The potential of pharmacotranscriptomic markers for predicting mycophenolic acid efficacy in children with steroid-dependent nephrotic syndrome

Nephrotic syndrome is one of the most common glomerular diseases in childhood. It is known that about half of patients with nephrotic syndrome develop dependence on steroid therapy, which requires the inclusion of a treatment regimen of selective immunosuppressive therapy. Mycophenolic acid (MPA) has been identified as a promising drug for steroid-resistant nephrotic syndrome, and it forms the basis of immunosuppressive therapy for this condition. The present study evaluates the importance of determining the expression of genes responsible for the metabolism of mycophenolic acid in patients with steroid-dependent nephrotic syndrome to maintain stable clinical and laboratory remission of the disease. The article demonstrates the significance and role of MDR1, UGT1A7, UGT1A9 and UGT2B7 gene expression as potential markers of increased risk of relapses and opens up prospects for the use of a transcriptomic approach to identify patients who require careful selection of pharmacotherapy. Although the results obtained are promising, changes in the expression of metabolic enzymes are only one of several factors that contribute to the effectiveness of treatment. Based on these data, it may be possible in the future to develop personalized monitoring strategies that can help tailor treatment to individual patients and increase its effectiveness.