{"doi":"10.1016/j.kint.2023.11.018","title":"Rationale and design of the Nephrotic Syndrome Study Network (NEPTUNE) Match in glomerular diseases: designing the right trial for the right patient, today","abstract":"Glomerular diseases are classified using a descriptive taxonomy that is not reflective of the heterogeneous underlying molecular drivers. This limits not only diagnostic and therapeutic patient management, but also impacts clinical trials evaluating targeted interventions. The Nephrotic Syndrome Study Network (NEPTUNE) is poised to address these challenges. The study has enrolled >850 pediatric and adult patients with proteinuric glomerular diseases who have contributed to deep clinical, histologic, genetic, and molecular profiles linked to long-term outcomes. The NEPTUNE Knowledge Network, comprising combined, multiscalar data sets, captures each participant’s molecular disease processes at the time of kidney biopsy. In this editorial, we describe the design and implementation of NEPTUNE Match, which bridges a basic science discovery pipeline with targeted clinical trials. Noninvasive biomarkers have been developed for real-time pathway analyses. A Molecular Nephrology Board reviews the pathway maps together with clinical, laboratory, and histopathologic data assembled for each patient to compile a Match report that estimates the fit between the specific molecular disease pathway(s) identified in an individual patient and proposed clinical trials. The NEPTUNE Match report is communicated using established protocols to the patient and the attending nephrologist for use in their selection of available clinical trials. NEPTUNE Match represents the first application of precision medicine in nephrology with the aim of developing targeted therapies and providing the right medication for each patient with primary glomerular disease. Glomerular diseases are classified using a descriptive taxonomy that is not reflective of the heterogeneous underlying molecular drivers. This limits not only diagnostic and therapeutic patient management, but also impacts clinical trials evaluating targeted interventions. The Nephrotic Syndrome Study Network (NEPTUNE) is poised to address these challenges. The study has enrolled >850 pediatric and adult patients with proteinuric glomerular diseases who have contributed to deep clinical, histologic, genetic, and molecular profiles linked to long-term outcomes. The NEPTUNE Knowledge Network, comprising combined, multiscalar data sets, captures each participant’s molecular disease processes at the time of kidney biopsy. In this editorial, we describe the design and implementation of NEPTUNE Match, which bridges a basic science discovery pipeline with targeted clinical trials. Noninvasive biomarkers have been developed for real-time pathway analyses. A Molecular Nephrology Board reviews the pathway maps together with clinical, laboratory, and histopathologic data assembled for each patient to compile a Match report that estimates the fit between the specific molecular disease pathway(s) identified in an individual patient and proposed clinical trials. The NEPTUNE Match report is communicated using established protocols to the patient and the attending nephrologist for use in their selection of available clinical trials. NEPTUNE Match represents the first application of precision medicine in nephrology with the aim of developing targeted therapies and providing the right medication for each patient with primary glomerular disease. Nephrotic syndrome (NS) comprises focal segmental glomerular sclerosis (FSGS), minimal change disease, and membranous nephropathy, which are rare glomerular diseases associated with debilitating complications, including possible progression to kidney failure. Despite similar and overlapping symptoms (e.g., edema, proteinuria, and loss of kidney function), individual clinical courses can vary markedly. The only US Food and Drug Administration–approved medical treatments are corticosteroid-based immunosuppressive agents (i.e., prednisone and adrenocorticotrophic hormone) that cause severe adverse effects. Off-label use of second-line immunosuppressive medications is currently part of","journal":"Kidney International","year":2024,"id":483970,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9201,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":712745,"name":"Hailey Desmond","orcid":"0000-0002-5866-6644","position":1,"is_corresponding":false},{"id":638938,"name":"Amanda Williams","orcid":"0000-0002-3569-2153","position":2,"is_corresponding":false},{"id":5961,"name":"Laura Mariani","orcid":"0000-0002-4305-9884","position":3,"is_corresponding":false},{"id":5959,"name":"Sean Eddy","orcid":"0000-0001-8578-3443","position":4,"is_corresponding":false},{"id":5964,"name":"Wenjun Ju","orcid":"0000-0002-9136-8454","position":5,"is_corresponding":false},{"id":237302,"name":"Laura Barisoni","orcid":"0000-0003-0848-9683","position":6,"is_corresponding":false},{"id":1326117,"name":"Heather Ascani","orcid":null,"position":7,"is_corresponding":false},{"id":318274,"name":"Wendy R. 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