Журнал "Почки" №1 (19) 2017

Ïîãëÿä íà ïðîáëåìó / Looking at the Ðroblem
markers to distinguish these two forms, considering
that it is not always possible to do this using clinical
information alone, as this enables the most appropriate
treatment and management to be selected. The work of
Beck et al. presented a large step forward in the diagnosis
of MN, detecting the circulating antigens phospholipase
A2 receptor (PLA2R), IgG4, and thrombospondin
type 1 domain-containing 7A (THSD7A) in
the sera of primary MN patients [23]. However, there
is still the strong need for further markers that can be
used to stratify primary MN patients, given that the
aforementioned antigens only account for approximately
75 % of primary MN patients. Here, Smith et
al. employed MALDI-MSI to FFPE tissue of 20 patients
to evaluate the capability of this technology to
detect alterations in the tissue proteome of primary
and secondary MN patients and represented the first
example of MALDI-MSI being applied to FFPE renal
biopsies for this purpose. The positive results obtained
with this proteomic approach facilitated the detection
of a number of signals that could differentiate the different
forms of iMN that were positive to PLA2R or
IgG4 as well as distinguish primary from secondary
MN. In particular, MALDI-MSI was able to generate
molecular signatures of primary and secondary MN,
with one particular signal (m/z 1459), identified as
Serine/threonine-protein kinase MRCK gamma, being
over-expressed in the glomeruli of primary MN
patients with respect to secondary MN. Furthermore,
this proteomic approach detected a number of signals
that could differentiate the different forms of iMN that
were positive to PLA2R or IgG4 as well as a further set
of signals (m/z 1094, 1116, 1381 and 1459) that distinguish
these patients from those who were ne gative to
both. Although this study is only in the initial phase,
the preliminary results are encouraging and the line of
work holds a fair degree of promise. Following verification
on a larger cohort of patients, the signals detected
here could potentially represent future proteomic
markers of iMN [24].
All these studies show vast potential and represent
the value of employing modern proteomic techniques
for diagnostic purposes, particularly in CKD. It is
hoped that this already strong platform will encourage
further, more in-depth, studies that could eventually
reveal new specific and sensitive biomarkers that could
be used for the diagnosis, prognosis, and management
of renal disease. Renal diseases, as a very specific entity,
have been more widely investigated and understood
than ever before during recent decades. However, given
the ever increasing worldwide incidence of CKD,
in addition to advancements in analytical instrumentation,
it is both important, and possible, to obtain much
more molecular information than was ever possible.
Understanding the molecular nature of this disease will
open new horizons in its diagnosis management strategies.
A vast amount of information on this topic is accessible
on the OMICS international website which includes
open-access journals and other various information
(https://www.omicsonline.org/) as well as the CKD
database (http://www.padb.org/ckddb/).
Conflicts of interests: not declared.
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