Other Therapies
In vitro studies have shown that peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists can reduce the inflammatory response in IgAN-activated renal tubular epithelial cells by down-regulating the expression of angiotensin type 1 receptor. The dual treatment of PPAR-γ and ARB may provide synergistic effects in reducing inflammation and angiotensin II signaling in renal tubular epithelial cells, and this therapeutic benefit has been demonstrated in animal models of IgAN.
Treatment with Budesonide enema in the ileocecal intestine Peyer's junction for 6 months followed a 3-month observation in 16 patients showed a 23% reduction in proteinuria and a modest increase in GFR of 8%. Based on these encouraging results, a multi-center Phase IIb trial is being planned in Europe.
The pleiotropic effects of statins on renal protection were studied in 24 patients with IgAN who were not treated with glucocorticoids or immunosuppressive agents. After one year of statin therapy, although there was no significant reduction in proteinuria, eGFR increased by 8%.
Complement activation, including alternative pathways and lectin pathways, plays an important role in the pathogenesis of IgAN. Rosenblad et al. Administered iculizumab (anti-C5) to IgAN patients with renal failure due to rapid treatment of refractory immunosuppressive therapy, leading to renal function stabilization and decreased proteinuria. In the stop treatment after rapid deterioration of renal function, in a dose of Kurilizumab after renal function and temporary recovery.
Spleen tyrosine kinase (SYK) is an intracellular protein tyrosine kinase involved in downstream signaling of immune receptor cells and its potential role in IgAN is still under investigation. The increased SYK expression of total and phosphorylated SYK was observed in renal biopsy specimens of patients with IgAN, pharmacological inhibition of SYK or knockdown of SYK with siRNA significantly reduced the expression of IgA1 in human mesangial cells exposed to IgA1 isolated from IgAN patients Inflammatory mediators proliferation and synthesis, but also inhibited mesangial cell proliferation. An RCT is currently being conducted to investigate the clinical utility of fostamatinib, a selective oral tyrosine kinase inhibitor, in IgAN patients.

Author: kidney1234567

Link: http://neph.dxy.cn/article/139675?trace = related
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