Molecular Basis, Diagnostic Challenges and Therapeutic Approaches of Alport Syndrome: A Primer for Clinicians

Int J Mol Sci. 2021 Oct 14;22(20):11063. doi: 10.3390/ijms222011063.

Abstract

Alport syndrome is a genetic and hereditary disease, caused by mutations in the type IV collagen genes COL4A3, COL4A4 and COL4A5, that affects the glomerular basement membrane of the kidney. It is a rare disease with an underestimated prevalence. Genetic analysis of population cohorts has revealed that it is the second most common inherited kidney disease after polycystic kidney disease. Renal involvement is the main manifestation, although it may have associated extrarenal manifestations such as hearing loss or ocular problems. The degree of expression of the disease changes according to the gene affected and other factors, known or yet to be known. The pathophysiology is not yet fully understood, although some receptors, pathways or molecules are known to be linked to the disease. There is also no specific treatment for Alport syndrome; the most commonly used are renin-angiotensin-aldosterone system inhibitors. In recent years, diagnosis has come a long way, thanks to advances in DNA sequencing technologies such as next-generation sequencing (NGS). Further research at the genetic and molecular levels in the future will complete the partial vision of the pathophysiological mechanism that we have, and will allow us to better understand what is happening and how to solve it.

Keywords: Alport syndrome; COL4A; chronic kidney disease; collagen; hereditary kidney disease.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Animals
  • Collagen Type IV / genetics
  • Ergocalciferols / therapeutic use
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Integrins / genetics
  • Integrins / metabolism
  • Laminin / genetics
  • Laminin / metabolism
  • Nephritis, Hereditary / diagnosis*
  • Nephritis, Hereditary / pathology
  • Nephritis, Hereditary / therapy
  • Polymorphism, Genetic

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Collagen Type IV
  • Ergocalciferols
  • Integrins
  • Laminin
  • paricalcitol