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STEROID-RESISTANT IDIOPATHIC NEPHROTIC SYNDROME DEFINES A DISTINCT MALADAPTIVE MOLECULAR STATE.

ABSTRACT: INTRODUCTION: Idiopathic nephrotic syndrome (iNS) shows marked variability in treatment response, yet the molecular basis of multidrug resistance remains unclear. We hypothesized that multidrug-resistant nephrotic syndrome (MRNS) represents a distinct biological state rather than simply severe disease activity. METHODS: Serum proteomic profiling (LC–MS/MS) was performed in 165 pediatric and young adult patients with iNS, stratified by therapeutic phenotype (MRNS, steroid-dependent [SDNS], and multidrug-dependent [MDNS]). Differential protein expression was analyzed using pathway enrichment and machine learning–based approaches. Key biomarkers were validated by ELISA. Functional effects were evaluated in human podocytes exposed to patient-derived sera and in their peripheral blood mononuclear cells (PBMCs). RESULTS: Of 810 identified proteins, 322 differed significantly among groups. A 35-protein Random Forest signature discriminated MRNS from SDNS and MDNS. Integration of machine learning approaches identified dystroglycan 1 (DAG1), CD44 antigen (CD44), and RISC-loading complex subunit (TARBP2) as major contributors to group separation. Functional analyses revealed cytoskeletal disorganization, altered autophagy, inflammasome dysregulation, and increased endoplasmic reticulum stress in podocytes exposed to MRNS sera. A central mechanistic axis was the stress–survival imbalance with inverse regulation of the endoplasmic reticulum chaperon BIP (GRP78) and phosphorylated AKT (Ser473), a pattern also observed in peripheral blood mononuclear cells from MRNS patients. In contrast, sera from patients in remission showed phenotypes similar to those of healthy donors. CONCLUSIONS: MRNS represents a distinct molecular state characterized by systemic and organ-persistent stress activation and disrupted cellular homeostasis, whereas remission is characterized by a near-healthy profile. These findings support biomarker-guided stratification and therapeutic strategies aimed at restoring cellular balance rather than broadly suppressing immunity.

INSTRUMENT(S):

ORGANISM(S): Homo Sapiens (human)

TISSUE(S): Blood Serum

SUBMITTER: Martina Bartolucci

LAB HEAD: Andrea Petretto

PROVIDER: PXD074533 | Pride | 2026-07-16

REPOSITORIES: Pride

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			Action	DRS
	20230523_111644_sieri_sindrome_nefrosica_GruppiRivisti_Stringenza_Alta.sne	Other
	ALLOMI10092015_03102022_89.raw	Raw
	ALLOMI10092015_16022023_90.raw	Raw
	AMAN22081999_17022023_92.raw	Raw
	AMAN22081999_28102022_91.raw	Raw

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Project description:Altered immunoglobulin glycosylation has been implicated in antibody-mediated podocytopathies, yet the functional impact of IgM sialylation remains unclear. Previous evidence suggested that circulating cationic or hyposialylated IgM may contribute to podocyte injury in idiopathic nephrotic syndrome (iNS). Serum IgM from pediatric and young adult patients with podocytopathies, membranous nephropathy (MN), lupus nephritis (LN), and healthy controls were analyzed by lectin-based ELISA using a panel of six biotinylated lectins to detect terminal N-glycan residues. Among these, Sambucus nigra agglutinin (SNA) binds α2,6-linked sialic acid, and Ricinus communis agglutinin I (RCA-I) recognizes β1,4-linked galactose. Serum levels of the α2,6-sialyltransferase ST6GAL1 and the sialidases neuraminidase-1 (NEU1) and neuraminidase-3 (NEU3) were quantified. Cultured human podocytes were exposed to patient-derived, control, or enzymatically modified IgM (desialylated/resialylated) and analyzed by confocal microscopy, quantitative proteomics, phosphoproteomics, and metabolic assays. IgM from patients with podocytopathies showed reduced SNA binding, which inversely correlated with proteinuria (r = −0.69, P < 0.0001) and with serum sialidases NEU1/NEU3 (r = −0.67/−0.59, P < 0.0001). In paired samples, SNA reactivity decreased during relapse and normalized in remission, indicating dynamic modulation with disease activity. ST6GAL1 was undetectable in all groups. In contrast, PLA2R1-positive MN, in which pathogenic antibodies target podocyte PLA2R1, displayed reduced RCA-I binding. Podocytes exposed to hyposialylated or desialylated IgM exhibited actin disorganization, loss of nephrin signal, increased lipid peroxidation, and decreased ATP synthesis. In contrast, resialylated IgM preserved morphology and metabolism comparable to controls. Proteomic and phosphoproteomic profiling revealed enrichment of MAPK, mTOR, AMPK, and cytoskeletal remodeling pathways. IgM hyposialylation, driven by extracellular sialidases up-regulation, correlates with disease activity and promotes oxidative stress, mitochondrial dysfunction, and cytoskeletal remodeling in podocytes, identifying immune glycan remodeling as a modifiable determinant of podocyte injury and a potential biomarker of disease activity.

Project description:Focal and segmental glomerulosclerosis (FSGS) is a severe form of idiopathic nephrotic syn-drome (INS), a glomerulopathy of presumable immune origin and attributed to extrarenal path-ogenic circulating factors. FSGS recurrence (rFSGS) after transplant occurs in 30 to 50% of cases. Direct analysis of patient plasma proteome has been scarcely addressed to date, mainly due to methodological difficulties associated with plasma complexity and dynamic range. In this study, firstly we compared different methods of plasma preparation, secondly we compared the plasma proteome of rFSGS and controls using two preparation methods, and thirdly we analyzed the early proximal signaling events in podocytes subjected to patient plasma, by a combination of phosphoproteomics and lipid raft proteomics (raftomics). By combining immunodepletion and high pH fractionation, we performed a differential proteomic analysis of soluble plasma pro-teins and of extracellular vesicles (EV) obtained from healthy controls, non-INS patient controls, and rFSGS patients (n=4). In both soluble and EV protein sets from rFSGS patients we found a statistically significant increase in a cluster of proteins involved in neutrophil degranulation. A group of lipid binding proteins, generally associated with lipoproteins, was found decreased in the soluble set from rFSGS patients. In addition, three aminoacid transporters involved in mTORC1 activation were found significantly increased in EV from rFSGS. Next, we incubated human podocytes for 30min with 10% plasma from both groups of patients. Phosphoproteomics and raftomics of podocytes revealed profound differences in proteins involved in the mTOR pathway, in autophagy, and in cytoskeleton organization. We analyzed the correlation between the abundance of plasma and plasma-regulated podocyte proteins. The observed changes high-light some of the mechanisms involved in FSGS recurrence and could be used as specific early markers of circulating factor activity on podocytes.

Project description:Background: Minimal change nephrotic syndrome (MCNS) is considered to be associated with T cell dysfunction, via unknown mechanisms. Experimental observations suggest that some humoral factors alter the permeability of glomerular filtration barrier. However, the nature of such factors remains still uncertain. Methods: Using cDNA microarrays, we performed gene expression profiling of peripheral blood mononuclear cells (PBMC) from three patients with MCNS during nephrosis and remission phases. To confirm the cDNA microarray results, we performed quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) analyses in nephrosis and remission samples from 20 MCNS patients and six patients with nephrotic syndrome due to membranous nephropathy. Results: Out of 24,446 genes screened, 33 genes were up-regulated (at least 1.5-fold) in PBMC from these MCNS patients during the nephrosis phase. Up-regulated genes mainly encoded proteins involved in signal transduction and cytokine response. For further examination, we selected two genes encoding provable secretary proteins, chemokine (C-C) ligand 13 (also known as monocyte chemotactic protein-4) (CCL13) and a novel galectin-related protein (HSPC159). The results of RT-PCR showed that expressions of CCL13 and HSPC159 mRNA in nephrosis PBMC samples are higher than those in remission PBMC samples from all 20 MCNS patients examined. On the other hand, these mRNA expression patterns were variable among six patients with membranous nephropathy. Conclusions: We conclude that CCL13 and HSPC159 mRNA expressions in PBMC is up-regulated in MCNS patients during the nephrosis phase. These expression changes in PBMC might be involved in the pathophysiologic processes of MCNS. Using cDNA microarrays, we performed gene expression profiling of peripheral blood mononuclear cells (PBMC) from three patients with MCNS during nephrosis and remission phases. To confirm the cDNA microarray results, we performed quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) analyses in nephrosis and remission samples from 20 MCNS patients and six patients with nephrotic syndrome due to membranous nephropathy.

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STEROID-RESISTANT IDIOPATHIC NEPHROTIC SYNDROME DEFINES A DISTINCT MALADAPTIVE MOLECULAR STATE.

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