Emerging Modes of Treatment of IgA Nephropathy

Maixnerová, Dita; Tesař, Vladimı́r

doi:10.3390/ijms21239064

Cited by 26 publications

(22 citation statements)

References 99 publications

(127 reference statements)

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“…Historically, treatment of IgAN has been focused on supportive treatments that correct hypertension and proteinuria and may slow down the loss of eGFR in some patients, but most patients presenting with higher residual proteinuria still progress to ESKD. Selecting supportive care is often contingent upon balancing risks and benefits for each patient with the goal of preventing ESKD [ 22 , 23 , 24 ]. Renin-angiotensin system (RAS) inhibitors are often utilized to manage hypertension and slow down decreases in eGFR.…”

Section: Introductionmentioning

confidence: 99%

New Treatment Strategies for IgA Nephropathy: Targeting Plasma Cells as the Main Source of Pathogenic Antibodies

Maixnerová

Zhang

Rizk

et al. 2022

JCM

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Immunoglobulin A nephropathy (IgAN) is a rare autoimmune disorder and the leading cause of biopsy-reported glomerulonephritis (GN) worldwide. Disease progression is driven by the formation and deposition of immune complexes composed of galactose-deficient IgA1 (Gd-IgA1) and Gd-IgA1 autoantibodies (anti-Gd-IgA1 antibodies) in the glomeruli, where they trigger complement-mediated inflammation that can result in loss of kidney function and end-stage kidney disease (ESKD). With the risk of progression and limited treatment options, there is an unmet need for therapies that address the formation of pathogenic Gd-IgA1 antibody and anti-Gd-IgA1 antibody-containing immune complexes. New therapeutic approaches target immunological aspects of IgAN, including complement-mediated inflammation and pathogenic antibody production by inhibiting activation or promoting depletion of B cells and CD38-positive plasma cells. This article will review therapies, both approved and in development, that support the depletion of Gd-IgA1-producing cells in IgAN and have the potential to modify the course of this disease. Ultimately, we propose here a novel therapeutic approach by depleting CD38-positive plasma cells, as the source of the autoimmunity, to treat patients with IgAN.

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Section: Introductionmentioning

confidence: 99%

New Treatment Strategies for IgA Nephropathy: Targeting Plasma Cells as the Main Source of Pathogenic Antibodies

Maixnerová

Zhang

Rizk

et al. 2022

JCM

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“…IgA nephropathy (IgAN) is the most common primary glomerulonephritis [ 1 , 2 , 3 , 4 ], and its pathogenesis remains unclear [ 5 ]. Similar to other chronic kidney diseases, many atherosclerotic factors, such as hypertension, uric acid [ 6 ], cigarette smoking [ 7 ], and kidney function itself, promote the progression of IgAN.…”

Section: Introductionmentioning

confidence: 99%

Title IgA Nephropathy and Oral Bacterial Species Related to Dental Caries and Periodontitis

Nagasawa

Misaki

Itô

et al. 2022

IJMS

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A relationship between IgA nephropathy (IgAN) and bacterial infection has been suspected. As IgAN is a chronic disease, bacteria that could cause chronic infection in oral areas might be pathogenetic bacteria candidates. Oral bacterial species related to dental caries and periodontitis should be candidates because these bacteria are well known to be pathogenic in chronic dental disease. Recently, several reports have indicated that collagen-binding protein (cnm)-(+) Streptococcs mutans is relate to the incidence of IgAN and the progression of IgAN. Among periodontal bacteria, Treponema denticola, Porphyromonas gingivalis and Campylobacte rectus were found to be related to the incidence of IgAN. These bacteria can cause IgAN-like histological findings in animal models. While the connection between oral bacterial infection, such as infection with S. mutans and periodontal bacteria, and the incidence of IgAN remains unclear, these bacterial infections might cause aberrantly glycosylated IgA1 in nasopharynx-associated lymphoid tissue, which has been reported to cause IgA deposition in mesangial areas in glomeruli, probably through the alteration of microRNAs related to the expression of glycosylation enzymes. The roles of other factors related to the incidence and progression of IgA, such as genes and cigarette smoking, can also be explained from the perspective of the relationship between these factors and oral bacteria. This review summarizes the relationship between IgAN and oral bacteria, such as cnm-(+) S. mutans and periodontal bacteria.

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“…An early initiation of immunosuppressive regimen in patients with IgAN at risk of progression may slow down the progression to end-stage renal disease. Several new treatment options for patients with IgAN are currently under evaluation in clinical trials ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Outcome of 313 Czech Patients With IgA Nephropathy After Renal Transplantation

et al. 2021

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The recurrence of IgA nephropathy (IgAN) after kidney transplantation occurs in 20–35% of patients. The main aim of this study is to evaluate risk factors affecting the course of IgAN after renal biopsy of native kidney and kidney transplant. We evaluated clinical parameters and histological findings at the time of biopsy of native kidney and after kidney transplantation in 313 patients with IgAN with a follow-up of up to 36 years. Using hierarchical clustering method, patients with graft failure (n=50) were divided into two groups based on the mean time from kidney transplant to graft failure (11.2 versus 6.1 years). The time-to-graft failure corresponded well to the time from the renal biopsy of native kidney to end-stage renal disease (5.9 versus 0.4 years). Body mass index, proteinuria, microscopic hematuria, histological evaluation of fibrosis, and crescents at the time of renal biopsy of native kidney were the main variables for the differentiation of the two groups. Higher age of kidney-transplant donor, histological recurrence of IgAN, antibody-mediated rejection, and the onset of microscopic hematuria and proteinuria within 1 year after kidney transplant were also associated with worse graft survival in multivariate Cox regression analysis.

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Emerging Modes of Treatment of IgA Nephropathy

Cited by 26 publications

References 99 publications

New Treatment Strategies for IgA Nephropathy: Targeting Plasma Cells as the Main Source of Pathogenic Antibodies

New Treatment Strategies for IgA Nephropathy: Targeting Plasma Cells as the Main Source of Pathogenic Antibodies

Title IgA Nephropathy and Oral Bacterial Species Related to Dental Caries and Periodontitis

Outcome of 313 Czech Patients With IgA Nephropathy After Renal Transplantation

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