Evidence map›Paper›PMID 32187600›Full record

ArticleAmerican journal of nephrology2020

Relapse of Nephrotic Syndrome after Adrenocorticotropic Hormone-Induced Remission: Implications of Adrenocorticotropic Hormone Antibodies.

Snehal Shrivastava, Bohan Chen, Lance D Dworkin, Deepak K Malhotra, Rujun Gong

Open access · bronzeAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of nephrology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.6field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Snehal ShrivastavaDivision of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA.
Bohan ChenDivision of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA.
Lance D DworkinDivision of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA.
Deepak K MalhotraDivision of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA.
Rujun GongDivision of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA, Rujun.Gong@UToledo.edu.
University of Toledo · USUniversity of Toledo Medical Center · US

Funding

Therapeutic targeting of GSK3beta: A novel approach for podocyte protectionR01DK092485 · NIDDK · RHODE ISLAND HOSPITAL · PI GONG, RUJUN · 2011 to 2015
$1.8M
The Melanocortinergic pathway inglomerular diseaseR01DK114006 · NIDDK · UNIVERSITY OF TOLEDO HEALTH SCI CAMPUS · PI GONG, RUJUN · 2017 to 2021
$1.8M
NIDDK NIH HHS R01 DK092485NIDDK NIH HHS R01 DK114006
6 · The paper itself

Abstract

backgroundProlonged use of corticosteroids continues to be the mainstay in the management of most proteinuric glomerulopathies, but is limited by extensive side effects. Alternative medications such as adrenocorticotropic hormone (ACTH) have been recently used to treat refractory glomerulopathies and have shown superior outcomes when compared with steroids. However, the clinical responsiveness to ACTH therapy varies considerably with a number of patients exhibiting de novo or acquired resistance. The underlying mechanism remains unknown.

methodsA patient with steroid-dependent focal segmental glomerulosclerosis (FSGS) developed severe steroid side effects impacting quality of life and was converted to repository porcine ACTH therapy. Immediate response in the form of remission of nephrotic syndrome was noted followed by relapse in 10 weeks. Suspecting the role of some ACTH-antagonizing factors, the patient's serum was examined.

resultsImmunoblot-based antibody assay revealed high titers of de novo IgG antibodies in the patient's serum that were reactive to the porcine corticotropin with negligible cross-reactivity to human corticotropin. In vitro, in cultured B16 melanoma cells that express abundant melanocortin receptors, addition of the patient's serum substantially abrogated the porcine corticotropin triggered signaling activity of the melanocortinergic pathway, marked by phosphorylation of glycogen synthase kinase 3β, thus suggesting a mitigating effect on the biological functionality of porcine corticotropin.

conclusionACTH is a useful alternative therapeutic modality for refractory proteinuric glomerulopathies like FSGS. However, as quintessential therapeutic biologics, natural ACTH, regardless of purity and origin, is inevitably antigenic and may cause the formation of neutralizing antibodies in some sensitive patients, followed by resistance to ACTH therapy. It is imperative to develop ACTH analogues with less immunogenicity for improving its responsiveness in patients with glomerular diseases.

Indexed as

Adrenocorticotropic HormoneAdultAnimalsAntibodies, HeterophileAntibodies, NeutralizingBiopsyChronic DiseaseDrug ResistanceDrug SubstitutionFemaleGlucocorticoidsHumansKidneyNephrotic SyndromeRecombinant ProteinsRecurrenceAdrenocorticotropic HormoneAntibodies, HeterophileAntibodies, NeutralizingGlucocorticoidsRecombinant ProteinsCorticotropinFocal segmental glomerulosclerosisNeutralizing antibodyProteinuria

Identifiers

PMID32187600
PMCPMC7521046
OpenAlexW3011714496

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.