Department of Nephrology, General Teaching Hospital, 1st Faculty of Medicine, Prague, Czech Republic.
Expert Opin Biol Ther. 2023 May;23(5):419-427. doi: 10.1080/14712598.2023.2213800. Epub 2023 May 18.
IgA nephropathy is the most common primary glomerulonephritis worldwide. Immune complexes, composed of galactose-deficient IgA1 and Gd-IgA1 autoantibodies, are deposited in the mesangial area of the glomeruli where they induce complement-mediated inflammation. This may result in the reduced kidney function, which can progress to end-stage kidney disease. Treatment options are very limited. Treatments which directly affect the formation of pathogenic Gd-IgA1 antibodies and anti-Gd-IgA1 antibody-containing immune complexes are needed.
This article reviews potential therapies, namely monoclonal antibodies, that may affect the main axis of pathogenesis of IgA nephropathy with a discussion of their potential impact on the outcome of IgAN. PubMed was used to perform the literature search, which included papers on "treatment of IgA nephropathy"combined with "biological therapy", or 'monoclonal antibodies, atacicept, sibeprenlimab, rituximab, felzartamab, narsoplimab, iptacopan' published up to 2023.
The new treatment options are aimed at the immunopathogenesis of IgAN, including depletion or modulation of Gd-IgA1 producing B cells, plasma cells, alternate or lectin pathway of complement. Monoclonal antibodies may target both B cells and T cells and also the factors needed for their activation and survival, e.g. BAFF or APRIL.
IgA 肾病是全球最常见的原发性肾小球肾炎。免疫复合物由缺乏半乳糖的 IgA1 和 Gd-IgA1 自身抗体组成，沉积在肾小球的系膜区，在那里诱导补体介导的炎症。这可能导致肾功能下降，进而发展为终末期肾病。治疗选择非常有限。需要针对形成致病性 Gd-IgA1 抗体和含 Gd-IgA1 抗体的免疫复合物的直接治疗方法。
本文综述了潜在的治疗方法，即单克隆抗体，这些方法可能影响 IgA 肾病发病机制的主要轴，并讨论了它们对 IgAN 结局的潜在影响。使用 PubMed 进行文献检索，包括与“IgA 肾病治疗”相结合的论文，或“生物治疗”，或“单克隆抗体、atacicept、sibeprenlimab、rituximab、felzartamab、narsoplimab、iptacopan”，发表时间截至 2023 年。
新的治疗选择针对 IgAN 的免疫发病机制，包括耗尽或调节产生 Gd-IgA1 的 B 细胞、浆细胞、替代或补体凝集素途径。单克隆抗体可针对 B 细胞和 T 细胞，以及它们激活和存活所需的因子，如 BAFF 或 APRIL。
