In a review paper entitled “Precision renal medicine: a roadmap towards targeted kidney fibrosis therapies”, published in the Fibrogenesis & Tissue Repair journal, researchers from the University Medical Center Göttingen, Germany discuss the evolution of molecular-targeted therapies in cancer medicine and how these can be applied for clinical use in chronic kidney diseases.
Renal fibrosis, the progressive connective tissue deposition and inflammation caused by the kidney’s limited capacity to regenerate after injury, is a common manifestation of several chronic kidney diseases. This condition leads to a continuous deterioration of renal function and eventually to renal failure, with patients requiring dialysis or kidney transplantation. At the cellular level, the main process causing renal fibrosis is the transformation of specialized epithelial cells into scarring mesenchymal cells, as the kidney heals from an injury. However, effective therapies against this pathology are still not available.
In this review paper authors discuss how cancer treatments have evolved from the use of generic chemotherapeutic drugs that target all rapidly dividing cells to molecularly-targeted agents against specific types of malignant cells. As novel analytical tools become available and further findings of cancer biology are unveiled, a rapidly increasing number of anti-cancer specific drugs become available. These targeted-therapies not only prevail over their nonspecific counterparts, but also raise support for the reclassification of cancers according to their molecular profiles and targets instead of the traditional histopathology and origin. The authors point out how the substantial findings about cancer that have been achieved over the past years have led to the emergence of the precision medicine area. This clinical branch aims at the development of targeted-therapies that take into account the genetic variability, environment and life-style of each patient. The USA program “Precision Medicine Initiative” announced early this year intends to extend patient directed-treatments to other diseases besides cancer.
Indeed, the authors suggest that a precision medicine approach should be followed in renal fibrosis trials to develop an effective therapy. Different studies suggest that renal fibrosis regression is possible, accompanied by the preservation of renal functions. While there are several ongoing trials using anti-fibrotics in chronic kidney diseases, most of these are done without the molecular profiling of the patients and also without kidney biopsies. Biopsies are usually omitted to avoid further complications of the kidneys, whereas anti-fibrotic drugs are used under the assumption they might be effective in all chronic kidney disease patients.
These are only some of the necessary challenges to overcome when applying precision medicine to treat renal pathologies. Others include the distinct pathways underlying chronic kidney disease development. Authors finish their work with a call-of-attention to the way that ongoing clinical trials are being conducted and their unsuccessful implementation into effective renal therapies, which might be highly improved if a precise medicine approach begins to be actively employed.