title: Effectiveness of sulodexide might be associated with inhibition of complement system in hepatitis B virus-associated membranous nephropathy: An inspiration from a pilot trial.
abstract: BACKGROUND
  The activation of complement system is associated with the development of hepatitis B virus-associated membranous nephropathy (HBV-MN) and heparin could inhibit the activation of complement system.
  
  
  METHODS
  This was a three-center trial. Seventy-nine patients with HBV-MN participated in the study. The follow-up of the study consisted of two periods: Stage 1 (S1) and Stage 2 (S2). All patients received 0.5mg entecavir plus 150-300mg/day of irbesartan but sulodexide was prescribed during S1. They were randomized into 4 groups according to sulodexide dose: blank (Group 1), 250 lipasemic unit (lsu)/day for 1year (Group 2), 500 lsu/day for 1year (Group 3) and 1000 lsu/day for 6months followed by 250 lsu/day for 6months (Group 4). Major clinical outcomes were valid remission (VR): (1) urine albumin/creatinine ratio (UACR) <150mg/mmol and >50% decline of baseline; (2) albumin >35g/L; (3) glomerular filtration rate (GFR) >90ml/(min*1.73m(2)).
  
  
  RESULTS
  (1) Groups 3 and 4 had significantly lower UACR and higher albumin than did Groups 1 and 2 at major visits; (2) Groups 3 and 4 achieved more VR compared with Group 1 (42.1% and 60.0% vs. 9.1%, p both<0.05); (3) in Groups 3 and 4, instead of Groups 1 and 2, more C3 deposition in the kidney was observed in those achieving VR; (4) plasma C3a, C5a and C5b-9 decreased significantly in Groups 3 and 4 during S1.
  
  
  CONCLUSIONS
  (1) The prescription of both sulodexide and entecavir could improve the prognosis of patients with HBV-MN but their mechanisms might be different; (2) the renoprotection of sulodexide in HBV-MN might probably relate to the inhibition of complement system.
authors.affiliation: Kidney Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Ma
authors.affiliation: Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Haerbin Medical University, Haerbin, China.
authors.forename: Deyang
authors.initials: D
authors.lastname: Kong
authors.affiliation: Department of Nephrology, General Hospital of Beijing Military Region, Beijing, China.
authors.forename: YaPing
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Kidney Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: kidneyM@163.com.
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D003165:Complement System Proteins / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000821:virology; D006025:Glycosaminoglycans / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy*; D006515:Hepatitis B virus; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D000998:Antiviral Agents; D001713:Biphenyl Compounds; D006025:Glycosaminoglycans; D013777:Tetrazoles; C413685:entecavir; D006147:Guanine; C007858:glucuronyl glucosamine glycan sulfate; D003165:Complement System Proteins; D000077405:Irbesartan
keywords: Anti-virus therapy; Complement; Glycosaminoglycan; Hepatitis B virus; Membranous nephropathy