“What Can I Do to Prolong the Life of My Kidneys?” June 1, 2018 by Lauren Eva Read our expert panel’s answers to this community-generated question. Mindy Banks, MD Rocky Mountain Pediatric Kidney Center Denver, CO FSGS, or focal segmental glomerulosclerosis, is a diagnosis that is made based on kidney biopsy often after it is noted that a person has high amounts of protein in the urine, high cholesterol, and/or swelling. Hypertension and progressive kidney dysfunction can also be a part of the disease. FSGS is really a descriptive term where scarring is found in segmental portions of the some of the filtering units of the kidney, also known as “glomeruli”. Because it is a descriptive term, there are actually many different underlying causes, including immunologic (essentially “autoimmune” in nature, often responsive to medications that suppress the immune system), genetic, viral (such as HIV), obesity, severe prematurity with intrauterine growth restriction, and even related to scarring from other primary disorders, such as lupus. Because there is such a wide range of causes of FSGS, there are also varying approaches to treatment. Often, medications such as prednisone or other steroids are first-line therapies. It is important to take these medications as prescribed and not miss doses because these medications can affect the normal functioning of the adrenal glands. Therefore, a person can become quite sick if doses are missed without their doctor knowing. Not taking medications as prescribed may also decrease their efficacy. Calcineurin inhibitors (tacrolimus and cyclosporine), are also commonly prescribed. These medications are time-sensitive and must be taken every 12 hours apart to achieve appropriate levels and not risk toxicity. These medications also have many significant interactions with food you may eat or other medications you may take. Other immunosuppressive therapies have been tried, including mycophenolate (CellCept), rituximab, plasmapheresis, LDL pheresis, and abatacept, each with its own side-effect profile. Being your own advocate and discussing options in detail with your provider is important to make sure you understand the medications you are taking, how to take them, and what the risks are. Without this knowledge, you may not be getting the medications’ full benefit and be putting yourself at unnecessary risk. Non-immunosuppressive interventions are also important. ACE inhibitors (such as lisinopril or enalapril) or ARBs (such as losartan) are blood pressure medications that are also useful to help reduce the protein in the urine by preferentially decreasing pressure inside the filtering units of the kidneys. Statins, which are high cholesterol medications, can also be very helpful. Water pills such as Lasix/furosemide may also be necessary to control swelling. Good diet and exercise are also important parts of the equation. Restricting sodium in the diet helps reduce the amount of diuretic that may be needed and thus, limit side effects. A low-sodium diet can also help with hypertension. Protein is not usually restricted if someone is spilling significant amounts of protein in the urine. Controlling obesity also limits the stress on the kidneys and can slow progression of the FSGS. Certainly, avoiding smoking is critical to the lifespan of any kidney. Having an FSGS diagnosis can profoundly impact a person’s life. However, it is important to know that you have the power to make a difference in your health. It is important to work with your providers to come up with a healthcare plan that works individually for you. Find a team that you trust and communicate well with. Be involved and be your own advocate. Lastly, find a support group to help you through this. Treating your mental health is just as important as treating your physical health. You are not alone and you can do this! Dr. Mindy Banks is board-certified in pediatrics, internal medicine, adult nephrology and pediatric nephrology. Her combined internal medicine/pediatrics training was at Nationwide Children’s Hospital in Columbus, Ohio. She continued her medical training in the Midwest with fellowship at Northwestern University Hospital and Lurie Children’s Hospital in Chicago. Her medical practice focuses on children and young adults with the whole spectrum of kidney diseases ranging from frequent urinary tract infections to hypertension, nephrotic syndrome, dialysis and post kidney transplant care. She lives in Denver, Colorado with her husband and 3 boys. Besides nephrology, her life is spent either with sticky fingers from crafting or baking or sitting sidelines at a soccer game. Diane K. Jorkasky, MD, FACP Complexa, Inc. Berwyn, PA Having been in clinical research for 30 years as well as having been in practice in nephrology, I have seen as new medicines have come to make a huge difference in patients’ lives. Unfortunately, few of those medicines have benefited kidney disease. When I advise a patient on how best to manage their disease, I think about how I advise my own parents. The first is to make sure you read and know as much about the disease as you can. You have to do your homework. But you have to be careful as there is a lot of misinformation out there, especially on the internet. I would turn to sources such as NephCure Kidney International or other patient advocacy organizations as they provide extremely important and correct information to patients. The patient with the disease is always first in their minds. Do not be afraid to ask your doctor questions! A good doctor always takes the time to speak to their patients, no matter how busy they are. Write down your questions and take the list with you when you see your doctor. If the doctor ignores your questions or dismisses them, I would look for another doctor. The second thing is to ensure that you follow the instructions that your doctor recommends. All kidney diseases, regardless of cause, will get worse if your blood pressure is abnormally high, for example. Taking your blood pressure as prescribed and watching your diet is extremely important for patients with kidney disease and Nephrotic Syndrome. Finally, it is important to ask your doctor about clinical trials that may be ongoing or are about to start for new medicines that could benefit your kidney disease. Many of the current medicines used in kidney disease have severe side effects, like prednisone. Do not assume that your doctor knows what new medicines may be available for use in a clinical trial. NephCure and some, but not all, disease advocacy websites may list the drugs, the studies and the nephrology practices in the country where trials are being conducted. The only way that old, poorly effective and very risky drugs can be replaced with good ones that truly make a difference in the disease is by studying them in clinical trials. There are now more drugs than ever being considered for the treatment of FSGS and other kidney diseases. I would encourage patients to think about exploring these opportunities. Your physician can guide you on this journey as well. Be inquisitive, as it can make a difference in your life. Diane Jorkasky, MD, is Executive Vice President, Chief Medical Officer, and Head of Development at Complexa Inc. (Berwyn, PA), a patient-focused, science-driven, clinical stage biopharmaceutical company developing a novel class of compounds, Nitrated Fatty-Acids, for the safe and effective treatment of debilitating fibrotic and inflammatory diseases. She has over 30 years of experience in the pharmaceutical industry across all phases of clinical research and development for a broad range of drugs in multiple therapeutic areas. Diane currently serves on the Board of Directors for OSE Immunotherapeutics (Paris, France), the Scientific Advisory Boards of Sigilon (Cambridge, MA) and Alzheon (Framingham, MA) and the Strategic Advisory Board of BioMotiv. She is also a member of the faculty at the University of California at San Francisco and Uniformed Service of Health Sciences Medical Schools. She serves on the executive committee of the American Course on Drug Development and Regulatory Science. Diane has published over 100 peer-reviewed articles and teaches internationally on drug development. She received her MD from the University of Pennsylvania, where she also completed her nephrology fellowship. In 2016, she was awarded the Elizabeth Kirk Rose Woman in Medicine Award by the University of Pennsylvania. She holds board certifications in clinical pharmacology, nephrology and internal medicine. Diane obtained her BA in Chemistry from the College of Wooster, where she was honored with the Distinguished Graduate award in 2013. Jenna Henderson, ND Holistic Kidney New Paltz, NY FSGS and Minimal Change patients from all over the world consult with our naturopathic clinic, Holistic Kidney. Many of them are looking for alternatives to medications or as adjunct therapy for when medications help somewhat but they are still not able to reach full remission. Naturopathic doctors are the only healthcare professionals with broad training in both botanical medicine and pharmacology. I can tell if a particular herb would work well with a patient’s current prescription medications. I don’t encourage patients to abruptly stop any medication, but over time, we may be able to reduce the need for some medications. We recommend plant-based supplements and dietary changes to reduce kidney inflammation and proteinuria. We also address long term cardiovascular health and bone density issues for patients. The connection between Nephrotic Syndrome and low-thyroid hormones is often not talked about, even though many kidney patients report feeling chronically cold. This is something we address. We also consider chronic insomnia, which is very common with Nephrotic Syndrome. By looking at Nephrotic Syndrome from different perspectives, we are able to use natural medicine to reduce kidney stress and improve kidney function. Dr. Jenna Henderson’s practice, Holistic Kidney, is dedicated to the unique needs of renal patients with an international clientele and patients on 6 continents. A kidney patient herself for over 25 years, she has experienced all stages of kidney disease firsthand. She is a graduate of the University of Bridgeport. Dr. Henderson has had several articles on kidney health published in Townsend Letter, Natural Medicine Journal, and NDNR. She has lectured extensively across the U.S. to naturopathic doctors, kidney patients and kidney professionals, and co-hosted the radio show Improve Your Kidney Health. Dr. Henderson seeks to bridge the gap between mainstream nephrology and natural medicine. In her practice, she helps patients sort through often conflicting information to understand what is appropriate for their individual needs and stage of kidney function. She is often able to help patients delay the need for dialysis. For those already in kidney failure, she helps patients find optimal wellness with dialysis or a transplant. She holds a naturopathic license in the state of CT and has recently relocated to New Paltz, NY. For more information, visit www.holistic-kidney.com.
Dr. Peter Mundel, Kidney Disease Researcher May 31, 2017 by Lauren Eva Why I Do What I Do: Spotlight on Dr. Peter Mundel, Kidney Disease Researcher Dr. Peter Mundel is a physician-scientist who has spent the past 30 years studying kidney cells called podocytes, which are specialized cells with a central role in glomerular diseases like FSGS. Dr. Mundel has been an esteemed member of NephCure’s Scientific Advisory Board since 2007, and in 2011, NephCure helped fund his work by providing him with a bridge grant. A major focus of his work has been the development of new, targeted treatments for patients with FSGS and other glomerular diseases. Last year, he left his professorship at Harvard Medical School/Massachusetts General Hospital to lead the research of a new start-up company called Goldfinch Bio, a biotechnology company that is singularly focused on discovering and developing precision therapies for kidney disease. We spoke with Dr. Mundel about his work and what inspired him to leave academia to create new treatments for people living with FSGS and Nephrotic Syndrome. NKI: How did you first become interested in studying the kidney? What is it about glomerular diseases specifically that interests you? Dr. Peter Mundel Dr. Mundel: I first became interested in studying the kidney when I was in medical school, back in Germany in the late ‘80’s. I had joined the laboratory of Dr. Wilhelm Kriz, who was one of the leading investigators in the field. At that time, there was nothing known about podocytes. They were considered passive bystanders. Everybody was thinking about mesangial cells and their role in the pathogenesis of kidney disease. So, I saw an opportunity and I entered the field and started to work on podocytes, and that’s what I focused on for 30 years since then: I got into the biology of these cells, learned about their function in health and disease, and then later of course I was trying to find podocyte-targeted therapies. But it all started 30 years ago in medical school in Germany. I still remember how I would sit with Professor Kriz in his office and we would say “one day we should develop podocyte protective medicines.” That’s what we said, and 30 years later, we’re doing it! NKI: Could you tell us about your discovery process of deciding to study a new drug? I am thinking specifically of abatacept because many people in our community are familiar with it, and I know you were instrumental in discovering its use in treating Nephrotic Syndrome. Dr. Mundel: We can definitely talk about the abatacept story, because it has good parallels, and it also helps explain what brought me to Goldfinch Bio. We identified B7-1/CD80 in podocytes, way back at my lab in Heidelberg, using differential Display PCR, a technique that allows you to monitor changes in gene expression between normal and diseased cells. We had our first paper on B7-1 in 2004 in The Journal of Clinical Investigation, where we showed that B7-1/CD80 has a role in podocytes in proteinuria, in addition to its role in the immune system. We studied the role of B7-1/CD80 in podocytes for another for 10 years, and then we began studying the use of abatacept [which targets CD80/B-71] in patients. What’s interesting with abatacept is that we now know that there is a subgroup of patients that respond well to this drug. Going forward, the challenge will be in identifying with precision who are these patients for whom it will work. There is no silver bullet: not every patient with Nephrotic Syndrome and FSGS will respond to the same drug. Some people will respond to abatacept and some people will respond to some as-yet-unidentified new drug. We will need to take a precision medicine approach. Knowing this, we will now need to define patients molecularly—not by saying they have FSGS or proteinuria, but by saying they have proteinuria driven by CD80/B7-1, or by protein ‘X’ or protein ‘Y’. That is exactly what our colleagues in oncology do: when you have a mutation in BRAF [which causes, for example, skin cancer or melanoma], you get a BRAF blocker for your melanoma. At Goldfinch, we are basically bringing the oncology playbook to the kidney space. We need to figure out who will respond to which drug, and we will need to use people’s genetics to identify targets for new, specific drugs. I think abatacept was the first stop at personalized medicine. When our paper [on abatacept] came out, there was an accompanying editorial by Börje Harraldsson that said exactly that—“A New Era of Podocyte-Targeted Therapy.” There is a trial going on with abatacept right now. I’m very pleased about that, because if you see in our original New England Journal of Medicine (NEJM) paper, patient number 5, this woman was on and off all kinds of drugs. But abatacept works so well for her that she is now in complete remission. And now, in her late 20’s, for the first time she has a good life; she enjoys her life. She doesn’t go from medicines with side effects to being hospitalized as she used to. I think this is a great success, because this is an idea that started in my lab almost 20 years ago. Because of this work, there is someone who really feels good and has a good life. And so as I said, the challenge now is to find all those patients who will respond to each of our precision treatments. NKI: Wow. That must make you feel incredible to know that years and years of your research led to this woman finally feeling like she could have a good life. Dr. Mundel: It’s a humbling experience. It’s very humbling that I had the privilege to have an impact on someone’s life. Because you see, I’m an MD by training, but after medical school I have only done research. But indirectly I act like a physician—I don’t treat her myself, but because of my work, she now has a better life, and I’m very happy for her. For all of our patients at NephCure that we care about with FSGS and Nephrotic Syndrome, I think this is a beacon of hope. For some of them [abatacept] will work too, and for others we will now find new drugs. But it clearly shows that the overall idea of finding podocyte protective drugs is a good idea, and it can work. NKI: So in the future, how would what you’re describing work? Would patients come in to their clinician and have gene mapping done, and when the results come in, their clinician would know exactly how to treat them? Dr. Mundel: That is basically the end goal. At Goldfinch, we are building a patient registry where we will sequence thousands of patients with FSGS. This will allow us to stratify patients, so when we have a drug that we know will work for a certain pathway or mutation, we will be able to select patients who can benefit from this drug. We will be able to say, “You have a mutation in protein ‘X’, so we are giving you a drug correcting the effects of protein ‘X’ mutation.” That’s the targeted approach that we’re talking about when we refer to precision medicine. At the same time, we need to identify more causes of FSGS. The work done by Dr. Martin Pollak and Dr. Friedhelm Hildebrandt has identified a lot of these genes, and there are even more to be found. What their work shows is that there is a genetic underpinning of FSGS. At Goldfinch, we will continue that work and work closely with many academic collaborators. So to answer your question more directly, down the road what you described is exactly what we are going to bring to patients with kidney diseases. At some point, the patient comes in and they have proteinuria, and their doctor will do a genetic test. Right now, we can do it for about 70 or 80 genes [that are associated with FSGS and Nephrotic Syndrome], somewhere in that ballpark. Down the road, there may be hundreds, and patients will be tested for them. And we will have different medicines, so based on the patient’s mutation, we will be able to give them a specific treatment. We will no longer give patients nonspecific steroids or cyclosporine, but instead give them a targeted medicine because we will understand exactly what’s causing the disease. That’s what we want to do at Goldfinch—bring this personalized medicine to patients with FSGS. NKI: Right, and that way they’re not wasting time cycling through drugs that aren’t working, and in the meantime, not just not having a very great life, but also heading towards end stage kidney disease. That will save a lot of time. Dr. Mundel: Exactly. That’s the other goal—we want to prevent patients with FSGS to progress to end stage kidney disease and from going on to dialysis. At Goldfinch, our goal is to prevent people from going on to dialysis or needing a transplant—to stop the disease in a specific way by addressing the root cause. NKI: This is fascinating. And before you mentioned Dr. Pollak and Dr. Hildebrandt’s work, which has been funded in part by NephCure, I was going to refer to it and say, it’s really interesting from an outsider’s view how all this research is culminating: the genetic research, and drug discovery research, and podocyte research. It seems like it’s finally all coming together. Dr. Mundel: Oh, absolutely. Let me give you a prime example. My own work has been focused on the podocyte actin cytoskeleton. Independently, over the last five or six years, geneticists identified several FSGS causing mutations affecting the podocyte cytoskeleton. We now understand the genetics of the podocyte cytoskeleton, and this dovetails with what we understand about the biology. We are living in a time when genetics and biology are coming together. When you have both, then you can have the precision and the tools to make a targeted therapy. NKI: Wow, what an exciting time to be a glomerular disease researcher. That excitement and that feeling of being just around the corner, that must have been part of what led you to leave academia. You had a very distinguished position at Harvard, and you left it to join Goldfinch Bio. That speaks volumes of your confidence in it. Dr. Mundel: It does, and I believe that what we’re doing is the right thing. I’ll tell you, when I first came to Harvard in 2010, I thought I would continue doing academic research until I die in my office. And then this amazing opportunity came. As we discussed, it’s the dovetailing of the biology and the genetics, but also the work done by Dr. Melissa Little and by Dr. Joseph Bonventre, who’s one of our founders. They showed that it is possible to make kidney organoids, which are “kidneys in a dish”. So now we have the ability to study human kidney disease, if you will, in a dish. There’s also been an explosion of technical data, where analyzing the genetic data is becoming cheaper and cheaper. And cloud computing has arrived, which we didn’t have five years ago. Now we have all the computational tools, the biological tools, the genetic tools to bring such a push to this field. It’s absolutely exciting. In 2008 we had a manuscript where we showed how cyclosporine, which is clinically used to treat NS, works on podocytes. Then we had the NEJM paper where we repurposed the drug abatacept from Rheumatoid Arthritis to patients with FSGS. Joining Goldfinch was the next logical step. I want to make new drugs targeting the causes of the diseases, and I think Goldfinch is the perfect place to do it. And as you said my confidence is reflected in the fact that I have left Harvard. I’m not on a leave of absence, I have not kept my professorship; I have shut down my laboratory and returned all my grants and funding. I want to focus on Goldfinch now, because by focusing on it we can do our best. I wholeheartedly believe in what we are doing here, and I wholeheartedly believe that we will be successful in helping our patients. They really need new treatments. There are no drugs approved in the US to treat FSGS, and the last approved therapy to treat proteinuric kidney disease occurred over 20 years ago. It is pretty much the same since I graduated from medical school in 1991 . It’s time to bring a renaissance and provide new therapies for our patients. For me there is no better mission than doing that. The goldfinch was a prominent symbol during the Renaissance, and signified hope and a new beginning. We chose to name our company Goldfinch Bio because we feel that the vision of our company is to lead a renaissance in developing new therapies for patients with kidney disease. I think it’s a sign of hope and optimism that there’s a new chapter, a new age that we are ushering in and that we want to lead. Because the patients deserve that we find good therapies for them. I’m proud to be part of the team here at Goldfinch that will do exactly that: find new therapies for patients with kidney disease. For me there’s nothing better that I can think of doing with my time. We were thrilled to speak with Dr. Mundel and learn more about his latest venture. Researchers like Dr. Mundel and many others provide us with real hope and conviction that we will one day find a cure for the diseases that cause FSGS and Nephrotic Syndrome. Since 1999, NephCure has helped provide funding for more than 50 research projects to learn more about causes and potential cures for the diseases that cause Nephrotic Syndrome. Today, these researchers are closer than ever to moving new treatments from the laboratory to the pharmacy shelf. Thank you for your commitment to this work, Dr. Mundel, and all who have dedicated their lives to eliminating these rare and chronic diseases! Dr. Peter Mundel is a past awardee of the esteemed American Society of Nephrology Young Investigator Award and a distinguished investigator who lead the Mundel Laboratory at Massachusetts General Hospital and Harvard Medical School from 2010 to 2016. In April 2014, Dr. Mundel received, jointly with Dr. Anna Greka, Renal Division, Brigham and Women’s Hospital, a 2014 Top 10 Clinical Research Outstanding Achievement Award from the Clinical Research Forum. In 2013, he and distinguished colleagues published the first targeted treatment for proteinuric kidney disease in the New England Journal of Medicine. (Abatacept in B-71; N Engl J Med 2013; 369:2416-2423). The associated editorial in the NEJM describes their discovery as a “New Era of Podocyte-Targeted Therapy for Proteinuric Kidney Disease.” Dr. Mundel attended medical school at the University of Heidelberg, Germany. He completed a Postdoctoral Research Fellowship in the program “Experimental Kidney and Circulation Research” at the University of Heidelberg, which was funded by the German Research Foundation. He is also the author or co-author of over 86 original research articles. Dr. Mundel’s research focus has been on the makeup and function of podocytes, key cells found in each of the one million separate filtration units packed into a single human kidney.
Potential FSGS Treatment Option To Be Tested In Phase 3 Clinical Trial April 2, 2017 by Kylie Karley Potential FSGS Treatment Option To Be Tested In Phase 3 Clinical Trial Early in March, Retrophin, Inc. announced plans to launch a phase 3 clinical trial to evaluate a potential therapy for FSGS patients. The therapy, called Sparsentan, successfully completed a phase 2 clinical trial in 2016 with promising results. The phase 2 clinical trial, known as the DUET Trial, showed a significant decrease in proteinuria for patients that received the therapy, and a greater proportion of patients that received Sparsentan during the trial reached partial remission. Retrophin plans to launch the phase 3 trial in the second half of 2017. Phase 3 clinical trials are meant to demonstrate the effectiveness of a drug to determine how valuable it may be in clinical practice. It is the last step of research before a drug becomes approved by the FDA for clinical use. The company is currently working with the FDA to approve the protocol for the clinical trial, which includes using the reduction of proteinuria as an endpoint to demonstrate the therapy’s effectiveness. If approved, Sparsentan would be the first FDA-approved drug for FSGS patients. NephCure will be working closely with Retrophin to bring awareness to this clinical trial and help bring the patient perspective to their research. To learn more about Retrophin, Inc. and Sparsentan, click here. To learn more about ongoing studies, click here.
NephCure Accelerating Cures Institute: Worldwide Launch and US Expansion March 23, 2017 by Lauren Eva The NACI Network is expanding worldwide to speed more effective treatments to individuals with Nephrotic Syndrome Thanks to a significant funding contribution, we’re proud to announce that the NephCure Accelerating Cures Institute (NACI) Care Network is expanding. An investment from Pfizer’s Centers for Therapeutic Innovation (PFE) and Retrophin (RTRX) will help grow the network from 8 sites to 30 sites worldwide. For patients living with Nephrotic Syndrome, more NACI sites means greater access to specialized care and trial opportunities specific to their unique kidney condition. Equally important, a more robust Network gives families across the globe a hub for community building and support at their individual care sites. NephCure Accelerating Cures Institute Global Trials Network The NACI story began in 2014, when leaders from NephCure Kidney International sought advice from leading medical professionals about ways to get better treatment options to patients faster. That following year, NKI launched NACI in partnership with the University of Michigan. Today, NACI is co-led by veteran representatives from NKI in suburban Philadelphia and an expert team from the University of Michigan, Ann Arbor. NephCure Accelerating Cures Institute United States Trials Network To read more about NACI, you can view the full press release here, or visit the NACI website at www.nephcureaci.org. If you have any questions or want to learn more, please send us an email at info@nephcure.org, and we will direct your message to the appropriate party.
Pharmaceutical Company ChemoCentryx Announces Plans for Potential New FSGS Therapy January 30, 2017 by Kylie Karley Pharmaceutical Company ChemoCentryx Announces Plans for Potential New FSGS Therapy Late last year, ChemoCentryx announced plans to launch a clinical trial in 2017 to evaluate a potential treatment option for FSGS patients. The treatment option, known as CCX140, successfully completed a Phase 2 trial (testing for safety and effectiveness) that included patients with diabetic nephropathy. ChemoCentryx is hoping that success indicates that CCX140 will be beneficial to FSGS patients. Currently, there are no FDA approved treatments for FSGS. NephCure is dedicated to supporting research efforts that would result in approved treatment options for FSGS patients, and we are excited about the potential of CCX140 to help the patient community. Please make sure to “like” us on Facebook and check our website regularly for updates on this development.
Q&A with Dr. Kopp of the NIH December 1, 2016 by Kylie Karley Dr. Jeffrey Kopp is a physician and researcher who focuses on FSGS and related diseases. He currently leads a group in the kidney disease section (officially called the National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK) of the National Institutes of Health (NIH). Dr. Kopp is also working on a new clinical trial for FSGS, MCD, and MN patients at the NIH headquarters near Washington D.C. We had the awesome pleasure of sitting down and catching up with Dr. Kopp about his fascinating job and new clinical trial. Keep reading to learn more, and read about some of his other research projects here. Interview highlights: Dr. Kopp works at the National Institute of Health’s kidney branch, where he studies glomerular diseases such as FSGS and MCD. He also serves as Captain for the United States Public Health Service, and has been deployed to help with medical care during natural disasters. Dr. Kopp is leading a new clinical trial for FSGS, MCD, and MN patients at the NIH studying a compound called ManNAc as a treatment option. ManNAc is a sugar that occurs naturally in your body. Another researcher at the NIH found that mice without ManNAc developed MCD, and adding ManNAc to their diet was helpful in treating it. Therefore, it may be effective at treating MCD, FSGS, and MN in humans (Dr. Kopp describes the full mechanism below—make sure you read the article!) This study requires people to stay at the NIH for 11 days total, but it can be split up into 2 trips. Luckily, there is a lot to do to pass free time you may have at the NIH, including movie marathons, exercise programs, an art gallery, and an in-house business center. Learn more about taking part in the study by clicking here or contacting Emily Brede, RN at emily.brede@nih.gov Full interview: NKI: What is your job at the NIDDK? Jeffrey B. Kopp, M.D. Dr. Kopp: I am fortunate to lead a translational research group at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which is part of the National Institutes of Health. Our mission is to develop a better understanding of the disease mechanisms responsible for focal segmental glomerulosclerosis (FSGS) and to develop more effective and less toxic therapies. I also serve in the United States Public Health Service, with a rank of Captain. My primary mission at NIH is to carry out basic and clinical research in FSGS. I also deploy for public health emergencies, such as natural disasters. Thus, I participated in the medical response to Hurricanes Katrina and Ike. SIDE NOTE: What is NIH? Dr. Kopp: The NIH is a federal biomedical research facility located in Bethesda, MD. The campus includes a 240-bed Clinical Research Center and extensive outpatient clinics. Every patient who comes to NIH participates in a research protocol. Some protocols involve novel treatments and other protocols involve giving samples for research. NIH physicians may give advice about standard therapies that can be used. There are no charges for any medical care provided by the NIH Clinical Center. NKI: What do you enjoy about CKD research? Dr. Kopp: CKD, and particularly glomerular diseases (such as FSGS), are incompletely understood, and the available therapies are not ideal. I like the challenge of understanding and treating these diseases, and most of all I like the opportunity to improve the lives of patients with these conditions. NKI: The newest clinical trial for FSGS, MCD, and MN patients at the NIH is looking at MaNAc as a treatment option. Why did you decide to study MaNAc? Dr. Kopp: A colleague at NIH developed mice unable to make ManNac. She found that these mice developed glomerular disease soon after birth. This disease resembled a human glomerular disease, minimal change disease. Providing extra ManNAc orally to the mice cured the kidney disease. This prompted the question: can we use ManNAc to induce remissions in our patients? Chemical Structure of ManNAc NKI: What is ManNAc? Dr. Kopp: Perhaps the word sounds to you like manna, the food the Israelites found in the desert and that helped sustain them. There is a tree in Europe that exudes a sweet white resin, similar to the sap of the sugar maple, and people who knew the Bible story called the tree the manna tree. A chemist found a distinctive and novel sugar in the manna resin, and he called the new sugar “mannose”. NKI: Does ManNAc occur naturally in the body? Is it found in food? Dr. Kopp: ManNAc is a natural product and essential for good health. Our food does not contain much ManNAc. Our bodies make ManNAc, which is converted in our cells to mannose. This in turn is converted to sialic acid, which is put on many proteins. All of these are sugars, but they differ from glucose in that they are not related to diabetes and they are present in very small amounts, so that they do not add calories in the diet. NKI: What is the reason for believing that ManNAc might be useful in treating glomerular diseases? Dr. Kopp: Podocytes are cells on the outside of the kidney glomeruli and serve to prevent plasma proteins from leaking into the urinary space. Many patients with glomerular diseases have lost sialic acid from the proteins on the podocyte. We think that providing extra ManNAc might promote the return of sialic acid to podocyte proteins and that this might improve podocyte function. We see some evidence in mouse models of FSGS that supplemental ManNAc in the diet helps treat these mice. NKI: What is involved for patients in this study? Dr. Kopp: Patients will provide their medical records for review by the NIDDK team. We also review the kidney biopsy materials from past kidney biopsy. No kidney biopsy is done as part of this study. If patients appear to qualify for the study, they will come to NIH for an outpatient visit for evaluation and to discuss study participation. NKI: Is travel to NIH paid for? Dr. Kopp: Travel to NIH can be arranged and provided by NIH. If overnight accommodation is needed, NIH can provide this also. NKI: Why are patients required to stay at the NIH during this study? NIH Headquarters Dr. Kopp: The study requires being an inpatient for 11 days, either as a single stay or as two stays of five and six days. The reason for the inpatient stay is allow frequent sampling of blood and urine and for safety, to be sure there are no side effects. NKI: What can patients do with any “free time” during the study? How much free time do you expect patients to have? Dr. Kopp: During the first five days, there are frequent time points for sample collection. During the second six days, samples are needed at 8 am and 8 pm. There is extensive free time that patients can use as they like. There are many activities that can help pass the time at NIH • Patient Computers combination television and computer (with Internet access) at most patients’ bedsides to provide access to games, web browsing, and personal e-mail via the Internet • Patient Library has more than more than 5,000 books, including a selection of current best-sellers, reference, foreign language, large-print, picture, and audio books • Clinical Center’s Fine Art Program has more than 2,000 works of art. Most artwork remains on permanent display throughout the hospital, but there are six galleries on the first floor that change every eight weeks. A walking tour is available to assist patients, caregivers and visitors in their enjoyment of the artwork on display. •Recreation Therapy programs include: o Arts and crafts o Music o Games and sports o Social events o Exercise o A large selection of DVD movies o Instruction in coping skills such as relaxation, enhanced communication, and stress management • Spiritual Care Department offers Catholic, Jewish, Islamic, and Protestant services in the interfaith chapel • Business Center has four PCs and four MACs (all with Internet connection) as well as a combined printer/copier/FAX and telephones are available. NKI: Who can participate in the ManNAc study? Dr. Kopp: We are recruiting adults (age ≥18 years) with a primary glomerular disease, including minimal change disease, FSGS, and membranous nephropathy, and with nephrotic range proteinuria (urine protein/creatinine ratio > 2 g/g). Exclusion criteria include having diabetes mellitus and receiving pulse therapies, such as rituximab. Monetary compensation is provided. NKI: How do I get more information about the study? Dr. Kopp: The study, like all clinical research studies, is described at clinicaltrials.gov. You also contact the study research nurse, Emily Brede, RN at Emily.brede@nih.gov
DUET Study Releases Preliminary Results (SPOILER it looks promising!) September 7, 2016 by Kylie Karley On September 7, 2016, Retrophin Inc. released the “Top Line” results from their recently completed DUET study, a Phase 2 clinical trial testing safety and efficacy of Sparsentan for FSGS patients. Results showed promise for Sparsentan’s effectiveness at reducing proteinuria in patients with FSGS, with one group of patients seeing an average reduction of 44.8%. The DUET study included 96 patients, and only one serious adverse side effect (anemia) was reported. All patients chose to extend their treatment with Sparsentan during the trial’s open label extension period. Alvin Shih MD, the executive vice-president for Retrophin Inc., said “significant reductions in proteinuria, along with a well-tolerated preliminary safety profile have us excited about being one step closer to providing a new treatment option for patients with FSGS.” NephCure Kidney International is excited about these results and support Dr. Shih’s hope that we are moving closer to providing a new, effective, and safe treatment option for FSGS patients. Mark Stone, Chief Executive Officer of NephCure Kidney International, remarked “These preliminary results are very exciting for our community. This gives us hope that better treatment options will be available for our families in the near future.” NephCure Kidney International would like to thank everyone who contributed time, talent, and resources to this study. Thank you, especially, to the patients and families who participated and helped bring effective treatments within reach. Read the official press release here