samedi 5 mai 2012

Stratégies thérapeutiques IgA

Academic Editor: Jiri Mestecky
Copyright © 2011 Mototsugu Tanaka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Predominant or codominant immunoglobulin (Ig) A deposition in the glomerular mesangium characterizes IgA nephropathy (IgAN). Accumulated glomerular IgA is limited to the IgA1 subclass and usually galactose-deficient. This underglycosylated IgA may play an important role in the pathogenesis of IgAN. Recently, antibodies against galactose-deficient IgA1 were found to be well associated with the development of IgAN. Several therapeutic strategies based on corticosteroids or other immunosuppressive agents have been shown to at least partially suppress the progression of IgAN. On the other hand, several case reports of kidney transplantation or acquired IgA deficiency uncovered a remarkable ability of human kidney to remove mesangial IgA deposition, resulting in the long-term stabilization of kidney function. Continuous exposure to circulating immune complexes containing aberrantly glycosylated IgA1 and sequential immune response seems to be essential in the disease progression of IgAN. Removal of mesangial IgA deposition may be a challenging, but fundamental approach in the treatment of IgAN....

....5. Conclusion

Galactose-deficient glycosylated IgA1 seems to be a key factor in the pathogenesis of IgAN. Based on the recent studies, continuous exposure to circulating immune complexes containing aberrantly glycosylated IgA1 may be essential in the disease progression of IgAN. While several clinical trials based on the immunosuppressive agents reported promising effects, it remains unclear whether such therapies really improve the long-term prognosis of IgAN.

Soit : Plusieurs stratégies thérapeutiques basées sur des corticostéroïdes ou d'autres agents immunosuppresseurs ont été montré à supprimer au moins partiellement la progression de IgAN. D'autre part, plusieurs rapports de cas de transplantation rénale ou acquise déficit en IgA découvert une remarquable capacité de rein humain pour éliminer les dépôts mésangiaux d'IgA, ce qui entraîne la stabilisation à long terme de la fonction rénale.

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