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Published on: January 18, 2019
Multicentre comparative study of neural epidermal growth factor-like 1 protein vs M-type phospholipase A2
Subrahmanian Sathiavageesan1, Abirami Krishnan2, Krishnaswamy Sampathkumar3
1Department of Nephrology, Sundaram Hospital, Tiruchirappalli 620017, Tamil Nādu, India. spssubrahmanian@yahoo.co.in.
Background:
The understanding of membranous nephropathy (MN) has significantly evolved with the discovery of novel antigenic targets. M-type phospholipase A2 receptor-associated MN (PLA2R-MN) is the most common antigenic variant, followed by neural epidermal growth factor-like 1 protein-associated MN (NELL1-MN). Few studies have directly compared the outcomes of these two variants.
Aim:
To compare the outcomes of NELL1-MN with PLA2R-MN.
Methods:
In this retrospective cohort study, we compared the outcomes of NELL1-MN and PLA2R-MN using time-to-event analysis. Rate of remission - complete or partial - was the primary outcome of interest.
Results:
The 17 patients diagnosed with NELL1-MN during the study period were compared with 24 patients with PLA2R-MN diagnosed during the same month. Antecedent exposure to traditional indigenous medicines was more common in NELL1-MN than PLA2R-MN (70.6% vs 13%, P < 0.001). 11.8% with NELL1-MN had rheumatoid arthritis while none with PLA2R-MN had the same (P = 0.08). NELL1-MN showed a significantly higher remission-rate than PLA2R-MN (11.7 per 100-patient-months vs 5 per 100-patient-months, P = 0.01) and a shorter time-to-remission than PLA2R-MN (median: 7 months vs 13 months, P = 0.001). In multivariate Cox-regression, NELL1-MN was independently associated with a higher likelihood of remission compared with PLA2R-MN (hazard ratio = 2.65; 95% confidence interval: 1.25-5.64; P = 0.01). Spontaneous remission-rate was higher for NELL1-MN than PLA2R-MN (3.4 per 100-patient-months vs 0.3 per 100-patient-months, P = 0.01). Resistant nephrotic syndrome was more common among PLA2R-MN than NELL1-MN (2.5 per 100-patient-months vs 0 per 100-patient-months, P = 0.04).
Conclusion:
NELL1-MN has a favourable prognosis compared to PLA2R-MN. Antigen-specific outcomes research could inform prognosis and guide treatment strategies in MN.
Insights
Neural epidermal growth factor-like 1 protein-associated membranous nephropathy (NELL1-MN) shows a better prognosis than M-type phospholipase A2 receptor-associated MN (PLA2R-MN). NELL1-MN patients achieved higher remission rates and faster recovery times.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Membranous nephropathy (MN) understanding has advanced with new antigenic targets.
- M-type phospholipase A2 receptor-associated MN (PLA2R-MN) is the most prevalent variant.
- Neural epidermal growth factor-like 1 protein-associated MN (NELL1-MN) is another key variant, with limited comparative outcome data.
Purpose of the Study:
- To compare clinical outcomes between NELL1-MN and PLA2R-MN.
- To evaluate remission rates and time to remission in these MN variants.
Main Methods:
- Retrospective cohort study design.
- Comparison of outcomes between NELL1-MN and PLA2R-MN patients.
- Time-to-event analysis focusing on remission rates (complete or partial).
Main Results:
- NELL1-MN demonstrated significantly higher remission rates (11.7 per 100-patient-months) compared to PLA2R-MN (5 per 100-patient-months).
- Patients with NELL1-MN achieved remission faster (median 7 months) than those with PLA2R-MN (median 13 months).
- NELL1-MN was independently associated with a higher likelihood of remission (HR=2.65), and spontaneous remission was more frequent.
Conclusions:
- NELL1-MN presents a more favorable prognosis than PLA2R-MN.
- Antigen-specific research in MN is crucial for refining prognostic predictions and treatment strategies.
