Autoantibodies in the Diagnosis, Monitoring, and Treatment of Membranous Nephropathy

• Published in: Frontiers in immunology Vol. 12; p. 593288
• Main Authors: Tesar, Vladimir, Hruskova, Zdenka
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 22.03.2021
• Subjects: Animals; anti-PLA2R antibodies; anti-THSD7A antibody; Autoantibodies - blood; Autoantibodies - immunology; Autoantigens - immunology; Autoimmunity; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Disease Management; Disease Susceptibility - immunology; Glomerulonephritis, Membranous - diagnosis; Glomerulonephritis, Membranous - immunology; Glomerulonephritis, Membranous - therapy; Humans; Immunology; Kidney Glomerulus - immunology; Kidney Glomerulus - pathology; membranous nephropathy; Molecular Diagnostic Techniques; outcome; Podocytes - immunology; Podocytes - pathology; Receptors, Phospholipase A2 - immunology; remission; anti-THSD7A antibody; anti-PLA2R antibodies; membranous nephropathy; outcome; remission
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2021.593288

The discovery of anti-podocyte antibodies in primary membranous nephropathy (MN) has revolutionized our approach toward the diagnosis and treatment of this disease. Evaluation of serum levels of anti-podocyte antibodies paved the way for non-invasive diagnosis and helped distinguish between primary and secondary MN although the relationship between anti-podocyte antibodies and cancer remains to be elucidated. Serum levels of anti-PLA2R antibodies directed against the major podocyte autoantigen are related to MN activity and the decrease in serum levels of anti-PLA2R antibodies in response to treatment (immunologic remission) also serves as an early indicator of the later putative proteinuric remission, enabling personalization of the treatment. The serum levels of anti-podocyte antibodies also enable the prediction of renal outcomes in terms of both remission and the risk of progression to end-stage renal disease. The positivity of anti-PLA2R antibodies before renal transplantation is associated with the risk of recurrence of MN. It remains to be established if all these relations observed in patients with anti-PLA2R antibodies are also valid for expanding spectrum of antibodies directed against recently discovered minor antigens (e.g., THSD7A, NELL-1, semaphorin 3B).