Chronic kidney disease is common. The prevalence of chronic kidney disease has rapidly increased over the past 20 years, and it now affects 13% of people around the world (1). Chronic kidney disease can be difficult to treat because it often occurs in combination with other diseases. People with diabetes or high blood pressure have an increased risk of developing kidney disease. Patients with chronic kidney disease are also more likely to develop cardiovascular disease.
Without treatment, patients with end-stage kidney disease can die within months. The only treatment options currently available for people with end-stage kidney disease are dialysis or kidney transplant (2). Patients who receive a kidney transplant have better quality of life and live longer than patients treated with dialysis (3). However, kidney transplant is not a permanent cure for many patients. Around 50% of transplanted kidneys will fail within 10 years (3). This failure rate has not improved over the past 20 years.
Recurring glomerular disease is a major cause of kidney transplant failure (3). Glomerular disease is a catch-all name for many different pathologies that affect the glomerulus of the kidney. These pathologies have different molecular causes and progress at different rates. Therefore, it has been difficult to identify risk factors that contribute to a kidney transplant patient developing recurrent glomerular disease.
The TANGO Project for Chronic Kidney Disease
The TANGO (Post-TrANsplant GlOmerular Diease) study is a large, multi-country biobanking and population study designed to characterize the spectrum of glomerular disease after kidney transplant. The study will look at whether the incidence of post-transplant glomerular disease varies in different countries. Researchers will also work to identify risk factors for recurring glomerular disease and assess whether anti-rejection, or immunosuppressive, therapy can decrease the risk of glomerular disease.
To facilitate the TANGO study, researchers plan to collect and biobank biological samples from patients at 15 centers across the US, South America and Europe. This will create a large biorepository for future research into biomarkers and novel therapeutic candidates.
Patients are eligible for the study if they were diagnosed with glomerular disease from a biopsy performed before kidney transplant surgery. So far, 435 patients have been enrolled in the study. The goal is to enrol 1000 patients by the end of 2018.
The TANGO Project will happen in three stages. In Phase 1, clinicians will enter patient data including patient demographics, medical history, kidney history, transplant details and outcome into an online database. In Phase 2, researchers will biobank samples. Phase 3 will consist of interventional clinical trials. All protocols used in the TANGO Project follow Good Clinical Practice Guidelines. All participating centers have ethics approval for Phase 1 and data collection is currently underway. One center also has ethics approval for Phase 2 biobanking.
During Phase 2, TANGO researchers will use standardized protocols to biobank a range of patient samples including kidney tissue, urine, stool, saliva and blood. Researchers will use these samples to identify any genetic variants or gene expression signatures that predict the risk of post-transplant glomerular disease. Studies will also look for new drug targets with the goal of developing therapeutics that can effectively treat or prevent glomerular disease before and after transplant.
NURTuRE Biorepository for Chronic Kidney Disease
The National Unified Renal Translational Research Enterprise (NURTuRE) is a UK biorepository focused on chronic kidney disease (4). They store samples and anonymized linked clinical data from 3,000 British chronic kidney disease patients. NURTure is a collaborative project between academic institutions and industry partners. All samples and data are collected using standardized protocols. NURTuRE is managed by Kidney Research UK and funded by AbbVie, Evotec, Retrophin, UCB Celltech Biopharma and Kidney Research UK. Researchers can apply to access the data.
Conclusions
We are well into the era of precision medicine where large scale population studies allow for more accurate characterization of the molecular and biological progression of diseases within different patient populations. Biobanking is an essential part of precision medicine because biobanks provide access to large numbers of high quality biological samples. Biobanking projects such as TANGO and NURTuRE will hopefully help researchers to better understand the genetic and molecular causes of chronic kidney disease, and to develop new therapeutics to combat these conditions.
References
- Hill et al. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One. 2016
- Chronic kidney disease. Mayo Clinic (Online).
- Uffing et al. A large, international study on post-transplant glomerular diseases: the TANGO project. BMC Nephrology. 2018.
- Nurture: National Unified Renal Translational Research Enterprise. (Online).
