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Bonilla M, Efe O, Selvaskandan H, Lerma EV, Wiegley N. A Review of Focal Segmental Glomerulosclerosis Classification With a Focus on Genetic Associations. Kidney Med 2024; 6:100826. [PMID: 38765809 PMCID: PMC11099322 DOI: 10.1016/j.xkme.2024.100826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) defines a distinct histologic pattern observed in kidney tissue that is linked to several distinct underlying causes, all converging on the common factor of podocyte injury. It presents a considerable challenge in terms of classification because of its varied underlying causes and the limited correlation between histopathology and clinical outcomes. Critically, precise nomenclature is key to describe and delineate the pathogenesis, subsequently guiding the selection of suitable and precision therapies. A proposed pathomechanism-based approach has been suggested for FSGS classification. This approach differentiates among primary, secondary, genetic, and undetermined causes, aiming to provide clarity. Genetic FSGS from monogenic mutations can emerge during childhood or adulthood, and it is advisable to conduct genetic testing in cases in which there is a family history of chronic kidney disease, nephrotic syndrome, or resistance to treatment. Genome-wide association studies have identified several genetic risk variants, such as those in apolipoprotein L1 (APOL1), that play a role in the development of FSGS. Currently, no specific treatments have been approved to treat genetic FSGS; however, interventions targeting underlying cofactor deficiencies have shown potential in some cases. Furthermore, encouraging results have emerged from a phase 2 trial investigating inaxaplin, a novel small molecule APOL1 channel inhibitor, in APOL1-associated FSGS.
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Affiliation(s)
- Marco Bonilla
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL
| | - Orhan Efe
- Division of Nephrology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Haresh Selvaskandan
- IgA Mayer Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, IL
| | - Nasim Wiegley
- University of California Davis School of Medicine, Division of Nephrology, Sacramento, CA
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Selvaskandan H, Barratt J. Charting new frontiers in IgA nephropathy: a paradigm shift toward precision medicine and early intervention? Kidney Int 2024; 105:659-661. [PMID: 38519229 DOI: 10.1016/j.kint.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
Advancements in glomerular transcriptomics offer a promising avenue toward precision medicine in IgA nephropathy. Traditional prognostic biomarkers, including proteinuria, blood pressure, and histomorphometry, fall short at capturing the complexity of IgA nephropathy and can only crudely guide therapeutic decisions. This issue needs to be addressed urgently as pathway-specific treatments become available. Glomerular transcriptomics, although technically challenging, offers an opportunity to refine prognostic precision and identify therapeutic targets, even when apparent risk of disease progression is low.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK; Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK; Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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Vaz de Castro PAS, Amaral AA, Almeida MG, Selvaskandan H, Barratt J, Simões E Silva AC. Examining the association between serum galactose-deficient IgA1 and primary IgA nephropathy: a systematic review and meta-analysis. J Nephrol 2024:10.1007/s40620-023-01874-8. [PMID: 38427309 DOI: 10.1007/s40620-023-01874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/26/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND IgA nephropathy (IgAN) is a common primary glomerular disease. The O-glycosylation status of IgA1 plays a crucial role in disease pathophysiology. The level of poorly-O-galactosylated IgA1, or galactose-deficient IgA1 (Gd-IgA1), has also been identified as a potential biomarker in IgAN. We sought to examine the value of serum Gd-IgA1 as a biomarker in IgAN, by investigating its association with clinical, laboratory, and histopathological features of IgAN. METHODS The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in PROSPERO (CRD42021287423). The literature search was conducted in PubMed, Web of Science, Cochrane, and Scopus, and the selected articles were evaluated for eligibility based on predefined criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. Statistical analysis was performed to calculate effect sizes and assess heterogeneity among the studies. RESULTS This review analyzed 29 out of 1,986 studies, conducted between 2005 and 2022, with participants from multiple countries. Gd-IgA1 levels were not associated with age and gender, while associations with hypertension, hematuria, and proteinuria were inconsistent. In the meta-analyses, a correlation between serum Gd-IgA1 and estimated glomerular filtration rate was identified, however, the relationships between Gd-IgA1 levels and chronic kidney disease (CKD) stage and progression to kidney failure were inconsistent. CONCLUSIONS Serum Gd-IgA1 levels were not associated with validated prognostic risk factors, but were negatively correlated with kidney function. Further research in larger studies using standardized assays are needed to establish the value of Gd-IgA1 as a prognostic risk factor in IgAN.
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Affiliation(s)
- Pedro Alves Soares Vaz de Castro
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Arthur Aguiar Amaral
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariana Godinho Almeida
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Haresh Selvaskandan
- The Mayer IgA Nephropathy Laboratories, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- The Mayer IgA Nephropathy Laboratories, University of Leicester, Leicester, UK.
- Department of Cardiovascular Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Selvaskandan H, Gee PO, Seethapathy H. Technological Innovations to Improve Patient Engagement in Nephrology. Adv Kidney Dis Health 2024; 31:28-36. [PMID: 38403391 DOI: 10.1053/j.akdh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 02/27/2024]
Abstract
Technological innovation has accelerated exponentially over the last 2 decades. From the rise of smartphones and social media in the early 2000s to the mainstream accessibility of artificial intelligence (AI) in 2023, digital advancements have transformed the way we live and work. These innovations have permeated health care, covering a spectrum of applications from virtual reality training platforms to AI-powered clinical decision support tools. In this review, we explore fascinating recent innovations that have and can facilitate patient engagement in nephrology. These include integrated care mobile applications, wearable health monitoring tools, virtual/augmented reality consultation and education platforms, AI-powered appointment booking systems, and patient information tools. We also discuss potential pitfalls in implementation and paradigms to adopt that may protect patients from unintended consequences of being cared for in a digitalized health care system.
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Affiliation(s)
- Haresh Selvaskandan
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | | | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Selvaskandan H, Gaultney T, Heath D, Linfoot S, Xu G. Can artificial intelligence predict the need for acute renal replacement therapy among inpatients with acute kidney injury? Future Healthc J 2023; 10:19-20. [PMID: 38406742 PMCID: PMC10884700 DOI: 10.7861/fhj.10-3-s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
| | | | | | | | - Gang Xu
- University Hospitals of Leicester NHS Trust; UK
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Abstract
INTRODUCTION IgA nephropathy (IgAN) is the commonest primary glomerulonephritis worldwide and may progress to end-stage kidney disease (ESKD) within a 10-20 year period. Its slowly progressive course has made clinical trials challenging to perform, however the acceptance of proteinuria reduction as a surrogate end point has significantly improved the feasibility of conducting clinical trials in IgAN, with several novel and repurposed therapies currently undergoing assessment. Already, interim results are demonstrating value to some of these, offering great hope to those with IgAN. AREAS COVERED This review explores the rationale, candidates, clinical precedents, and trial status of therapies that are currently or have recently been evaluated for efficacy in IgAN. All IgAN trials registered with the U.S. National Library of Medicine; ClinicalTrials.gov were reviewed. EXPERT OPINION For the first time, effective treatment options beyond supportive care are becoming available for those with IgAN. This is the culmination of commendable international efforts and signifies a new era for those with IgAN. As more therapies become available, future challenges will revolve around deciding which treatments are most appropriate for individual patients, which is likely to push IgAN into the realm of precision medicine.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Jonathan Barratt
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Chee Kay Cheung
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Barratt J, Pawluczyk I, Selvaskandan H. Clinical application of microRNAs in glomerular diseases. Nephrol Dial Transplant 2022; 38:1375-1384. [PMID: 35906877 DOI: 10.1093/ndt/gfac230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
RNA interference (RNAi) occurs in all organisms and modulates most, if not all, biological pathways. It is the process by which non-coding RNAs, including microRNAs (miRs), regulate gene transcription and post-transcriptional processing of messenger RNA (mRNA). A single miR can modulate several genes within a cell, and several miRs can regulate expression of the same gene, adding tiers of complexity to regulation of gene expression. MicroRNAs and other RNAi approaches have been successfully used in vitro and in vivo to selectively manipulate gene transcription, making them pivotal agents for basic science research and candidates for targeted therapeutics. This review will focus on miRs and their potential as biomarkers and novel therapeutics for glomerular disease.
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Affiliation(s)
- Jonathan Barratt
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
| | - Izabella Pawluczyk
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
| | - Haresh Selvaskandan
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
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Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open 2022; 12:e054869. [PMID: 35636784 PMCID: PMC9152624 DOI: 10.1136/bmjopen-2021-054869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. SETTING A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. PARTICIPANTS All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. EXPOSURE The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. MAIN OUTCOMES AND MEASURES Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. RESULTS 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. CONCLUSION The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine L Hull
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna Adenwalla
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Safa Ahmed
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria-Cristina Cusu
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ammar Kanbar
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hemali Kanji
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark Lambie
- School of Medicine, Keele University, Keele, UK
| | - Han Sean Lee
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Mahdi
- Department of Renal Medicine, Lincoln County Hospital, Lincoln, UK
| | - Rupert Major
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Health Sciences, University Hospital of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Boavojuvie Oseya
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Tabinor
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Selvaskandan H, Baharani J, Hamer R. Regional variations in nephrology trainee confidence with clinical skills may relate to the availability of local training opportunities in the UK: results from a national survey. Clin Exp Nephrol 2022; 26:886-897. [PMID: 35524893 PMCID: PMC9077353 DOI: 10.1007/s10157-022-02228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Background The United Kingdom offers a standardised training program for nephrology fellows. However, local training opportunities vary resulting in mismatches between trainee interests and accessible opportunities. This may impact trainee confidence, satisfaction, and future service provision. Methods A survey assessing confidence with key procedures and sub-specialities was disseminated. Associations with region of training were probed using Chi square tests, with significance set at p < 0.0008 following a Bonferroni correction. Results were compared to trainee views on available opportunities for development. Results 139 responses were received (32% response rate, demographics representative of the UK nephrology trainee cohort). Procedural independence varied from 98% for temporary femoral vascular catheters to 5% for peritoneal dialysis catheters (PDIs). Independence with inserting tunnelled vascular catheters varied with region (p < 0.0001). Trainees expressed a desire for formal training in kidney ultrasound scanning and PDIs, corresponding with procedures they had least opportunity to become independent with. Trainees felt least confident managing kidney disease in pregnancy. Suggestions for improving training included protected time for garnering sub-speciality knowledge, developing procedural skills and for experiencing practice in other nephrology units. Conclusions A mismatch between trainee interests and professional development opportunities exists, which may threaten trainee autonomy and impact patient care particularly with regards to peritoneal dialysis. Provisions to facilitate trainee directed development need to be made while balancing the rigors of service provision. Such measures could prove critical to promoting trainee well-being and preventing attrition within the nephrology workforce.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK. .,Department of Cardiovascular Sciences, Mayer IgA Nephropathy Laboratories, University of Leicester, Hodgkin Building, Lancaster Road, Leicester, LE1 7HB, UK.
| | - Jyoti Baharani
- Department of Renal Medicine, Birmingham Heartlands Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals of Coventry and Warwickshire, Coventry, UK
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Selvaskandan H, Nimmo A, Savino M, Afuwape S, Brand S, Graham-Brown M, Medcalf J, Cockwell P, Beckwith H. Burnout and long COVID among the UK nephrology workforce: results from a national survey investigating the impact of COVID-19 on working lives. Clin Kidney J 2021; 15:517-526. [PMID: 35198158 PMCID: PMC8754810 DOI: 10.1093/ckj/sfab264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is placing a significant strain on healthcare. We conducted a national survey of the UK nephrology workforce to understand its impacts on their working lives. Methods An online questionnaire incorporating the Maslach Burnout Inventory score was distributed between 31 March and 1 May 2021, with a focus on COVID-19 and long COVID incidence, vaccine uptake, burnout and working patterns. Data were analysed qualitatively and quantitatively; multivariable logistic regression was used to identify associations. Results A total of 423 responses were received. Of them, 29% had contracted COVID-19, which was more common among doctors and nurses {odds ratio [OR] 2.18 [95% confidence interval (CI) 1.13–4.22]} and those <55 years of age [OR 2.60 (95% CI 1.38–4.90)]. Of those who contracted COVID-19, 36% had symptoms of long COVID, which was more common among ethnicities other than White British [OR 2.57 (95% CI 1.09–6.05)]. A total of 57% had evidence of burnout, which was more common among younger respondents [OR 1.92 (95% CI 1.10–3.35)] and those with long COVID [OR 10.31 (95% CI 1.32–80.70)], and 59% with reconfigured job plans continued to work more hours. More of those working full-time wished to retire early. A total of 59% experienced remote working, with a majority preference for continuing this in the future. In terms of vaccination, 95% had received one dose of a COVID-19 vaccine and 86% had received two doses by May 2021. Conclusions Burnout and long COVID is prevalent with impacts on working lives. Some groups are more at risk. Vaccination uptake is high and remote and flexible working were well received. Institutional interventions are needed to prevent workforce attrition.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
| | | | | | - Sarah Afuwape
- Kidney and Urology Department, Royal Free London NHS Foundation Trust
| | - Sarah Brand
- Department of Renal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
| | - James Medcalf
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
- UK Renal Registry, The Renal Association, Bristol, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Hannah Beckwith
- Institute of Clinical Sciences, Imperial College London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Selvaskandan H, Barratt J, Cheung CK. Immunological drivers of IgA nephropathy: Exploring the mucosa-kidney link. Int J Immunogenet 2021; 49:8-21. [PMID: 34821031 DOI: 10.1111/iji.12561] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022]
Abstract
IgA nephropathy (IgAN) is the most common pattern of primary glomerular disease reported worldwide. Up to 40% of those with IgAN progress to end-stage kidney disease within 20 years of diagnosis, with no currently available disease-specific treatment. This is likely to change rapidly, with evolving insights into the mechanisms driving this disease. IgAN is an immune-complex-mediated disease, and its pathophysiology has been framed by the 'four-hit hypothesis', which necessitates four events to occur for clinically significant disease to develop. However, this hypothesis does not explain the wide variability observed in its presentation or clinical progression. Recently, there has been great interest in exploring the role of the mucosal immune system in IgAN, especially given the well-established link between mucosal infections and disease flares. Knowledge of antigen-mucosal interactions is now being successfully leveraged for therapeutic purposes; the gut-directed drug Nefecon (targeted release formulation-budesonide) is on track to become the first medication to be approved specifically for the treatment of IgAN. In this review, we examine established immunological paradigms in IgAN, explore how antigen-mucosal immune responses drive disease, and discuss how this knowledge is being used to develop new treatments.
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Affiliation(s)
- Haresh Selvaskandan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Chee Kay Cheung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Scionti K, Molyneux K, Selvaskandan H, Barratt J, Cheung CK. New Insights into the Pathogenesis and Treatment Strategies in IgA Nephropathy. Glomerular Dis 2021; 2:15-29. [PMID: 36751267 PMCID: PMC9677740 DOI: 10.1159/000519973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Abstract
Background Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. It is defined by mesangial IgA deposition, with consequent mesangial cell proliferation, inflammation, and tubulointerstitial fibrosis. Summary Approximately 30% of affected patients will progress to end-stage kidney disease within 20 years of diagnosis. Currently, there is no disease-specific treatment available and management recommendations are, in general, limited to optimization of lifestyle measures and use of renin-angiotensin-aldosterone system blockers. More recently, advances in the understanding of the pathogenesis of IgAN have informed the development of novel therapeutic strategies that are now being tested in clinical trials. These have focused on different areas that include modulating the production of poorly galactosylated IgA1, which is central to the development of IgAN, and inhibiting the downstream signaling pathways and complement activation that are triggered following mesangial IgA1 deposition. In this review, we will summarize important pathogenic mechanisms in IgAN and highlight important areas of interest where treatment strategies are being developed. Key messages IgAN is a common form of primary glomerulonephritis for which there is no current approved specific therapy. Recent advances in the understanding of its pathogenesis have led to the development of novel therapies, with the hope that new treatment options will be available soon to treat this condition.
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Affiliation(s)
- Katrin Scionti
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Karen Molyneux
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Haresh Selvaskandan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom,*Jonathan Barratt,
| | - Chee Kay Cheung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Pawluczyk I, Nicholson M, Barbour S, Er L, Selvaskandan H, Bhachu JS, Barratt J. A Pilot Study to Predict Risk of IgA Nephropathy Progression Based on miR-204 Expression. Kidney Int Rep 2021; 6:2179-2188. [PMID: 34386667 PMCID: PMC8343780 DOI: 10.1016/j.ekir.2021.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Immunoglobulin (Ig)A nephropathy (IgAN) is the most frequently diagnosed primary glomerulonephritis worldwide. Despite the common diagnostic feature of mesangial IgA-containing immune complex deposition, the clinical course of the disease is extremely variable, with 30% of patients developing end-stage kidney disease within 20 years of diagnosis. Therefore, identifying which patients are likely to progress is paramount. Results In this pilot study, we found that urinary exosomal miR-204 expression was significantly reduced in IgAN compared with healthy subjects. However, there was no difference in miR-204 expression between IgAN and non-IgAN chronic kidney disease controls. Analysis of miR-204 expression in kidney biopsy cores by next-generation sequencing followed by quantitative polymerase chain reaction validation in independent cohorts demonstrated that expression of miR-204 was significantly lower in IgAN compared with thin-membrane nephropathy but not compared with membranous nephropathy. Patients with IgAN at high risk of future progression had significantly lower expression of miR-204 than those at low risk of progression. Cortical localization indicated that miR-204 was preferentially expressed in the interstitium compared with glomeruli in IgAN nonprogressors and that this distribution was lost in IgAN progressors. Receiver operating characteristic curve analysis between the 2 IgAN cohorts revealed an area under the curve of 0.82. In addition, miR-204 expression correlated with known clinicopathological prognostic risk factors. Importantly, incorporating miR-204 into the International IgAN risk prediction tool improved the diagnostic power of the algorithm to predict risk of progression. Conclusion Additional large-scale studies are now needed to validate the additive value of miR-204 in improving risk prediction in IgAN and more broadly in chronic kidney disease.
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Affiliation(s)
- Izabella Pawluczyk
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Matthew Nicholson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sean Barbour
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Lee Er
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Haresh Selvaskandan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jasraj S Bhachu
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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14
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Selvaskandan H, Moorthy A. An Ethnic Variation in the Acceptance of Biological Disease-Modifying Therapies: A University Hospital Experience. Cureus 2021; 13:e15270. [PMID: 34194874 PMCID: PMC8234561 DOI: 10.7759/cureus.15270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/05/2022] Open
Abstract
Ethnic variations in the outcomes of rheumatological diseases are well documented. While physiological differences may account for these disparities, attitude to treatment is also likely to be a significant modifiable contributor. We sought to determine if an ethnic variation exists in the uptake of biological disease-modifying anti-rheumatic drugs (DMARD) among a multi-ethnic cohort when offered in-person through a healthcare system free at the point of access. We conducted a retrospective cross-sectional study of patients seen in a biologic therapy counselling clinic between December 2016 and April 2017. Clinic letters from consultations were reviewed, and data including ethnicity, language spoken, and decision to accept or reject the therapy were extracted. We chose to measure uptake over adherence, as we believe it is an earlier, more direct marker of attitudes to joint saving medications. Ninety-one cases were included in the analysis. Over 13.2% (12/91) of the cohort declined a biologic treatment when it was offered as the standard of care for joint disease. Non-Caucasian patients accepted treatment less often than Caucasian (White British) patients (OR 0.265, CI 0.73-0.959, p = 0.043), as did those who did not speak English as a first language (OR 0.094, CI 0.18-0.497, p = 0.005). Age, sex, and diagnosis were well matched between those who accepted and declined therapy. We demonstrate a disparity in the uptake of biologic therapies between the White British population and patients from other ethnicities. The reasons for this are likely multifactorial and could be related to socio-economic factors, language barriers, and cultural differences. Addressing this discrepancy is a crucial first step to tackling preventable disparities in the outcomes of rheumatological disease between different ethnicities.
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Affiliation(s)
- Haresh Selvaskandan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, GBR
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Arumugam Moorthy
- College of Life Sciences, University of Leicester, Leicester, GBR
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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15
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Beckwith H, Nimmo A, Savino M, Selvaskandan H, Graham-Brown M, Medcalf J, Cockwell P. Impact of the COVID-19 Pandemic on Training, Morale and Well-Being Among the UK Renal Workforce. Kidney Int Rep 2021; 6:1433-1436. [PMID: 34013121 PMCID: PMC8116903 DOI: 10.1016/j.ekir.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Ailish Nimmo
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | | | - Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - James Medcalf
- UK Renal Registry, The Renal Association, Bristol, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - UK Renal SpR Club and Renal Association
- Department of Renal Medicine, Imperial College London, UK
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
- UK Renal Registry, The Renal Association, Bristol, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Pawluczyk IZA, Soares MSF, Barratt WA, Brown JR, Bhachu JS, Selvaskandan H, Zeng Y, Sarania R, Molyneux K, Roberts ISD, Barratt J. Macrophage interactions with collecting duct epithelial cells are capable of driving tubulointerstitial inflammation and fibrosis in immunoglobulin A nephropathy. Nephrol Dial Transplant 2021; 35:1865-1877. [PMID: 32830258 DOI: 10.1093/ndt/gfaa079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tubulointerstitial fibrosis is a powerful predictor of future progression inimmunoglobulin A (IgA) nephropathy (IgAN). Proximal tubular epithelial cells (PTECs), in concert with infiltrating macrophages, are regarded as the agents provocateurs for driving this fibrotic process. However, evidence is now emerging for a contributory role of the distal nephron. The aim of this study was to examine the potential influence of macrophages on collecting duct epithelial cells (CDECs) and their combined role in the progression of IgAN. METHODS CDECs were cultured with macrophage-conditioned media (MCM) generated from human monocyte cell lines U937 and THP-1 stimulated with or without 100 μg/mL galactose-deficient IgA1. CDECs were analysed for evidence of inflammation and fibrosis. RESULTS Staining of IgAN biopsies for CD68+ macrophages revealed the presence of macrophages juxtaposed to collecting ducts and within their lumina. CDEC exposed to MCM from IgA1-stimulated THP-1 cells (THP-1-IgA-MCM) exhibited markedly increased expression of neutrophil-associated gelatinase (NGAL) and proinflammatory cytokinesinterleukin (IL)-1β, tumour necrosis factor-α, IL-6 and IL-8 compared with MCM from non-IgA-stimulated THP-1 cells (THP-1-MCM). U937-IgA-MCM increased fibronectin levels and reduced E-cadherinmRNA expression. THP-1-IgA-MCM-derived exosomes induced similar increases in NGAL and cytokine expression while in cross-over experiments exosomes extracted from IL-1β-exposed CDEC induced IL-1β and IL-6 mRNA expression in both sets of macrophages. MiRnome analysis revealed that microRNA (miR)-146a, -155 and -200b exhibited a >2-fold increase in expression in CDEC treated with THP-1-IgA-MCM compared with THP-1-MCM. Enforced miR-146a suppression further enhanced NGAL expression, while ectopic miR-146a over-expression downregulated it. NGAL mRNA and miR-146a were upregulated in the biopsies of patients with progressive IgAN compared with non-progressive IgAN. CONCLUSIONS Taken together, these data suggest that CDEC-macrophage interactions potentially contribute to the tubulointerstitial fibrosis characteristic of progressive IgAN.
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Affiliation(s)
| | - Maria S F Soares
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | | | | | | | | | - Ian S D Roberts
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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17
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Selvaskandan H, Shi S, Twaij S, Cheung CK, Barratt J. Monitoring Immune Responses in IgA Nephropathy: Biomarkers to Guide Management. Front Immunol 2020; 11:572754. [PMID: 33123151 PMCID: PMC7572847 DOI: 10.3389/fimmu.2020.572754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
IgA nephropathy (IgAN) is the commonest biopsy-reported primary glomerulonephritis worldwide. It has an incidence which peaks among young adults, and 30 to 40% of patients' progress to end stage kidney disease within twenty years of diagnosis. Ten-year kidney survival rates have been reported to be as low as 35% in some parts of the world. The successful management of IgAN is limited by an incomplete understanding of the pathophysiology of IgAN and a poor understanding of how pathophysiology may vary both from patient to patient and between patient groups, particularly across races. This is compounded by a lack of rigorously designed and delivered clinical trials in IgAN. This is slowly changing, with a number of Phase 2 and 3 clinical trials of novel therapies targeting a number of different putative pathogenic pathways in IgAN due to report in the next 5 years. From our current, albeit limited, understanding of the pathophysiology of IgAN it is unlikely a single therapy will be effective in all patients with IgAN. The successful management of IgAN in the future is, therefore, likely to be reliant on targeted therapies, carefully selected based on an individualized understanding of a patient's risk of progression and underlying pathophysiology. The potential role of biomarkers to facilitate personalization of prognostication and treatment of IgAN is immense. Here we review the progress made over the past decade in identifying and validating new biomarkers, with a particular focus on those that reflect immunological responses in IgAN.
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Affiliation(s)
- Haresh Selvaskandan
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sufang Shi
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sara Twaij
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Chee Kay Cheung
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jonathan Barratt
- Mayer IgA Nephropathy Laboratories, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
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18
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Major R, Selvaskandan H, Makkeyah YM, Hull K, Kuverji A, Graham-Brown M. The Exclusion of Patients with CKD in Prospectively Registered Interventional Trials for COVID-19-a Rapid Review of International Registry Data. J Am Soc Nephrol 2020; 31:2250-2252. [PMID: 32900842 DOI: 10.1681/asn.2020060877] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Rupert Major
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom .,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Haresh Selvaskandan
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Yahya Mostafa Makkeyah
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Katherine Hull
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Apexa Kuverji
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Matthew Graham-Brown
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
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19
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Selvaskandan H, Kay Cheung C, Dormer J, Wimbury D, Martinez M, Xu G, Barratt J. Inhibition of the Lectin Pathway of the Complement System as a Novel Approach in the Management of IgA Vasculitis-Associated Nephritis. Nephron Clin Pract 2020; 144:453-458. [PMID: 32721954 DOI: 10.1159/000508841] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
IgA vasculitis can present as a glomerulonephritis histologically indistinguishable from IgA nephropathy (IgAN). In IgAN, the alternative and lectin pathways mediate glomerular injury and contribute to kidney function decline. Narsoplimab is a monoclonal antibody against mannan-binding lectin serine peptidase 2 (MASP-2), a key component of the lectin pathway. It is being evaluated in a phase III trial in IgAN (NCT03608033). Histopathological similarities with IgAN suggest lectin pathway activation also occurs in IgAV-associated nephritis (IgAVN). Here, we report the first ever case of narsoplimab use for the treatment of IgAVN.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom, .,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom,
| | - Chee Kay Cheung
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - John Dormer
- Department of Pathology, University Hospitals of Leicester, Leicester, United Kingdom
| | - David Wimbury
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Maria Martinez
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Gang Xu
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Jonathan Barratt
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
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20
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Selvaskandan H, Modha DE, Denton-Beaumont R, Ashton C, Hamilton RA. High-dose oral linezolid achieved rapid clinical and microbiological recovery in a severely overweight male with long-standing infected ulcers. J Antimicrob Chemother 2019; 74:1755-1757. [PMID: 30783670 DOI: 10.1093/jac/dkz071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Haresh Selvaskandan
- Department of Acute Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Deborah E Modha
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ruth Denton-Beaumont
- Department of Acute Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Corrine Ashton
- Department of Pharmacy, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ryan A Hamilton
- Department of Pharmacy, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
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21
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Selvaskandan H, Karavadra M, Paramesparan K, Glasby M, Iyasere O. The Case | Microangiopathic hemolytic anemia in a young female. Kidney Int 2019; 95:1277-1278. [PMID: 31010484 DOI: 10.1016/j.kint.2018.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/10/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Haresh Selvaskandan
- Renal Department, Leicester General Hospital, University Hospitals of Leicester, Leicester, Leicestershire, UK.
| | - Minal Karavadra
- Renal Department, Leicester General Hospital, University Hospitals of Leicester, Leicester, Leicestershire, UK
| | - Kethesparan Paramesparan
- Radiology Department, Leicester General Hospital, University Hospitals of Leicester, Leicester, Leicestershire, UK
| | - Michael Glasby
- Radiology Department, Leicester General Hospital, University Hospitals of Leicester, Leicester, Leicestershire, UK
| | - Osasuyi Iyasere
- Renal Department, Leicester General Hospital, University Hospitals of Leicester, Leicester, Leicestershire, UK
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22
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Selvaskandan H, Moorthy A. 083 Is there an ethnic variation in acceptance of biologic therapy among axial spondyloathropathy patients? A university teaching hospital experience. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Haresh Selvaskandan
- Department of Rheumatology, University Hospitals of Leicester, Leicester, UNITED KINGDOM
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester, Leicester, UNITED KINGDOM
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23
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Selvaskandan H, Pawluczyk I, Barratt J. MicroRNAs: a new avenue to understand, investigate and treat immunoglobulin A nephropathy? Clin Kidney J 2018; 11:29-37. [PMID: 29423198 PMCID: PMC5798124 DOI: 10.1093/ckj/sfx096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022] Open
Abstract
IgA nephropathy (IgAN) is the most common cause of primary glomerulonephritis worldwide. Up to 30% of cases develop the progressive form of the disease, eventually requiring renal replacement therapy. Diagnosis and risk stratification relies on an invasive kidney biopsy and management options are limited, with recurrence following renal transplantation being common. Thus the quest to understand the pathophysiology of IgAN has been one of great importance. MicroRNAs (miRs) are short nucleotides that suppress gene expression by hybridizing to the 3' untranslated region of messenger RNA (mRNAs), promoting mRNA degradation or disrupting translation. First discovered in 1993, miRs have since been implicated in a number of chronic conditions, including cancer, heart disease and kidney disease. The mounting interest in the field of miRs has led to fascinating developments in the field of nephrology, ranging from their roles as biomarkers for disease to the development of miR antagonists as avenues for treatment. The translational potential for miRs in IgAN is thus well grounded and may represent a paradigm shift in current approaches to the disease. This review aims to summarize the literature with regard to miRs and their roles in IgAN.
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Affiliation(s)
- Haresh Selvaskandan
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Izabella Pawluczyk
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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Pilati N, Linley DM, Selvaskandan H, Uchitel O, Hennig MH, Kopp-Scheinpflug C, Forsythe ID. Acoustic trauma slows AMPA receptor-mediated EPSCs in the auditory brainstem, reducing GluA4 subunit expression as a mechanism to rescue binaural function. J Physiol 2016; 594:3683-703. [PMID: 27104476 PMCID: PMC4929335 DOI: 10.1113/jp271929] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/13/2016] [Indexed: 12/19/2022] Open
Abstract
KEY POINTS Lateral superior olive (LSO) principal neurons receive AMPA receptor (AMPAR) - and NMDA receptor (NMDAR)-mediated EPSCs and glycinergic IPSCs. Both EPSCs and IPSCs have slow kinetics in prehearing animals, which during developmental maturation accelerate to sub-millisecond decay time-constants. This correlates with a change in glutamate and glycine receptor subunit composition quantified via mRNA levels. The NMDAR-EPSCs accelerate over development to achieve decay time-constants of 2.5 ms. This is the fastest NMDAR-mediated EPSC reported. Acoustic trauma (AT, loud sounds) slow AMPAR-EPSC decay times, increasing GluA1 and decreasing GluA4 mRNA. Modelling of interaural intensity difference suggests that the increased EPSC duration after AT shifts interaural level difference to the right and compensates for hearing loss. Two months after AT the EPSC decay times recovered to control values. Synaptic transmission in the LSO matures by postnatal day 20, with EPSCs and IPSCs having fast kinetics. AT changes the AMPAR subunits expressed and slows the EPSC time-course at synapses in the central auditory system. ABSTRACT Damaging levels of sound (acoustic trauma, AT) diminish peripheral synapses, but what is the impact on the central auditory pathway? Developmental maturation of synaptic function and hearing were characterized in the mouse lateral superior olive (LSO) from postnatal day 7 (P7) to P96 using voltage-clamp and auditory brainstem responses. IPSCs and EPSCs show rapid acceleration during development, so that decay kinetics converge to similar sub-millisecond time-constants (τ, 0.87 ± 0.11 and 0.77 ± 0.08 ms, respectively) in adult mice. This correlated with LSO mRNA levels for glycinergic and glutamatergic ionotropic receptor subunits, confirming a switch from Glyα2 to Glyα1 for IPSCs and increased expression of GluA3 and GluA4 subunits for EPSCs. The NMDA receptor (NMDAR)-EPSC decay τ accelerated from >40 ms in prehearing animals to 2.6 ± 0.4 ms in adults, as GluN2C expression increased. In vivo induction of AT at around P20 disrupted IPSC and EPSC integration in the LSO, so that 1 week later the AMPA receptor (AMPAR)-EPSC decay was slowed and mRNA for GluA1 increased while GluA4 decreased. In contrast, GlyR IPSC and NMDAR-EPSC decay times were unchanged. Computational modelling confirmed that matched IPSC and EPSC kinetics are required to generate mature interaural level difference functions, and that longer-lasting EPSCs compensate to maintain binaural function with raised auditory thresholds after AT. We conclude that LSO excitatory and inhibitory synaptic drive matures to identical time-courses, that AT changes synaptic AMPARs by expression of subunits with slow kinetics (which recover over 2 months) and that loud sounds reversibly modify excitatory synapses in the brain, changing synaptic function for several weeks after exposure.
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Affiliation(s)
- Nadia Pilati
- Autifony Srl Laboratories, Medicines Research Centre, 37135, Verona, Italy.,MRC Toxicology Unit, Hodgkin Bldg, University of Leicester, Leicester, LE1 9HN, UK
| | - Deborah M Linley
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, LE1 9HN, UK
| | - Haresh Selvaskandan
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, LE1 9HN, UK
| | - Osvaldo Uchitel
- Instituto de Fisiología y Biología Molecular y Neurociencias, Universidad de Buenos Aires-CONICET, Facultad de Ciencias Exactas y Naturales, Ciudad Universitaria, C1428-Buenos Aires, Argentina
| | - Matthias H Hennig
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, Edinburgh, EH8 9AB, UK.,SynthSys, C. H. Waddington Building, The Kings Buildings Campus, Edinburgh, UK
| | - Cornelia Kopp-Scheinpflug
- MRC Toxicology Unit, Hodgkin Bldg, University of Leicester, Leicester, LE1 9HN, UK.,Department of Biology II, Ludwig-Maximilians-Universität München, Planegg-Martinsried, D-82152, Munich, Germany
| | - Ian D Forsythe
- MRC Toxicology Unit, Hodgkin Bldg, University of Leicester, Leicester, LE1 9HN, UK.,Department of Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, LE1 9HN, UK
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27
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Baheerathan A, Selvaskandan H. The importance of counseling in young, female epileptic patients. J Pediatr Neurosci 2013; 8:265. [PMID: 24470836 PMCID: PMC3888059 DOI: 10.4103/1817-1745.123720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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