Обоснование. Мембранозная нефропатия (МН) – иммунокомплексное гломерулярное заболевание, которое является наиболее частой причиной нефротического синдрома у взрослых. В многочисленных исследованиях установлено, что в развитии идиопатической МН ведущую роль играют антитела к собственным подоцитарным аутоантигенам, одним из которых является домен тромбоспондина 1-го типа, содержащий 7А (THSD7A). Цель. Изучить частоту выявления антител (АТ) к THSD7A в группе российских пациентов с МН. Материалы и методы. У 61 пациента с морфологически подтвержденной МН и 12 здоровых добровольцев, составивших контрольную группу, определены уровни АТ к THSD7A. Результаты. Уровни АТ к THSD7A у пациентов с МН и в контрольной группе статистически значимо не различались (110,9 [71,63; 210,62] и 159,25 [125,64; 231,97] пг/мл соответственно; p=0,111). При сравнении подгрупп анти-PLA2R-негативных пациентов и пациентов, не получавших иммуносупрессивную терапию, с контрольной группой статистически значимых различий в уровнях АТ к THSD7A также не выявлено (p>0,05). В группе МН анти-THSD7A-позитивным оказался 1 (1,6%) пациент – 60-летний мужчина с анти-PLA2R-негативной МН и наличием гормонально неактивных аденом обоих надпочечников и полипов толстой кишки (ворсинчатая аденома с очаговой умеренной дисплазией, тубуло-ворсинчатая и тубулярная аденома с очаговой умеренно тяжелой дисплазией). Заключение. THSD7-ассоциированная МН является редким вариантом МН и, как правило, выявляется у PLA2R-негативных пациентов. Всем THSD7A-позитивным пациентам следует проводить скрининг злокачественных новообразований.
Ключевые слова: мембранозная нефропатия, домен тромбоспондина 1-го типа, содержащий 7А, THSD7A, рецептор фосфолипазы А2 М-типа, PLA2R
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Background. Membranous nephropathy (MN) is an immunocomplex glomerular disease, which is the most common cause of nephrotic syndrome in adults. Numerous studies have established that autoantibodies against the target podocyte autoantigens, including the thrombospondin type 1 domain containing 7A (THSD7A), play a leading role in the development of idiopathic MN. Aim. To evaluate the prevalence of anti-THSD7A autoantibodies (anti-THSD7A AB) in a group of Russian patients with MN. Materials and methods. Serum titers of anti-THSD7A AB were tested in 61 patients with biopsy-proven MN and 12 healthy controls. Results. The prevalence of anti-THSD7A AB was not differing significantly in patients with MN and in the control group (110.9 [71.63; 210.62] and 159.25 [125.64; 231.97] pg/ml, respectively; p=0.111). When comparing subgroups of anti-PLA2R-negative patients and patients who did not receive immunosuppressive therapy with the control group, there were also no statistically significant differences in the Anti-THSD7A AB levels (p>0.05). In the MN group, 1 (1.6%) patient was anti-THSD7A-positive: a 60-year-old man with anti-PLA2R-negative MN and the presence of hormonally inactive adenomas of both adrenal glands and colon polyps (villous adenoma with focal moderate dysplasia, tubulo-villous and tubular adenoma with focal moderate severe dysplasia). Conclusion. THSD7-associated MN is a rare variant of MN and is usually detected in PLA2R-negative patients. Screening for malignancies in THSD7A-positive MN patients is proposed.
1. Debiec H, Guigonis V, Mougenot B, et al. Antenatal membranous glomerulonephritis due to anti-neutral endopeptidase antibodies. N Engl J Med. 2002;346(26):2053-60. DOI:10.1056/NEJMoa012895
2. Madaio MP, Salant DJ, Cohen AJ, et al. Comparative study of in situ immune deposit formation in active and passive Heymann nephritis. Kidney Int. 1983;23(3):498-505. DOI:10.1038/ki.1983.47
3. Beck LH Jr., Bonegio RG, Lambeau G, et al. M-Type Phospholipase A2 Receptor as Target Antigen in IdiopathicMembranous Nephropathy. N Engl J Med. 2009;361(1):11-21. DOI:10.1056/NEJMoa0810457
4. Qin W, Beck LH Jr., Zeng C, et al. Anti-phospholipase A2 receptor antibody in membranous nephropathy. J Am Soc Nephrol. 2011;22(6):1137-43. DOI:10.1681/ASN.2010090967
5. Hoxha E, Harendza S, Zahner G, et al. An immunofluorescence test for phospholipase-A₂-receptor antibodies and its clinical usefulness in patients with membranous glomerulonephritis. Nephrol Dial Transplant. 2011;26(8):2526-32. DOI:10.1093/ndt/gfr247
6. Akiyama S, Akiyama M, Imai E, et al. Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Clin Exp Nephrol.
2015;19(4):653-60. DOI:10.1007/s10157-014-1054-2
7. Hayashi N, Akiyama S, Okuyama H, et al. Clinicopathological characteristics of M-type phospholipase A2 receptor (PLA2R)-related membranous nephropathy in Japanese. Clin Exp Nephrol. 2015;19(5):797-803. DOI:10.1007/s10157-014-1064-0
8. Hara S, Goto S, Kamiura N, et al. Reappraisal of PLA2R1 in membranous nephropathy: immunostaining method influence and association with IgG4-dominant phenotype. Virchows Arch. 2015;467(1):87-94. DOI:10.1007/s00428-015-1754-3
9. Bobart SA, De Vriese AS, Pawar AS, et al. Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney Int. 2019;95:429-38. DOI:10.1016/j.kint.2018.10.021
10. De Vriese AS, Glassock RJ, Nath KA, et al. A proposal for a serology-based approach to membranous nephropathy. J Am Soc Nephrol. 2017;28:421-30. DOI:10.1681/ASN.2016070776
11. Hofstra JM, Beck LH Jr., Beck DM, et al. Anti-Phospholipase A(2) Receptor Antibodies Correlate With Clinical Status in Idiopathic Membranous Nephropathy. Clin J Am Soc Nephrol. 2011;6(6):1286-91. DOI:10.2215/CJN.07210810
12. Bech AP, Hofstra JM, Brenchley PE, Wetzels JF. Association of anti-PLA₂R antibodies with outcomes after immunosuppressive therapy in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. 2014;9(8):1386-92. DOI:10.2215/CJN.10471013
13. Ruggenenti P, Debiec H, Ruggiero B, et al. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy. J Am Soc Nephrol. 2015;26(10):2545-58. DOI:10.1681/ASN.2014070640
14. Kanigicherla D, Gummadova J, McKenzie EA, et al. Anti-PLA2R Antibodies Measured by ELISA Predict Long-Term Outcome in a Prevalent Population of Patients With Idiopathic Membranous Nephropathy. Kidney Int. 2013;83(5):940-8. DOI:10.1038/ki.2012.486
15. Quintana LF, Blasco M, Seras M, et al. Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy. Transplantation. 2015;99(8):1709-14. DOI:10.1097/TP.0000000000000630
16. Tomas NM, Beck LH Jr., Meyer-Schwesinger C, et al. Thrombospondin Type-1 Domain-Containing 7A in Idiopathic Membranous Nephropathy. N Engl J Med. 2014;371(24):2277-87. DOI:10.1056/NEJMoa1409354
17. Hoxha E, Beck LH Jr., Wiech T, et al. An Indirect Immunofluorescence Method Facilitates Detection of Thrombospondin Type 1 Domain-Containing 7A-Specific Antibodies in Membranous Nephropathy. J Am Soc Nephrol. 2017;28(2):520-31. DOI:10.1681/ASN.2016010050
18. Wang J, Cui Z, Lu J, et al. Circulating Antibodies against Thrombospondin Type-I Domain-Containing 7A in Chinese Patients with Idiopathic Membranous Nephropathy. Clin J Am Soc Nephrol. 2017;12(10):1642‑51. DOI:10.2215/CJN.01460217
19. Tomas NM, Hoxha E, Reinicke AT, et al. Autoantibodies against thrombospondin type 1 domain-containing 7A induce membranous nephropathy. J Clin Invest. 2016;126(7):2519-32.
DOI:10.1172/JCI85265
20. Tomas NM, Meyer-Schwesinger C, von Spiegel H, et al. A Heterologous Model of Thrombospondin Type 1 Domain-Containing 7A-Associated Membranous Nephropathy. J Am Soc Nephrol. 2017;28(11):3262-77. DOI:10.1681/ASN.2017010030
21. Hoxha E, Wiech T, Stahl PR, et al. A Mechanism for Cancer-Associated Membranous Nephropathy. N Engl J Med. 2016;374(20):1995-6. DOI:10.1056/NEJMc1511702
22. Liu Y, Zheng S, Ma C, et al. Meta-Analysis of the Diagnostic Efficiency of THSD7A-AB for the Diagnosis of Idiopathic Membranous Nephropathy. Glob Chall. 2020;4(11):1900099. DOI:10.1002/gch2.201900099
23. Zaghrini C, Seitz-Polski B, Justino J, et al. Novel ELISA for thrombospondin type 1 domain-containing 7A autoantibodies in membranous nephropathy. Kidney Int. 2019;95(3):666-79. DOI:10.1016/j.kint.2018.10.024
24. Sharma SG, Larsen CP. Tissue staining for THSD7A in glomeruli correlates with serum antibodies in primary membranous nephropathy: a clinicopathological study. Mod Pathol. 2018;31(4):616-22. DOI:10.1038/modpathol.2017.163
25. Hara S, Tsuji T, Fukasawa Y, et al. Clinicopathological characteristics of thrombospondin type 1 domain-containing 7A-associated membranous nephropathy. Virchows Arch. 2019;474(6):735-43. DOI:10.1007/s00428-019-02558-0
26. Ren S, Wu C, Zhang Y, et al. An update on clinical significance of use of THSD7A in diagnosing idiopathic membranous nephropathy: a systematic review and meta-analysis of THSD7A in IMN. Ren Fail. 2018;40(1):306-13. DOI:10.1080/0886022X.2018.1456457
27. Leeaphorn N, Kue-A-Pai P, Thamcharoen N, et al. Prevalence of cancer in membranous nephropathy: a systematic review and meta-analysis of observational studies. Am J Nephrol. 2014;40(1):29-35. DOI:10.1159/000364782
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1. Debiec H, Guigonis V, Mougenot B, et al. Antenatal membranous glomerulonephritis due to anti-neutral endopeptidase antibodies. N Engl J Med. 2002;346(26):2053-60. DOI:10.1056/NEJMoa012895
2. Madaio MP, Salant DJ, Cohen AJ, et al. Comparative study of in situ immune deposit formation in active and passive Heymann nephritis. Kidney Int. 1983;23(3):498-505. DOI:10.1038/ki.1983.47
3. Beck LH Jr., Bonegio RG, Lambeau G, et al. M-Type Phospholipase A2 Receptor as Target Antigen in IdiopathicMembranous Nephropathy. N Engl J Med. 2009;361(1):11-21. DOI:10.1056/NEJMoa0810457
4. Qin W, Beck LH Jr., Zeng C, et al. Anti-phospholipase A2 receptor antibody in membranous nephropathy. J Am Soc Nephrol. 2011;22(6):1137-43. DOI:10.1681/ASN.2010090967
5. Hoxha E, Harendza S, Zahner G, et al. An immunofluorescence test for phospholipase-A₂-receptor antibodies and its clinical usefulness in patients with membranous glomerulonephritis. Nephrol Dial Transplant. 2011;26(8):2526-32. DOI:10.1093/ndt/gfr247
6. Akiyama S, Akiyama M, Imai E, et al. Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Clin Exp Nephrol.
2015;19(4):653-60. DOI:10.1007/s10157-014-1054-2
7. Hayashi N, Akiyama S, Okuyama H, et al. Clinicopathological characteristics of M-type phospholipase A2 receptor (PLA2R)-related membranous nephropathy in Japanese. Clin Exp Nephrol. 2015;19(5):797-803. DOI:10.1007/s10157-014-1064-0
8. Hara S, Goto S, Kamiura N, et al. Reappraisal of PLA2R1 in membranous nephropathy: immunostaining method influence and association with IgG4-dominant phenotype. Virchows Arch. 2015;467(1):87-94. DOI:10.1007/s00428-015-1754-3
9. Bobart SA, De Vriese AS, Pawar AS, et al. Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney Int. 2019;95:429-38. DOI:10.1016/j.kint.2018.10.021
10. De Vriese AS, Glassock RJ, Nath KA, et al. A proposal for a serology-based approach to membranous nephropathy. J Am Soc Nephrol. 2017;28:421-30. DOI:10.1681/ASN.2016070776
11. Hofstra JM, Beck LH Jr., Beck DM, et al. Anti-Phospholipase A(2) Receptor Antibodies Correlate With Clinical Status in Idiopathic Membranous Nephropathy. Clin J Am Soc Nephrol. 2011;6(6):1286-91. DOI:10.2215/CJN.07210810
12. Bech AP, Hofstra JM, Brenchley PE, Wetzels JF. Association of anti-PLA₂R antibodies with outcomes after immunosuppressive therapy in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. 2014;9(8):1386-92. DOI:10.2215/CJN.10471013
13. Ruggenenti P, Debiec H, Ruggiero B, et al. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy. J Am Soc Nephrol. 2015;26(10):2545-58. DOI:10.1681/ASN.2014070640
14. Kanigicherla D, Gummadova J, McKenzie EA, et al. Anti-PLA2R Antibodies Measured by ELISA Predict Long-Term Outcome in a Prevalent Population of Patients With Idiopathic Membranous Nephropathy. Kidney Int. 2013;83(5):940-8. DOI:10.1038/ki.2012.486
15. Quintana LF, Blasco M, Seras M, et al. Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy. Transplantation. 2015;99(8):1709-14. DOI:10.1097/TP.0000000000000630
16. Tomas NM, Beck LH Jr., Meyer-Schwesinger C, et al. Thrombospondin Type-1 Domain-Containing 7A in Idiopathic Membranous Nephropathy. N Engl J Med. 2014;371(24):2277-87. DOI:10.1056/NEJMoa1409354
17. Hoxha E, Beck LH Jr., Wiech T, et al. An Indirect Immunofluorescence Method Facilitates Detection of Thrombospondin Type 1 Domain-Containing 7A-Specific Antibodies in Membranous Nephropathy. J Am Soc Nephrol. 2017;28(2):520-31. DOI:10.1681/ASN.2016010050
18. Wang J, Cui Z, Lu J, et al. Circulating Antibodies against Thrombospondin Type-I Domain-Containing 7A in Chinese Patients with Idiopathic Membranous Nephropathy. Clin J Am Soc Nephrol. 2017;12(10):1642‑51. DOI:10.2215/CJN.01460217
19. Tomas NM, Hoxha E, Reinicke AT, et al. Autoantibodies against thrombospondin type 1 domain-containing 7A induce membranous nephropathy. J Clin Invest. 2016;126(7):2519-32.
DOI:10.1172/JCI85265
20. Tomas NM, Meyer-Schwesinger C, von Spiegel H, et al. A Heterologous Model of Thrombospondin Type 1 Domain-Containing 7A-Associated Membranous Nephropathy. J Am Soc Nephrol. 2017;28(11):3262-77. DOI:10.1681/ASN.2017010030
21. Hoxha E, Wiech T, Stahl PR, et al. A Mechanism for Cancer-Associated Membranous Nephropathy. N Engl J Med. 2016;374(20):1995-6. DOI:10.1056/NEJMc1511702
22. Liu Y, Zheng S, Ma C, et al. Meta-Analysis of the Diagnostic Efficiency of THSD7A-AB for the Diagnosis of Idiopathic Membranous Nephropathy. Glob Chall. 2020;4(11):1900099. DOI:10.1002/gch2.201900099
23. Zaghrini C, Seitz-Polski B, Justino J, et al. Novel ELISA for thrombospondin type 1 domain-containing 7A autoantibodies in membranous nephropathy. Kidney Int. 2019;95(3):666-79. DOI:10.1016/j.kint.2018.10.024
24. Sharma SG, Larsen CP. Tissue staining for THSD7A in glomeruli correlates with serum antibodies in primary membranous nephropathy: a clinicopathological study. Mod Pathol. 2018;31(4):616-22. DOI:10.1038/modpathol.2017.163
25. Hara S, Tsuji T, Fukasawa Y, et al. Clinicopathological characteristics of thrombospondin type 1 domain-containing 7A-associated membranous nephropathy. Virchows Arch. 2019;474(6):735-43. DOI:10.1007/s00428-019-02558-0
26. Ren S, Wu C, Zhang Y, et al. An update on clinical significance of use of THSD7A in diagnosing idiopathic membranous nephropathy: a systematic review and meta-analysis of THSD7A in IMN. Ren Fail. 2018;40(1):306-13. DOI:10.1080/0886022X.2018.1456457
27. Leeaphorn N, Kue-A-Pai P, Thamcharoen N, et al. Prevalence of cancer in membranous nephropathy: a systematic review and meta-analysis of observational studies. Am J Nephrol. 2014;40(1):29-35. DOI:10.1159/000364782
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*kamyshova_e_s@staff.sechenov.ru
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Patimat A. Kakhsurueva, Elena S. Kamyshova*, Irina N. Bobkova, Ekaterina V. Stavrovskaya, Tatiana E. Rudenko, Elena Yu. Andreeva