Nephrotic Syndrome Rare Disease Clinical Research Network

描述（由申请人提供）：局灶性和节段性肾小球硬化（FSGS）、微小病变疾病（MCD）和膜性肾病（MN）引起的肾病综合征（NS）是一组罕见疾病，可导致灾难性并发症和终末期肾病。尽管罕见，但这一疾病组产生了巨大的个人和社会经济负担。目前采用的，基于组织病理学的NS分类是不够的，未能捕捉这些疾病的分子基础。最近的发现，已经确定了家族性[孟德尔] FSGS的致病基因，表征MN的靶足细胞抗原，以及APOL1变体与非裔美国人NS患者FSGS组织学的相关性，提供了无可争议的证据，表明多种独特的疾病机制可以呈现难以区分的组织病理学。精确医学方法对于识别和执行导致NS的许多独特肾小球疾病中的每一种的特定疗法是必要的。这需要了解肾小球疾病的分子基础。在过去的4年里，NEPTUNE通过建立一个强大的调查基础设施，包括21个站点，招募了500多名严格分型的NS患者，提供生物材料和相关的详细临床数据，推进了NS患者的护理。此外，NEPTUNE还建立了强大的培训和辅助研究计划，向所有感兴趣的研究人员开放。在这项更新提案中，我们建议利用这些资源，进一步将临床上有意义的终点与肾小球疾病的共同和特定的遗传、分子和结构特征相关联，以产生一种新的分子NS分类法，从而发现新的治疗靶点和试验设计。两项队列研究将入组NS个体，（1）非裔美国人富集的重度NS和（2）活检前首次出现时的NS儿科队列。这些队列将增加NS疾病表型的关键部分，以反映NEPTUNE中的完整NS疾病谱。培训和试点项目将继续利用NEPTUNE的独特资源，并与患者利益集团NephCure合作，参与非专业社区，临床医生和科学家，以推进NS研究

DESCRIPTION (provided by applicant): Nephrotic Syndrome (NS) from Focal and Segmental Glomerulosclerosis (FSGS), Minimal Change Disease (MCD) and Membranous Nephropathy (MN) is a group of rare diseases that can cause catastrophic complications and end stage kidney disease. Despite their rarity, this disease group generates an enormous individual and societal economic burden. The currently employed, histopathology-based taxonomy of NS is inadequate and fails to capture the molecular bases of these diseases. Recent discoveries, which have identified causal genes in familial [mendelian] FSGS, the target podocyte antigen characterizing MN, and the association of APOL1 variants with FSGS histology in African American NS patients, provides indisputable evidence that multiple, unique disease mechanisms can present with indistinguishable histopathology. A Precision Medicine approach is necessary to identify and to execute specific therapies for each of the many unique glomerular diseases that result in NS. This requires understanding of the molecular bases of glomerular disease. Over the past 4 years NEPTUNE has advanced the care of NS patients by establishing a robust investigative infrastructure encompassing 21 sites, which has recruited more than 500 rigorously phenotyped NS patients, with biological materials and associated detailed clinical data. In addition, NEPTUNE has established robust training and ancillary study programs open to all interested investigators. In this renewal proposal, we propose to leverage these resources to further associate clinically meaningful endpoints with shared and specific genetic, molecular and structural features of glomerular diseases to generate a new, molecular NS taxonomy that will permit discovery of novel therapeutic targets and trial design. Two cohort studies will enroll NS individuals with (1) severe NS enriched for African Americans and (2) pediatric cohort with NS at time of first presentation prior to biopsy. These cohorts will add critical segments of NS disease phenotypes to reflect the full NS disease spectrum in NEPTUNE. Training and pilot programs will continue to leverage the unique resources in NEPTUNE and outreach in conjunction with patient interest group NephCure engaging lay communities, clinicians and scientists to advance NS research