The expanding spectrum and utility of antigens in membranous nephropathy

Abstract

Purpose of reviewMultiple antigenic targets were discovered in membranous nephropathy, representing distinct autoimmune diseases with a similar morphologic pattern of injury. An overview of recent developments, including antigen types, clinical associations, serologic monitoring, and advancements in understanding disease pathogenesis are provided. Recent findingsSeveral new antigenic targets have defined subtypes of membranous nephropathy, including Neural epidermal growth factor-like 1, protocadherin 7, HTRA1, FAT1, SEMA3B, NTNG1, NCAM1, exostosin 1/2, transforming growth factor beta receptor 3, CNTN1, proprotein convertase subtilisin/kexin type 6, and neuron-derived neurotrophic factor. Autoantigens in membranous nephropathy may demonstrate unique clinical associations, assisting the nephrologist to identify potential disease etiologies and triggers, such as autoimmune disease, cancer, medications, and infections.

Present and Future of IgA Nephropathy and Membranous Nephropathy Immune Monitoring: Insights from Molecular Studies

“…Patients with MN who tested negative for antibodies against PLA2R1 and THSD7A were recently found to have circulating antibodies against serine protease HTRA1 [130], Netrin G1 (NTNG1) [131] and Contactin 1 (CNTN1) [132]. These proteins are produced by podocytes and co-localize in glomerular immune deposits with IgG4 antibodies.…”

“…These proteins are produced by podocytes and co-localize in glomerular immune deposits with IgG4 antibodies. Anti-CNTN1 antibodies have been found in individuals with chronic inflammatory demyelinating polyneuropathy (CIDP), which raises the possibility that the autoimmune response in MN and the pathophysiology of the underlying neurological lesion are linked [131]. These three antigens still lack clinical relevance and an established illness onset mechanism.…”