospholipase A2 receptor antibodies. We previously demonstrated that in proteinuric patients with preserved eGFR and absence of associated conditions (e.g., autoimmunity, malignancy, infection, drugs, and paraproteinemia), a positive anti-phospholipase A2 receptor antibody test by ELISA and immunofluorescence assay confirms the diagnosis of membranous nephropathy noninvasively. These data have not been externally validated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The clinical and pathologic characteristics of patients with a positive anti-phospholipase A2 receptor antibody test at the Mayo Clinic, the University Hospital Vall D'Hebron (Barcelona), and the Columbia University Medical Center (New York) were retrospectively reviewed. Biopsy findings and presence or absence of a potential associated condition were assessed. RESULTS From a total of 276 patients with positive anti-phospholipase A2 receptor serology, previously reported patients (n=33), kidney transplant recipients (n=9), pediatric patients (n=2), and patients without kidney biopsy (n=69) were excluded. Among the 163 remaining patients, associated conditions were identified in 47 patients, and 15 patients had diabetes mellitus. All 101 patients of the final cohort had a primary diagnosis of membranous nephropathy on kidney biopsy. In the 79 patients with eGFR≥60 ml/min per 1.73 m2, none of the biopsy findings altered diagnosis or management. Among the 22 patients with decreased eGFR, additional findings included superimposed acute interstitial nephritis (n=1). CONCLUSIONS In patients with preserved eGFR and absence of associated conditions or diabetes, a positive anti-phospholipase A2 receptor test by either ELISA >20 RU/ml or a positive immunofluorescence assay confirms the diagnosis of membranous nephropathy, precluding the requirement for a kidney biopsy.
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Affiliation(s)
- Shane A. Bobart
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Nephrology and Hypertension, Cleveland Clinic Florida, Weston, Florida
| | - Heedeok Han
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Shahrzad Tehranian
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - An S. De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Callen D. Giesen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Maria Jose Soler
- Nephrology Department, University Hospital Vall D’Hebron, Barcelona, Spain
| | - Andrew S. Bomback
- Division of Nephrology, Columbia University Medical Center, New York, New York
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Spain RI, Andeen NK, Gibson PC, Samuels MH, Morris CD, Solomon AJ, Solomon R, Waslo C, Avasare RS. Lipoic acid supplementation associated with neural epidermal growth factor-like 1 (NELL1)-associated membranous nephropathy. Kidney Int 2021; 100:1208-1213. [PMID: 34662650 DOI: 10.1016/j.kint.2021.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 12/13/2022]
Abstract
Lipoic acid (alpha lipoic acid, thioctic acid) is a popular over-the-counter antioxidant and insulin-mimetic supplement under investigation in a variety of conditions including multiple sclerosis, diabetes, and schizophrenia. Unfortunately, high-grade proteinuria was an unexpected adverse event specific to the treatment arm of our clinical trial investigating lipoic acid supplementation in patients with multiple sclerosis. This observation led to detection of similar patients in our nephrology practice. Here, we describe four biopsy-proven cases of neural epidermal growth factor-like 1 (NELL1)-associated membranous nephropathy following lipoic acid supplementation and a fifth suspected case. Discontinuation of lipoic acid and supportive therapy resulted in remission.
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Affiliation(s)
- Rebecca I Spain
- Neurology Division, Portland VA Medical Center, Portland, Oregon, USA.
| | - Nicole K Andeen
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Pamela C Gibson
- Department of Pathology and Larboratory Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mary H Samuels
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Cynthia D Morris
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Richard Solomon
- Division of Nephrology and Hypertension, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Carin Waslo
- Research Division, Portland VA Medical Center, Portland, Oregon, USA
| | - Rupali S Avasare
- Department of Medicine, Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA
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Luo J, Zhang W, Su C, Zhou Z, Wang G. Seropositive PLA2R-associated membranous nephropathy but biopsy-negative PLA2R staining. Nephrol Dial Transplant 2020; 36:2216-2223. [PMID: 33236093 DOI: 10.1093/ndt/gfaa239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Serum phospholipase A2 receptor (PLA2R) antibody (SAb) and glomerular deposits of PLA2R antigen (GAg) have been tested widely in idiopathic membranous nephropathy (MN). Recently, we noticed a special form of PLA2R-associated MN with positive circulating PLA2R antibody but negative PLA2R deposits in the glomeruli by immunofluorescence on frozen tissue (IF-F). The significance of this form of PLA2R-associated MN is yet to be elucidated. This study aimed to explore the clinicopathological features of these PLA2R-associated MN patients. METHODS This study enrolled 229 biopsy-proven PLA2R-associated MN patients with SAb+. SAb was measured by enzyme-linked immunosorbent assay, and GAg was detected by IF-F. These patients were divided into SAb+/GAg+ and SAb+/GAg- groups. Clinicopathological characteristics of SAb+/GAg+ and SAb+/GAg- PLA2R-associated MN patients were compared. PLA2R antigens of 19 SAb+/GAg- PLA2R-associated MN patients were verified by immunohistochemistry on paraffin tissue (IHC-P). RESULTS Among 229 SAb+ PLA2R-associated MN patients, 210 (91.70%) were GAg+ and 19 (8.3%) were GAg-. These 19 SAb+/GAg- PLA2R-associated MN patients presented positive PLA2R deposits by IHC-P. Compared with SAb+/GAg+ PLA2R-associated MN patients, SAb+/GAg- PLA2R-associated MN patients had higher levels of serum PLA2R antibody (P = 0.004), increased proteinuria (P = 0.008), lower serum albumin (P = 0.019), more prominent chronic pathological lesions in terms of glomerulosclerosis score (P = 0.025), interstitial fibrosis score (P = 0.016), tubular atrophy score (P = 0.010) and total renal chronicity score (P = 0.010), and were more likely to be accompanied by focal segmental glomerulosclerosis (P = 0.014). Higher SAb level was associated with the total renal chronicity score (odds ratio per 100 RU/mL, 1.16; 95% confidence interval 1.01-1.33; P = 0.033). CONCLUSIONS PLA2R-associated MN patients with seropositive PLA2R antibody but negative PLA2R deposits in the glomeruli by IF-F have higher levels of SAb and worse clinicopathological manifestations compared with their double-positive counterparts. IHC-P can be an alternative technique to reveal PLA2R glomerular deposits.
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Affiliation(s)
- Jiao Luo
- Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Wang Zhang
- Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Cailing Su
- Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Zhanmei Zhou
- Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Guobao Wang
- Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
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Huang B, Yang X, Zhang W, Wu J, Liu P, Hu Z, Wang T. Receptor antibody time-resolved A2 phospholipase bead immunochromatography and its application in idiopathic membranous nephropathy. J Clin Lab Anal 2020; 34:e23508. [PMID: 32767448 PMCID: PMC7755819 DOI: 10.1002/jcla.23508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To detect phospholipase A2 receptor (PLA2R) antibody by established time-resolved fluorescent bead immunochromatographic assay. METHODS The reaction time of coupling, pH of the reaction, and coupling ratio of the label to PLA2R were determined. The EDC method was used to covalently couple PLA2R to time-resolved fluorescent beads, which were sprayed onto a bonding pad. PLA2R and rabbit anti-PLA2R antibody sprayed onto a nitrocellulose membrane were used as detection and quality control lines, respectively. Immunochromatographic test strips were prepared to enable rapid detection of PLA2R antibodies. Various technical indicators were evaluated, and the correlation among this method, enzyme-linked immunosorbent assay (ELISA), and serum analysis was examined. RESULTS The pH suitable for labeling was 6.5. The optimal mass ratio of PLA2R protein to fluorescent beads was 0.08:1, and the reaction time of coupling was at least 1.5 hours. The appropriate spray film size of the coupled fluorescent bead was 5 μL/cm, and the appropriate staining concentration of the test line was 0.28 mg/mL. Further, 80 µL of sample was required for the test, and the result was obtained in only 15 minutes. The measurable range of this method was 5-1500 RU/mL. Intra- and inter-assay coefficients of variation were 7.61% and 11.07%, respectively, with an average recovery rate of 93.77%. The method showed a good correlation with ELISA, with a correlation coefficient of 0.936. CONCLUSIONS This method could better meet the clinical demand for idiopathic membranous nephropathy (IMN) detection.
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Affiliation(s)
- Biao Huang
- College of Life Sciences and MedicineZhejiang Sci‐Tech UniversityHangzhouChina
| | - Xue Yang
- The Affiliated Wuxi Children's Hospital of Nanjing Medical UniversityWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiChina
| | - Wenchen Zhang
- The Affiliated Wuxi Children's Hospital of Nanjing Medical UniversityWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiChina
| | - Jian Wu
- The First People's Hospital of Yancheng CityYanchengChina
| | - Pengfei Liu
- The Jiangyin Clinical College of Xuzhou Medical UniversityJiangyinChina
| | - Zhigang Hu
- The Affiliated Wuxi Children's Hospital of Nanjing Medical UniversityWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiChina
| | - Tingting Wang
- The Affiliated Wuxi Children's Hospital of Nanjing Medical UniversityWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiChina
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Prognostic value of phospholipase A2 receptor in primary membranous nephropathy: a systematic review and meta-analysis. Int Urol Nephrol 2019; 51:1581-1596. [PMID: 31140029 DOI: 10.1007/s11255-019-02147-9] [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: 11/13/2018] [Accepted: 04/10/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to evaluate the prognostic value of serum anti-PLA2R and glomerular PLA2R deposit (gPLA2R) in predicting remission of proteinuria in Primary Membranous Nephropathy (PMN) patients. METHODS PUBMED, EMBASE, WEB OF SCIENCE, COCHRANE LIBRARY and CNKI were searched from 2008 January to December 2018. Heterogeneity was assessed by Cochran Q test and I2. Source of heterogeneity was explored by subgroup analysis and sensitivity analysis. RESULTS Totally 2345 patients from 29 cohort studies were eligible for inclusion. The results suggested that PMN patients with negative anti-PLA2R at the time of biopsy had a 1.31 times (95% CI 1.12-1.46, p < 0.05) higher possibility in achieving remission than those with positive anti-PLA2R. The clearance of anti-PLA2R at the end of immunosuppressive therapy showed an even greater chance of achieving remission (RR = 2.86, 95% CI 1.75-4.69, p < 0.05). The relative ratios for complete remission and spontaneous remission with negative anti-PLA2R were 1.65 (95% CI 1.46-1.87, p < 0.05) and 1.93, respectively (95% CI 1.53-2.45, p < 0.05), and heterogeneity percentages were I2 = 18% and 46%, respectively. The possibility for remission was significantly greater among PMN patients with negative gPLA2R (RR = 1.30, 95% CI 1.13-1.50, p < 0.05). Subgroup analyses revealed that retrospective design of study might be the potential source of heterogeneity. CONCLUSIONS Negative anti-PLA2R or gPLA2R might predict higher possibility of remission, and the presence of anti-PLA2R or gPLA2R might serve as a useful biomarker for clinical outcome and predicting response to immunosuppressive therapy in PMN.
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Gentile G, Remuzzi G. Novel Biomarkers for Renal Diseases? None for the Moment (but One). SLAS DISCOVERY 2016; 21:655-670. [DOI: 10.1177/1087057116629916] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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9
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Radice A, Trezzi B, Maggiore U, Pregnolato F, Stellato T, Napodano P, Rolla D, Pesce G, D'Amico M, Santoro D, Londrino F, Ravera F, Ortisi G, Sinico RA. Clinical usefulness of autoantibodies to M-type phospholipase A2 receptor (PLA2R) for monitoring disease activity in idiopathic membranous nephropathy (IMN). Autoimmun Rev 2015; 15:146-54. [PMID: 26527329 DOI: 10.1016/j.autrev.2015.10.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
Autoantibodies to M-type phospholipase A2 receptor (PLA2R) are specific markers of idiopathic membranous nephropathy (IMN). They can differentiate IMN from other glomerular diseases and primary from secondary forms of MN. Preliminary data suggest that anti-PLA2R antibody titer correlates with disease activity but more solid evidence is needed. To evaluate the performance of anti-PLA2R antibody for monitoring nephropathy activity, 149 anti-PLA2R antibody measurements were performed during the follow-up of 42 biopsy proven IMN consecutive patients. Patients were enrolled either at time of diagnosis (33 cases, inception cohort) or after diagnosis (9 patients, non-inception cohort). Anti-PLA2R detection was performed using the highly sensitive transfected cell-based indirect immunofluorescence (IIFT). Over the follow-up there was a linear time-trend of decreasing proteinuria (P<0.001), increasing serum albumin (P<0.001) and decreasing PLA2R antibody levels (P=0.002). There was a statistically significant association between changes in PLA2R antibody levels and the clinical course of PLA2R-positive IMN. The positive PLA2R serum antibody status was linearly associated with increasing proteinuria and decreasing serum albumin over time, compared with negative antibody status. Moreover, the strong correlation between the clinical conditions and PLA2R antibody levels allowed the prediction of prevalence distribution of patients with active disease, partial and complete remission. Over the course of the follow-up, the probability of halving proteinuria increased 6.5 times after disappearance of PLA2R antibodies. Our data suggest that the serial evaluation of anti-PLA2R antibodies could help in optimal timing and duration of the immunosuppressive therapy, reducing over(under)-treatment and associated side-effects.
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Affiliation(s)
- Antonella Radice
- Microbiology and Virology Department, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Barbara Trezzi
- Clinical Immunology & Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy; Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Umberto Maggiore
- Nephrology & Transplant, Maggiore Hospital Parma University, Italy.
| | | | | | | | | | | | | | | | | | | | - Giuseppe Ortisi
- Microbiology and Virology Department, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Renato Alberto Sinico
- Clinical Immunology & Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy; Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy.
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Caster DJ, Hobeika L, Klein JB, Powell DW, McLeish KR. Changing the concepts of immune-mediated glomerular diseases through proteomics. Proteomics Clin Appl 2015; 9:967-71. [PMID: 25907758 DOI: 10.1002/prca.201400159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/01/2015] [Accepted: 04/21/2015] [Indexed: 01/27/2023]
Abstract
Standard classification of glomerular diseases is based on histopathologic abnormalities. The recent application of proteomic technologies has resulted in paradigm changes in the understanding and classification of idiopathic membranous nephropathy and membranoproliferative glomerulonephritis. Those examples provide evidence that proteomics will lead to advances in understanding of the molecular basis of other glomerular diseases, such as lupus nephritis. Proof of principle experiments show that proteomics can be applied to patient renal biopsy specimens. This viewpoint summarizes the advances in immune-mediated glomerular diseases that have relied on proteomics, and potential future applications are discussed.
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Affiliation(s)
- Dawn J Caster
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA
| | - Liliane Hobeika
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jon B Klein
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA
| | - David W Powell
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kenneth R McLeish
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA
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11
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Ruggenenti P, Debiec H, Ruggiero B, Chianca A, Pellé T, Gaspari F, Suardi F, Gagliardini E, Orisio S, Benigni A, Ronco P, Remuzzi G. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy. J Am Soc Nephrol 2015; 26:2545-58. [PMID: 25804280 DOI: 10.1681/asn.2014070640] [Citation(s) in RCA: 234] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/28/2014] [Indexed: 11/03/2022] Open
Abstract
Rituximab induces nephrotic syndrome (NS) remission in two-thirds of patients with primary membranous nephropathy (MN), even after other treatments have failed. To assess the relationships among treatment effect, circulating nephritogenic anti-phospholipase A2 receptor (anti-PLA2R) autoantibodies and genetic polymorphisms predisposing to antibody production we serially monitored 24-hour proteinuria and antibody titer in patients with primary MN and long-lasting NS consenting to rituximab (375 mg/m(2)) therapy and genetic analyses. Over a median (range) follow-up of 30.8 (6.0-145.4) months, 84 of 132 rituximab-treated patients achieved complete or partial NS remission (primary end point), and 25 relapsed after remission. Outcomes of patients with or without detectable anti-PLA2R antibodies at baseline were similar. Among the 81 patients with antibodies, lower anti-PLA2R antibody titer at baseline (P=0.001) and full antibody depletion 6 months post-rituximab (hazard ratio [HR], 7.90; 95% confidence interval [95% CI], 2.54 to 24.60; P<0.001) strongly predicted remission. All 25 complete remissions were preceded by complete anti-PLA2R antibody depletion. On average, 50% anti-PLA2R titer reduction preceded equivalent proteinuria reduction by 10 months. Re-emergence of circulating antibodies predicted disease relapse (HR, 6.54; 95% CI, 1.57 to 27.40; P=0.01), whereas initial complete remission protected from the event (HR, 6.63; 95% CI, 2.37 to 18.53; P<0.001). Eighteen patients achieved persistent antibody depletion and complete remission and never relapsed. Outcome was independent of PLA2R1 and HLA-DQA1 polymorphisms and of previous immunosuppressive treatment. Therefore, assessing circulating anti-PLA2R autoantibodies and proteinuria may help in monitoring disease activity and guiding personalized rituximab therapy in nephrotic patients with primary MN.
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Affiliation(s)
- Piero Ruggenenti
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and Unit of Nephrology, Azienda Ospedaliera Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Hanna Debiec
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR_S1155, Paris, France; Sorbonne Universités, Universitè Pierre and Marie Curie University, Paris 06, Paris, France; and
| | | | | | - Timothee Pellé
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR_S1155, Paris, France; Sorbonne Universités, Universitè Pierre and Marie Curie University, Paris 06, Paris, France; and
| | - Flavio Gaspari
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and
| | - Flavio Suardi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and
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- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and
| | - Ariela Benigni
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and
| | - Pierre Ronco
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR_S1155, Paris, France; Sorbonne Universités, Universitè Pierre and Marie Curie University, Paris 06, Paris, France; and Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Dialysis, Tenon Hospital, Paris, France
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, and Unit of Nephrology, Azienda Ospedaliera Ospedale Papa Giovanni XXIII, Bergamo, Italy;
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Jiang S, Wang Y, Liu Z. The application of urinary proteomics for the detection of biomarkers of kidney diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 845:151-65. [PMID: 25355578 DOI: 10.1007/978-94-017-9523-4_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Urine is a biological material that can be easily obtained in the clinic. The identification of proteins excreted in urine provides useful biological information about the kidney as well as a unique opportunity to examine physiological and pathological changes in the kidney in a noninvasive manner. Recent technological advances in urinary proteomic profiling have provided the foundation for a number of urinary proteomic studies directed at identifying markers of kidney disease diagnosis, prognosis, or responsiveness to therapy. In this review, we describe the strengths of different urinary proteomic methods for the discovery of potential biomarkers of kidney diseases. We also highlight the limitations and future goals of these approaches.
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Affiliation(s)
- Song Jiang
- National Kidney Disease Clinical Research Center, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Ardalan M, Ghafari A, Hamzavi F, Nasri H, Baradaran B, Majidi J, Nikbin B. Anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy: A report from Iranian population. J Nephropathol 2013; 2:241-8. [PMID: 24475456 DOI: 10.12860/jnp.2013.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 12/28/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Idiopathic Membranous Nephropathy (iMN) is the most common cause of nephrotic syndrome in adults. Approximately one third of patients with iMN progress to end-stage renal disease. Anti-phospholipase A2-receptor (anti-PLA2R) antibodies are present in patients with iMN and appear to play a role in the pathogenesis of iMN. OBJECTIVES In this study, we explored the prevalence of anti-PLA2R antibodies in a cohort of patients with iMN in Iran. We also sought to determine circulating levels of anti-secretory PLA2 (anti-sPLA2) antibodies in those with anti-PLA2R antibodies. PATIENTS AND METHODS Using an indirect immunofluorescence assay, we measured anti-PLA2R antibodies in a group of patients with iMN in Iran. The serum levels of anti-sPLA2 antibodies were also measured in those with positive results for anti-PLA2R antibodies. RESULTS We studied 23 patients with iMN (M/F 12/11, 34±9.8 year), two patients with secondary MN and five patients with the nephrotic syndrome of other causes.Anti-PLA2R antibodies were detected in 17/23 (74%) of patients with iMN, but not in those with secondary MN or other forms of primary glomerular diseases. We found no correlation between anti-PLA2R antibody titer and the degree of proteinuria. We found high titers of anti-sPLA2 antibodies in a subset of patients with high levels of anti-PLA2R antibodies. CONCLUSIONS Anti-PLA2R antibodies are specific for iMN. Proteinuria may also reflect glomerular structural damage rather than immunological activity of the disease. The preliminary idea of any presumptive role of anti-sPLA2antibodies in iMN needs further investigation.
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Affiliation(s)
- Mohammadreza Ardalan
- DrugApplied Research and 2Chronic kidney disease research center, Tabriz University of Medical Sciences.Tabriz, Iran.
| | - Ali Ghafari
- Department of Nephrology, Urmia University of medical sciences, Urmia, Iran
| | - Fatemeh Hamzavi
- ; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Nasri
- Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Science, Isfahan, Iran
| | - Behrooz Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Majidi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Nikbin
- Immunogenetic research center, Department of Immunology, Tehran University of Medical Science, Tehran, Iran
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Abstract
Our understanding of the pathogenesis of most primary glomerular diseases, including IgA nephropathy, membranous nephropathy and focal segmental glomerulosclerosis, is limited. Advances in molecular technology now permit genome-wide, high-throughput characterization of genes and gene products from biological samples. Comprehensive examinations of the genome, transcriptome, proteome and metabolome (collectively known as omics analyses), have been applied to the study of IgA nephropathy, membranous nephropathy and focal segmental glomerulosclerosis in both animal models and human patients. However, most omics studies of primary glomerular diseases, with the exception of large genomic studies, have been limited by inadequate sample sizes and the lack of kidney-specific data sets derived from kidney biopsy samples. Collaborative efforts to develop a standardized approach for prospective recruitment of patients, scheduled monitoring of clinical outcomes, and protocols for sampling of kidney tissues will be instrumental in uncovering the mechanisms that drive these diseases. Integration of molecular data sets with the results of clinical and histopathological studies will ultimately enable these diseases to be characterized in a comprehensive and systematic manner, and is expected to improve the diagnosis and treatment of these diseases.
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Ardalan M. Triggers, bullets and targets, puzzle of membranous nephropathy. Nephrourol Mon 2012; 4:599-602. [PMID: 23573498 PMCID: PMC3614303 DOI: 10.5812/numonthly.2330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 10/13/2011] [Accepted: 10/25/2011] [Indexed: 01/25/2023] Open
Abstract
Introduction Idiopathic Membranous Nephropathy (MN) is a common cause of adult nephrotic syndrome. Recently, M-type phospholipase A2 receptor (PLA2-R) has been discovered as the main podocyte antigen in the pathogenesis of idiopathic MN. Materials and Methods In this mini review, the author searched English-language MEDLINE for the terms “membranous nephropathy”, “rituximab”, and “phospholipase A2 receptor” up to October 2011. Results In support of its earlier discovery, reports from China and Europe confirmed the major pathogenic role of non-complement fixing IgG4 antibody against PLA2-R in the pathogenesis of idiopathic MN. Antibodies against aldose reductase (AR) and manganese superoxide dismutase (SOD2 ), and sub-epithelial deposition of cationic bovine serum albumin (BSA) are also reported in rare occasions. It seems that Rituximab is a good therapeutic choice for those patients who need immunosuppressive therapy. Conclusions Great discoveries in the diagnosis and treatment of idiopathic MN have been performed but pathogenic mechanism and triggers for anti-PLA2-R production are still unknown.
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Affiliation(s)
- Mohammadreza Ardalan
- Nephrology Department, Tabriz University of Medical sciences, Tabriz, IR Iran
- Mario NegriInstitute of Pharmacological Research, Bergamo, Italy
- Corresponding author: Mohammadreza Ardalan, 1) Nephrology Department, Tabriz University of Medical sciences, Tabriz, IR Iran. 2) Mario NegriInstitute of Pharmacological Research, Bergamo, Italy. Tel.: +98-4113344339, Fax: +98-4113344280, E-mail:
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Ruggenenti P, Cravedi P, Chianca A, Perna A, Ruggiero B, Gaspari F, Rambaldi A, Marasà M, Remuzzi G. Rituximab in idiopathic membranous nephropathy. J Am Soc Nephrol 2012; 23:1416-25. [PMID: 22822077 DOI: 10.1681/asn.2012020181] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Selective depletion of B cells with the mAb rituximab may benefit the autoimmune glomerular disease idiopathic membranous nephropathy (IMN). Here, we describe our experience treating 100 consecutive IMN patients with persistent nephrotic syndrome with rituximab. We defined complete remission as persistent proteinuria <0.3 g/24 h and partial remission as persistent proteinuria <3 g/24 h, each also having >50% reduction in proteinuria from baseline. During a median follow-up of 29 months after rituximab administration, 65 patients achieved complete or partial remission. The median time to remission was 7.1 months. All 24 patients who had at least 4 years of follow-up achieved complete or partial remission. Rates of remission were similar between patients with or without previous immunosuppressive treatment. Four patients died and four progressed to ESRD. Measured GFR increased by a mean 13.2 (SD 19.6) ml/min per 1.73 m(2) among those who achieved complete remission. Serum albumin significantly increased and albumin fractional clearance decreased among those achieving complete or partial remission. Proteinuria at baseline and the follow-up duration each independently predicted the decline of proteinuria. Furthermore, the magnitude of proteinuria reduction significantly correlated with slower GFR decline (P=0.0001). No treatment-related serious adverse events occurred. In summary, rituximab achieved disease remission and stabilized or improved renal function in a large cohort of high-risk patients with IMN.
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Affiliation(s)
- Piero Ruggenenti
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Italy
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Abstract
Antibodies to neutral endopeptidase, a podocyte protein, are responsible for rare alloimmune neonatal membranous nephropathy that develops in children from neutral endopeptidase-deficient mothers. Neutral endopeptidase was the first podocyte antigen described in human membranous nephropathy. PLA2R1, the type-M receptor of soluble phospholipase A2, is a major target antigen in so-called idiopathic membranous nephropathy in adults. Antibodies to PLA2R1 are detected in 60 to 80% of patients before immunosuppressive treatment, and are only occasionally found in secondary membranous nephropathy. To date, they have not been detected in other pathological conditions and in healthy individuals. PLA2R1 and HLA-DQA1 gene variants defined by single nucleotide polymorphisms are strongly associated with idiopathic membranous nephropathy in patients of white ancestry, and can thus be considered as predisposing genes. In addition to their diagnostic value, anti-PLA2R1 antibodies can be used to monitor treatment. Immunization against cationic bovine serum albumin is a cause of early childhood membranous nephropathy. This finding points to a possible role of food and environmental antigens in membranous nephropathy. The newly identified antigen-antibody systems should be considered as molecular signatures challenging the uniform histological definition and having a major impact on patient care in a near future.
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Ramanath V, Nistala R, Chaudhary K. Update on the role of rituximab in kidney diseases and transplant. Expert Opin Biol Ther 2011; 12:223-33. [DOI: 10.1517/14712598.2012.646984] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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