量化影响常染色体显性遗传性肾小管间质性肾病进展速率和严重程度的临床及遗传因素。
Quantifying clinical and genetic factors influencing rate and severity of autosomal dominant tubulointerstitial kidney disease progression.
作者信息
Ramesh Shyam S, Rogge Mark, Kidd Kendrah O, Williams Adrienne H, Yoon Deok Yong, Roignot Julie, Blakeslee Katherine, Bleyer Anthony J, Kim Sarah
机构信息
Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, FL, USA.
Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
出版信息
J Pharmacokinet Pharmacodyn. 2025 Jul 24;52(4):41. doi: 10.1007/s10928-025-09989-0.
Autosomal dominant tubulointerstitial kidney disease (ADTKD), caused by mutations in UMOD and MUC1 genes, leads to tubular damage and fibrosis, ultimately resulting in kidney failure (KF). This study investigated clinical and genetic factors influencing the rate and severity of ADTKD progression by developing quantitative models. An estimated glomerular filtration rate (eGFR) of 10 mL/min/1.73 m was used to define KF, corresponding to dialysis initiation. Natural history data from the Wake Forest University School of Medicine study were used to develop the models for UMOD (n = 371) and MUC1 (n = 233) disease types (age ≥ 18 years). Longitudinal change in eGFR and time-to-KF were quantified using nonlinear mixed-effects and parametric time-to-event modeling approaches, respectively, in Monolix (version 2024R1). Sigmoid I functions with steepness parameters varying before and after inflection points best captured eGFR decline. Patients with UMOD and MUC1 disease variants exhibited a similar initial shallow steepness ( 1), but after inflection, each declined rapidly. MUC1 patients progressed faster than UMOD during the post-inflection phase (γ₂ = 10.23 vs. 6.34). eGFR at first clinic visit (eGFR_FCV) and age at first clinic visit (AFCV) significantly affected between-subject variability in eGFR decline. A Weibull hazard function best described the time to KF. In UMOD, males reached Te (the age at which approximately 36.8% of individuals remain free from KF) 4 years earlier than females on average (β_Te_Male = -0.07), indicating faster progression in males. Older AFCV was associated with slower progression to KF (β_Te_AFCV = 0.59 for UMOD and 0.81 for MUC1). These models may help enable quantitative data-driven subgroup analysis in the future, optimizing inclusion/exclusion criteria for ADTKD clinical trials.
常染色体显性遗传性肾小管间质性肾病(ADTKD)由UMOD和MUC1基因突变引起,会导致肾小管损伤和纤维化,最终导致肾衰竭(KF)。本研究通过建立定量模型,调查了影响ADTKD进展速度和严重程度的临床和遗传因素。估计肾小球滤过率(eGFR)为10 mL/min/1.73 m²被用于定义KF,这对应于开始透析。来自维克森林大学医学院研究的自然史数据被用于建立UMOD(n = 371)和MUC1(n = 233)疾病类型(年龄≥18岁)的模型。在Monolix(2024R1版)中,分别使用非线性混合效应和参数化事件发生时间建模方法,对eGFR的纵向变化和至KF的时间进行了量化。具有拐点前后变化的陡度参数的Sigmoid I函数最能体现eGFR的下降情况。携带UMOD和MUC1疾病变异的患者最初表现出相似的浅陡度(γ₁),但在拐点后,各自下降迅速。在拐点后阶段,MUC1患者比UMOD患者进展更快(γ₂ = 10.23对6.34)。首次就诊时的eGFR(eGFR_FCV)和首次就诊时的年龄(AFCV)显著影响eGFR下降的个体间变异性。Weibull风险函数最能描述至KF的时间。在UMOD中,男性平均比女性早4年达到Te(约36.8%的个体仍未发生KF的年龄)(β_Te_Male = -0.07),表明男性进展更快。AFCV越大,进展至KF的速度越慢(UMOD的β_Te_AFCV = 0.59,MUC1的β_Te_AFCV = 0.81)。这些模型可能有助于未来进行定量数据驱动的亚组分析,优化ADTKD临床试验的纳入/排除标准。