title: Clinical trials in minimal change disease.
abstract: Minimal change disease (MCD) is a pathological condition characterized by subtle glomerular lesions causing massive and reversible proteinuria that is usually steroid sensitive. Recurrence of symptoms of active disease following successful treatment (including proteinuria, oedema and oliguria) and steroid toxicity requires the use of other drugs to attain or maintain remission. Unresolved MCD is considered the initial step in the pathological pathway leading to focal and segmental glomerulosclerosis (FSGS). Historically, cyclophosphamide, chlorambucil, mycophenolate and calcineurin inhibitors have been utilized with success in MCD; however, the chronic nature of the disease and the toxicity of long-term use of these medications has pushed the development of new therapies. Synthetic corticotropin (adrenocorticotropic hormone) and anti-CD20 monoclonal antibodies, for example, are currently under investigation in clinical trials. In addition, these new interventions have dramatically impacted our understanding of the mechanisms of the disease. Phase II-IV clinical trials targeting new mechanisms and/or molecules are in progress. The list is long and includes drugs blocking the adaptive immune system (abatacept and anti-CD40 antibodies), as well as retinoids and the sialic acid precursor N-acetyl-D-mannosamine (ManNAc), two agents that affect the sieving properties of the glomerular basement membrane. Other drugs are being tested against FSGS and, if successful, could also be utilized against MCD. Clinical trials currently in progress should furnish a proper solution to what appears to be a solvable problem.
authors.affiliation: Division of Nephrology, Faculty of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Division of Nephrology, Dialysis, Transplantation, Giannina Gaslini Children's Hospital, Genoa, Italy.|Laboratory on Pathophysiology of Uremia, Giannina Gaslini Children's Hospital, Largo Gerolamo Gaslini 5, Genoa, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bertelli
authors.affiliation: Division of Nephrology, Faculty of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Simardeep
authors.initials: S
authors.lastname: Gill
authors.affiliation: Division of Nephrology, Dialysis, Transplantation, Giannina Gaslini Children's Hospital, Genoa, Italy.|Laboratory on Pathophysiology of Uremia, Giannina Gaslini Children's Hospital, Largo Gerolamo Gaslini 5, Genoa, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Ghiggeri
mesh_terms: D002986:Clinical Trials as Topic / Q000592:standards*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D013256:Steroids
keywords: FSGS; calcineurin inhibitors; minimal change disease; nephrotic syndrome; podocytes