Journal of Nephrology & Renal Therapy Category: Clinical Type: Editorial
Biologics in Nephrotic Syndrome
- Ryszard Grenda1*
- 1 Department Of Nephrology And Kidney Transplantation, The Children’s Memorial Health Institute, Aleja Dzieci Polskich, 04-730 Warsaw, Poland
*Corresponding Author:Ryszard Grenda
Department Of Nephrology And Kidney Transplantation, The Children’s Memorial Health Institute, Aleja Dzieci Polskich, 04-730 Warsaw, Poland
Received Date: Jan 04, 2017 Accepted Date: Jan 06, 2017 Published Date: Jan 20, 2017
Nephrotic syndrome is a complex disease related to variety of underlying mechanisms. The minority of cases are related to podocyte microstructure abnormalities developing due to the specific genetic mutations, which from clinical point are associated with primary resistance to steroids and immunosuppression .
CD80 ( B7-1) is a molecule present on the surface of T cells, dendritic cells and podocytes. So called “two-hits hypothesis” claims, that immune response to the external trigger (e.g., viral infection) in fully immunocompetent humans is limited to transient expression of CD80 on podocytes, which (not necessarily) may cause short-term proteinuria. Humans with specific predisposition, like sustained dysregulation of regulatory T cells (Tregs) react to the similar trigger with sustained expression of CD80 in podocytes, which via dysregulation of cytoskeleton, leads to long lasting proteinuria (nephrotic syndrome) . High urine excretion of CD80 is being regarded as biomarker of minimal change disease . CTLA-4 ( Cytotoxic-T-Lymphocyte-Associated Protein-4), present on podocytes and Tregs is important co-factor in this mechanism  . Blocking of CTLA-4 with abatacept (CTLA-4-Ig) may ameliorate proteinuria. Primary report was optimistic, showing the efficacy of abatacept in 4 (of 5) cases, resistant to other drugs, including rituximab . Further reports were more reluctant and did not confirm preliminary therapeutic enthusiasm [18,19]. Probably, the use abatacept should be limited to the cases, in whom the renal biopsy (native or transplant) confirms the local expression of B7-1 (CD80) in podocytes or at least urinary excretion of CD80 is markedly increased. These cases remind us, that increasing availability of modern biologic drugs, with high affinity to specific receptors, not necessarily provide universal therapeutic success in clinical practice. Mundel and Greka have recently published in article, claiming availability of the “therapeutic arrows with the precision of William Tell” in kidney diseases , however clinicians must not forget that pre-emptive finding of the right shooting target is indispensable part of further therapeutic success.
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Citation: Grenda R (2017) Biologics in Nephrotic Syndrome. J Nephrol Renal Ther 3: 012
Copyright: © 2017 Ryszard Grenda, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.