New biologics for glomerular disease on the horizon

The major advances achieved in immunology and cellular biology have led to the development of biotherapies that specifically target different mediators and pathways involved in the physiopathology of renal diseases. After the major breakthroughs obtained with B-cell depletion in autoantibody-mediated glomerulopathies, several other immunomodulation strategies are being tested in autoimmune glomerulonephritides, such as blockade of B-cell costimulation and activation, inhibition of complement pathways or modification of the T-B-lymphocyte crosstalk. Other drugs, inhibiting proinflammatory cytokines, are being developed in order to control the inflammatory response initiating and amplifying the kidney tissue injury observed in different systemic diseases. Finally, several promising therapeutic agents target specific renal cells such as podocytes or fibroblasts, blocking the common final steps of the deleterious pathological process underlying various types of nephropathy. Although several of these drugs are still under evaluation in phase 2/3 clinical trials, biotherapies have undoubtedly opened a new era in the treatment of glomerular disease.