Ciudad Autonoma De Bs.as, Argentina

Natural History and Structural Functional Relationships in Fabry Renal Disease Treatment Outcomes(Changes)in Fabry Renal Disease Study

Fabry disease is a rare genetic disease with deficient activity of enzyme alpha-galactosidase A. Deficient activity of this enzyme leads to the accumulation of lipid-derived inclusions in different organs including kidney, heart and vessels. These inclusions can be found in the kidney even before birth. The earliest known clinical manifestation of Fabry kidney disease is the appearance of excess protein in the urine, which usually occurs in the second decade of life. However, our studies, as well as those of other investigators show evidence that kidney injury starts much earlier. Once excess protein is found in the urine, kidney function deterioration becomes progressive, and most Fabry patients require kidney transplantation or hemodialysis in the third to fifth decade of life. The lesion or composite of lesions responsible for functional deterioration of the kidney in Fabry disease are not well known. Their delineation using quantitative, unbiased, morphometric methods will help to understand this disease, and to develop surrogate structural outcomes for early intervention trials. Enzyme replacement therapy may stabilize kidney function. However, its long-term effect on kidney survival is not known. Moreover, there is no early known predictor of kidney dysfunction to adjust and evaluate effectiveness of enzyme replacement therapy. Our studies of renal GL-3 clearance comparing pre-and post-ERT renal biopsies using the above methods will allow us to determine whether age at institution of treatment and ERT dose affect ERT induced GL-3 cellular clearance, especially from those cells where ERT is less effective, i.e., podocytes, vascular smooth muscle cells and distal tubular cells. Finally, it is our hypothesis that mosaicism in Fabry disease females is such that cells such as podocytes are either affected or normal and that ERT clearance in the affected podocytes in females will, as in males, be dependant on age of institution of treatment and ERT dose.

Canadian Fabry Disease Initiative (CFDI) National Registry

CFDI NATIONAL REGISTRY: Canada-Wide Patient Recruitment There are over 600 people in Canada known to have Fabry Disease. For more details about Fabry Disease, please refer to the "Brief Summary." The goals of this nation-wide study are as follows: 1. To maintain an established national registry which will collect information related to the identification and monitoring of all persons with Fabry disease in Canada; 2. To determine clinical outcomes of patients with Fabry disease including those on treatment; 3. To determine if urine and plasma Gb3 and globotriasylsphingosine (LysoGb3) and their analogues can be biomarkers for Fabry disease and can predict clinical outcomes. Data will be collected at baseline and every 12 months, as follows: - Medical History - Physical examination - Neurological exam - Electrocardiogram (ECG) - an electrical tracing of one's heart rhythm - Echocardiogram (ultrasound of the heart) - Holter monitor - Magnetic Resonance Imaging (MRI) or CT Scan of the head - Lab tests (including alpha-galactosidase levels) - Review of current medications - 24-hour urine collection or a random spot urine test - Biomarker samples To date though, evidence of the usefulness of ERT and its direct impact on the natural course of Fabry disease has been limited, while its cost continues to be very high (approximately $300,000 CDN per year per patient). As a result of these issues, there will need to be continued and long-term collection of information related to the effectiveness of ERT and other treatments to better document its true clinical outcomes in Canadian people with Fabry disease.

Fabry Disease Registry & Pregnancy Sub-registry

Safety and Efficacy of PRG-1801 for Refractory Lupus Nephritis and IgG4-Related Disease

Safety and Efficacy of PRG-2311 for Refractory Lupus Nephritis and IgG4-Related Disease

Novel Treatments in Improving Renal Outcomes in Light Chain Cast Nephropathy

Objective 1: We will collect data from patients treated with plasma exchange from major centers across the United States to investigate whether plasma exchange improves renal outcomes. Specifically, we will collect data on at least 150 patients treated with plasma exchange along with 300 control patients not treated with plasma exchange. Objective 2: We will compare renal outcomes among patients with light chain cast nephropathy and AKI treated with plasma exchange (n=150) versus daratumumab based regimen (eg Dara-CyborD) (n=150) versus other novel regimens (e.g., CyborD or another non-daratumumab-based regimen) (n=150). We will examine whether patients who receive dara-based regimens are more likely to have renal recovery compared to patients who do not receive dara-based regimens and to patients who receive plasma exchange. Given the infrequency with which plasma exchange is performed on a single-center level, we will compare outcomes among patients treated with plasma exchange, utilizing data from the multicenter study to those patients who were treated with daratumumab-based regimens without plasma exchange versus non- daratumumab-based regimen.

Evaluation of the Effect of Finerenone on Renal Function in Patients With Type 2 Diabetes and Chronic Kidney Disease

Project Title Evaluation of the Effect of Finerenone on Renal Function in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Prospective, Single-Arm, Multicenter Clinical Study The Objective of the Study Primary Objective: Evaluate the effect of finerenone on renal function in patients with Type 2 diabetes and chronic kidney disease. Secondary Objectives: Assess the impact of finerenone on the progression of diabetic retinopathy, diabetic peripheral vascular disease, and diabetic neuropathy in patients with Type 2 diabetes and chronic kidney disease. Safety Objective: Evaluate the general safety of finerenone in patients with Type 2 diabetes and chronic kidney disease. Study Design This study is a prospective, single-arm, multicenter clinical trial conducted in patients with Type 2 diabetes and chronic kidney disease. It aims to evaluate the efficacy and safety of finerenone over a 48-week follow-up period, with a total of 300 participants. Total number of patients 300 participants The Selection of patients Inclusion Criteria: Diagnosed with Type 2 diabetes according to the 1999 WHO criteria; aged ≥18 years; UACR ≥30 mg/g and eGFR ≥30 ml/min/1.73 m² sustained for over 3 months, with stable ARB/ACEI treatment for ≥4 weeks prior to enrollment; willing to sign a written informed consent and comply with the study protocol. Exclusion Criteria: Chronic kidney disease diagnosed before Type 2 diabetes. Serum potassium >4.8 mmol/L. Ineffective blood pressure control at screening (systolic BP ≥160 mmHg and/or diastolic BP ≥100 mmHg, average of three measurements in the supine position). HbA1c >9%. Acute urinary tract infection or conditions affecting urine tests. Primary or secondary adrenal insufficiency. Use of mineralocorticoid receptor antagonists. Use of medications with clear effects on urine protein and eGFR within 4 weeks (except kininogenase). Use of strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, ritonavir, nelfinavir, cobicistat, clarithromycin, telithromycin, nefazodone, carbamazepine). ALT or AST >2.5 × ULN, total bilirubin (TBIL) >2 × ULN. Use of systemic glucocorticoids for more than 7 days within 12 weeks prior to screening, or use of systemic glucocorticoids (intravenous/oral or intra-articular) or need for systemic immunosuppressive treatment within the past 14 days. Any organ system cancer within the past 5 years, whether treated or untreated. Known pregnancy (positive pregnancy test), breastfeeding, recent plans for conception, or not using adequate contraception. Participation in other interventional clinical trials within 3 months prior to screening. Any severe systemic disease or other factors deemed inappropriate for study participation by the investigator. Intervention Plan / Observation Plan On top of the existing stable treatment regimen, add Finerenone 10-20 mg once daily (qd). If eGFR <60 mL/min/1.73 m² at enrollment, administer 10 mg qd; if eGFR ≥60 mL/min/1.73 m², administer 20 mg qd. Continue treatment for 48 weeks. Datas will be collected at baseline, 4 weeks, 12 weeks, 24 weeks, 36 weeks, and 48 weeks. Evaluation Indicators Primary Endpoint: Change in Urine Albumin-to-Creatinine Ratio (UACR). Secondary Endpoints: Change in 24-hour urine protein quantification. Change in eGFR before and after treatment. Change in blood uric acid levels before and after treatment. Change in the number and area of retinal microaneurysms/hemorrhages, hard exudates, and cotton wool spots. Change in pulse wave velocity (PWV). Change in Ankle-Brachial Index (ABI). Changes in echocardiographic measurements. Electromyography (EMG) (optional). Safety Endpoints: Serum potassium Serum sodium Blood pressure Statistical analysis Statistical analysis will be performed using R language. For normally distributed continuous data, mean ± standard deviation will be used for statistical description. For non-normally distributed data, median (P25, P75) will be used for statistical description. The comparison of quantitative data such as UACR before and after treatment will employ independent samples t-tests. Multivariate regression analysis will be conducted to assess the influencing factors of each endpoint. Study Duration From October 1, 2023, to December 31, 2026

Study of Therapeutic Efficacy of Anti-CD19 CAR-T Cell Therapy in Patients With MDR-SRNS

At present, there is no effective treatment for Multi-drug resistant steroid resistant nephrotic syndrome (MDR-SRNS), which has a high risk of progression to kidney failure, and about 55% of patients will have disease recurrence after receiving kidney transplantation, which is in urgent need of new treatment methods. CAR-T therapy is an adoptive cell therapy that uses genetic modification technology to reprogram T cells and eliminate target cells expressing disease-related antigens through antigen-specific recognition.Since 2019, CAR-T cell therapy has been successfully applied to autoimmune diseases. Although no clinical data related to CAR-T treatment of nephrotic syndrome has been disclosed, CAR-T is effective for systemic lupus erythematosus and systemic sclerosis.Many kinds of autoimmune diseases such as chemical syndrome and idiopathic inflammatory dermatomyositis have good therapeutic effect. These results suggest that the therapeutic effect of CAR T cells may not be limited to systemic lupus erythematosus, but may also play a role in several different B-cell-mediated and autoantibody-driven human autoimmune diseases, which is expected to bring breakthroughs in the treatment of MDR-SRNS.The purpose of this study is to assess the safety and efficacy of the anti-CD19 CAR-T cells in the treatment of patients with MDR-SRNS.

CD19-Directed Chimeric Antigen Receptor Autologous T Cells (CART19) for Lupus

Lupus disease activity is associated with increased numbers of activated naïve B cells and polyclonal expansion of antibody secreting cells, indicating a central role for B cells in the pathogenesis of SLE. While traditional anti-CD19 antibody therapies have been utilized with varying success in the treatment of Systemic lupus erythematosus (SLE), CD19 directed cellular therapies have emerged as an attractive therapeutic option that may lead to immunosuppression-free remission in this population given the ability of CD19 directed CAR T cells to more deeply deplete the B cell compartment. Previous clinical experience utilizing CD19 directed CAR T cells in patients diagnosed with Systemic lupus erythematosus (SLE) have exceeded any other Systemic lupus erythematosus (SLE) therapeutic available; although, those clinical trials have treated a limited number of subjects. During this trial the test article will be CART19 cells transduced with a lentiviral vector to express anti-CD19 scFv:41-BB:TCRζ, administered by IV injection.

Amino Acid Supplementation in Continuous Renal Replacement Therapy