|
| Treatments options | Description/usefulness | Drawback/limitation | Target molecule/cell |
|
| Prednisolone (glucocorticoids) | (i) Standardized treatment for MCD in children and adults [1, 11]
(ii) Responsiveness of infant towards prednisolone as diagnosis of MCD without biopsy | (i) Dreadful adverse effect [34]
(ii) Often used in combination with other medications
(iii) Exact mode of action is unknown [2]
(iv) Not useful for steroid-resistant MCD patients
(v) Not designed for MCD patients | (i) Glucocorticoid receptor, T helper subtype 2 (Th2) cytokines such as interleukin-4 and interleukin-13 [34] |
|
| Levamisole (synthetic imidazole) | (i) Useful in children but lack molecular explanation [37, 106]
(ii) Cheap, least toxic, and could prevent relapse [39] | (i) Availability issue [106]
(ii) Extremely high relapse followed by discontinued treatment [106] | (i) Modulates type 1 and type 2 immune response by enhancing interleukin-18 [107]
(ii) Glucocorticoid receptor’s signaling as critical target of levamisole’s action [37] |
|
| Cyclophosphamide (alkylating agent) | (i) The most effective and great experience in treatment for frequent relapse children and adults [1, 44]
(ii) Higher rate of cumulative sustained remission compared with cyclosporine [108] | (i) Various severe side effects reported including bone marrow suppression, bladder toxicity, gonadal toxicity, malignancy, hemorrhagic cystitis, gastrointestinal disturbances, alopecia, and infection [1, 109] | (i) Unknown in MCD [110]
(ii) Effective at reducing antibody production by B cell; T cells could be affected by the expression of aldehyde dehydrogenase [109] |
|
| Chlorambucil (alkylating agent) | (i) Second option after cyclophosphamide | (i) Greater toxicity without any improvement [1] | (i) Unidentified |
|
| Mycophenolate Mofetil (immunosuppressive agent) | (i) Less side effects than cyclosporine [49–51]
(ii) Important effects on treatment course together with rituximab [111] | (i) More effective in lupus nephritis instead of MCD [53]
(ii) No beneficial result for steroid-, cyclophosphamide-, and cyclosporine-resistant patients [112] | (i) Inosine monophosphate dehydrogenase (IMPDH) [51] |
|
| Cyclosporine A (calcineurin inhibitor) | (i) Effective in treating and preventing relapse in steroid-unresponsive children [113]
(ii) Effective strategy to combine with prednisolone [57]
(iii) The first option as immunosuppressant for treating children with refractory nephrotic syndrome [83] | (i) Optimal dose is unknown [2], but medium dose is safe for developing nephrotoxicity [56]
(ii) Long-term outcome is unknown and may not beneficial to steroid-dependent nephrotic syndrome patients [114]
(iii) High relapse rate right after medication withdrawal
(iv) Hypertension as the most common adverse effect followed by increase of creatinine levels, hyperkalemia, gingival hyperplasia, and hypertrichosis [110, 115] | (i) Nuclear factor of activated T cell (NFAT) [116]
(ii) Phosphorylates synaptopodin in podocyte (stabilization by binding to 14-3-3 site) [83] |
|
| Tacrolimus (calcineurin inhibitor) | (i) Promising second option of steroid and cyclosporine resistance with high remission rate [60]
(ii) Combined therapy with sirolimus was effective [62]
(iii) Tacrolimus is 10 to 100 times more potent than cyclosporine in its immunosuppressive effects [117]
(iv) Lower relapse rate and cosmetic side effects compared to cyclosporine [115, 118] | (i) Worsen and new onset of hypertension reported [59]
(ii) New onset of diabetes mellitus, infection was reported [59]
(iii) Increased risk of diabetes mellitus [115] | (i) Inhibit T lymphocyte by binding with FKBP-12, calcium, calmodulin, and calcineurin [117] |
|
| Dexamethasone (glucocorticoid) | (i) Stabilize actin filament (reduce podocyte effacement) [119]
(ii) Partially inhibit CD80 [64]
(iii) Protect podocyte from apoptosis [120] | (i) Hypertension and hypokalemia were reported with intravenous dexamethasone administration [46]
(ii) Worsened proteinuria condition was reported [121] | (i) RhoA activities [122]
(ii) Apoptosis mechanism protein such as tumor suppressor protein p53, bcl-2 family protein, caspase-3, and apoptosis-inducing factor (AIF) [120]
(iii) Upregulated nephrin and tubulin-α, downregulated vascular endothelial growth factor [28]
(iv) Interleukin-6 and interleukin-8 suppressed by dexamethasone [28] |
|
| Rituximab (antibody) | (i) Immediate response for 11-year nephrotic syndrome patient to achieve remission (free from proteinuria) [123]
(ii) Prevention of actin cytoskeleton disruption [66]
(iii) Achieved remission from proteinuria was reported in many case series [111, 124]
(iv) Safe and effective to induce and remain remission; serious side effects were uncommon [74, 125] | (i) Common adverse effects such as fever, chills, nausea; urticaria, orthostatic hypotension, and bronchospasm are rare; most of the adverse effects were during the first infusion [126]
(ii) Not recommended in the guideline of therapy due to serious side effects [67]; 45% of cases reported different types of mild or transient adverse effects in a case series [124] | (i) Type 1 chimeric monoclonal antibody CD20 [66, 75]
(ii) Relapse always associated with CD19 in FSGS patients (contradicts with other patients’ CD19 levels and lack of established evidence) [124]
(iii) T helper cell 17 (Th17) and interleukin-17 [127, 128] |
|
| Ofatumumab (antibody) | (i) Effective alternative of rituximab [75], fully humanized
(ii) Dramatic positive response reported [76] | (i) Various toxicities were reported [75] | (i) Different epitope of CD20 than rituximab [75] |
|
| Abatacept (fusion protein) | (i) Effective outcome of rheumatoid arthritis repurpose medication on MCD patients was reported [7, 23, 78] | (i) Increased risk of bacterial infection [129] | (i) CD80 (B7-1) [23]
(ii) Restore Β1 integrin activation [23, 83, 103] |
|
