New Advances in the Pathogenic Mechanisms and Therapeutic Approaches for Primary Podocytopathies

Main Article Content

Tanisorn Harnsirikarn
Palita Chittinandana

Abstract

Podocytopathies are a common group of glomerular diseases that can lead to end-stage kidney disease and various treatment-related complications. Traditionally, podocytopathies were classified based on histopathological findings, which do not reflect the true pathogenesis of each patient. Recently, there have been significant advancements in our understanding of podocyte biology and disease mechanisms, including the discovery of disease-causing genes and mutations in familial podocytopathies, the roles of various podocyte molecules and ion channels in health and disease, and the identification of pathogenic antibodies targeting podocyte proteins such as nephrin. These advances have led to a more mechanistic classification of podocytopathies, enabling personalized treatment selection and the development of novel therapeutic approaches.

Article Details

How to Cite
Harnsirikarn, T., & Chittinandana, P. (2025). New Advances in the Pathogenic Mechanisms and Therapeutic Approaches for Primary Podocytopathies. Journal of the Nephrology Society of Thailand, 31(2), 136–149. https://doi.org/10.63555/jnst.2025.277904
Section
Review Article

References

Kopp JB, Anders HJ, Susztak K, Podesta MA, Remuzzi G, Hildebrandt F, et al. Podocytopathies. Nat Rev Dis Primers. 2020;6(1):68. DOI: 10.1038/s41572-020-0196-7

Cirillo L, Lugli G, Raglianti V, Ravaglia F, Buti E, Landini S, et al. Defining diagnostic trajectories in patients with podocytopathies. Clin Kidney J. 2022;15(11):2006-19. DOI: 10.1093/ckj/sfac123

De Vriese AS, Wetzels JF, Glassock RJ, Sethi S, Fervenza FC. Therapeutic trials in adult FSGS: lessons learned and the road forward. Nat Rev Nephrol. 2021;17(9):619-30. DOI: 10.1038/s41581-021-00427-1

Daehn IS, Duffield JS. The glomerular filtration barrier: a structural target for novel kidney therapies. Nat Rev Drug Discov. 2021;20(10):770-88. DOI: 10.1038/s41573-021-00242-0

Salfi G, Casiraghi F, Remuzzi G. Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis. Front Immunol. 2023;14:1247606. DOI: 10.3389/fimmu.2023.1247606

Wharram BL, Goyal M, Wiggins JE, Sanden SK, Hussain S, Filipiak WE, et al. Podocyte depletion causes glomerulosclerosis: diphtheria toxin-induced podocyte depletion in rats expressing human diphtheria toxin receptor transgene. J Am Soc Nephrol. 2005;16(10):2941-52. DOI: 10.1681/ASN.2005010055

Ravaglia F, Melica ME, Angelotti ML, De Chiara L, Romagnani P, Lasagni L. The Pathology Lesion Patterns of Podocytopathies: How and why? Front Cell Dev Biol. 2022;10:838272. DOI: 10.3389/fcell.2022.838272

Saleem MA. Molecular stratification of idiopathic nephrotic syndrome. Nat Rev Nephrol. 2019;15(12):750-65. DOI: 10.1038/s41581-019-0217-5

D’Agati VD, Alster JM, Jennette JC, Thomas DB, Pullman J, Savino DA, et al. Association of histologic variants in FSGS clinical trial with presenting features and outcomes. Clin J Am Soc Nephrol. 2013;8(3):399-406. DOI: 10.2215/CJN.06100612

Ahn W, Bomback AS. Approach to Diagnosis and Management of Primary Glomerular Diseases Due to Podocytopathies in Adults: Core Curriculum 2020. Am J Kidney Dis. 2020;75(6):955-64. DOI: 10.1053/j.ajkd.2019.12.019

Kidney Disease: Improving Global Outcomes Glomerular Diseases Work G. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1-S276. DOI: 10.22141/2307-1257.11.1.2022.355

Bierzynska A, McCarthy HJ, Soderquest K, Sen ES, Colby E, Ding WY, et al. Genomic and clinical profiling of a national nephrotic syndrome cohort advocates a precision medicine approach to disease management. Kidney Int. 2017;91(4):937-47. DOI: 10.1016/j.kint.2016.10.013

Santin S, Bullich G, Tazon-Vega B, Garcia-Maset R, Gimenez I, Silva I, et al. Clinical utility of genetic testing in children and adults with steroid-resistant nephrotic syndrome. Clin J Am Soc Nephrol. 2011;6(5):1139-48. DOI: 10.2215/CJN.05260610

Massengill S, Trachtman H. Genetic Spectrum of Nephrotic Syndrome: Impact of Podocytopathy in Adult Life. Adv Chronic Kidney Dis. 2022;29(3):221-4. DOI: 10.1053/j.ackd.2022.04.005

Bertelli R, Ginevri F, Caridi G, Dagnino M, Sandrini S, Di Duca M, et al. Recurrence of focal segmental glomerulosclerosis after renal transplantation in patients with mutations of podocin. Am J Kidney Dis. 2003;41(6):1314-21. DOI: 10.1016/s0272-6386(03)00364-0

Vasquez-Rios G, De Cos M, Campbell KN. Novel Therapies in APOL1-Mediated Kidney Disease: From Molecular Pathways to Therapeutic Options. Kidney Int Rep. 2023;8(11):2226-34.

Sedor JR. APOL1 Kidney Disease: Discovery to Targeted Therapy in 10 Years. Clin J Am Soc Nephrol. 2023. DOI: 10.1016/j.ekir.2023.08.028

Dryer SE, Roshanravan H, Kim EY. TRPC channels: Regulation, dysregulation and contributions to chronic kidney disease. Biochim Biophys Acta Mol Basis Dis. 2019;1865(6):1041-66. DOI: 10.1016/j.bbadis.2019.04.001

Gallon L, Leventhal J, Skaro A, Kanwar Y, Alvarado A. Resolution of Recurrent Focal Segmental Glomerulosclerosis after Retransplantation. New England Journal of Medicine. 2012;366(17):1648-9. DOI: 10.1056/NEJMc1202500

Campbell RE, Thurman JM. The Immune System and Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol. 2022;17(12):1823-34. DOI: 10.2215/CJN.07180622

Basu B, Sander A, Roy B, Preussler S, Barua S, Mahapatra TKS, et al. Efficacy of Rituximab vs Tacrolimus in Pediatric Corticosteroid-Dependent Nephrotic Syndrome: A Randomized Clinical Trial. JAMA Pediatrics. 2018;172(8):757-64. DOI: 10.1001/jamapediatrics.2018.1323

Fenoglio R, Sciascia S, Beltrame G, Mesiano P, Ferro M, Quattrocchio G, et al. Rituximab as a front-line therapy for adult-onset minimal change disease with nephrotic syndrome. Oncotarget. 2018;9(48). DOI: 10.18632/oncotarget.25612

Watts AJB, Keller KH, Lerner G, Rosales I, Collins AB, Sekulic M, et al. Discovery of Autoantibodies Targeting Nephrin in Minimal Change Disease Supports a Novel Autoimmune Etiology. J Am Soc Nephrol. 2022;33(1):238-52. DOI: 10.1681/ASN.2021060794

de Cos M, Meliambro K, Campbell KN. Novel Treatment Paradigms: Focal Segmental Glomerulosclerosis. Kidney Int Rep. 2023;8(1):30-5. DOI: 10.1016/j.ekir.2022.10.004

The use of rituximab in the treatment of nephrotic glomerulonephritis (TURING) [Internet]. ISRCTN registry. 2019. Available from: https://www.isrctn.com/ISRCTN16948923.

RItuximab From the FIRst Episode of Idiopathic Nephrotic Syndrome (RIFIREINS) [Internet]. ClinicalTrials.gov. 2020. Available from: https://clinicaltrials.gov/study/NCT03970577.

Faul C, Donnelly M, Merscher-Gomez S, Chang YH, Franz S, Delfgaauw J, et al. The actin cytoskeleton of kidney podocytes is a direct target of the antiproteinuric effect of cyclosporine A. Nat Med. 2008;14(9):931-8. DOI: 10.1038/nm.1857

Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, et al. A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants. Kidney Int. 2023;103(5):962-72. DOI: 10.1016/j.kint.2023.02.022

Walsh L, Reilly JF, Cornwall C, Gaich GA, Gipson DS, Heerspink HJL, et al. Safety and Efficacy of GFB-887, a TRPC5 Channel Inhibitor, in Patients With Focal Segmental Glomerulosclerosis, Treatment-Resistant Minimal Change Disease, or Diabetic Nephropathy: TRACTION-2 Trial Design. Kidney Int Rep. 2021;6(10):2575-84. DOI: 10.1016/j.ekir.2021.07.006

Trachtman H, Kretzler M, Desmond HE, Choi W, Manuel RC, Soleymanlou N. TRPC6 Inhibitor BI 764198 in Focal Segmental Glomerulosclerosis: Phase 2 Study Design. Kidney Int Rep. 2023;8(12):2822-5. DOI: 10.1016/j.ekir.2023.09.026

Egbuna O, Zimmerman B, Manos G, Fortier A, Chirieac MC, Dakin LA, et al. Inaxaplin for Proteinuric Kidney Disease in Persons with Two APOL1 Variants. N Engl J Med. 2023;388(11):969-79. DOI: 10.1056/NEJMoa2202396

Wheeler DC, Jongs N, Stefansson BV, Chertow GM, Greene T, Hou FF, et al. Safety and efficacy of dapagliflozin in patients with focal segmental glomerulosclerosis: a prespecified analysis of the dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial. Nephrol Dial Transplant. 2022;37(9):1647-56. DOI: 10.1093/ndt/gfab335

Rheault MN, Alpers CE, Barratt J, Bieler S, Canetta P, Chae DW, et al. Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. N Engl J Med. 2023;389(26):2436-45. DOI: 10.1056/NEJMoa2308550

Miyaki T, Kawasaki Y, Hosoyamada Y, Amari T, Kinoshita M, Matsuda H, et al. Three-dimensional imaging of podocyte ultrastructure using FE-SEM and FIB-SEM tomography. Cell Tissue Res 2020;379(2):245-54. DOI: 10.1007/s00441-019-03118-3