Evolution of lupus nephritis therapy: From B-cell depletion to complex modulation of humoral immunity
Abstract. Systemic lupus erythematosus is a chronic autoimmune disease characterized by a broad spectrum of clinical manifestations; one of the most common and severe is lupus nephritis (LN). Standard LN therapy includes high-dose glucocorticoids and immunosuppressive agents; however, evidence from clinical studies and meta-analyses indicates that the current therapeutic paradigm has reached the limits of its efficacy, underscoring the need to develop new, more targeted and safer strategies for the treatment of LN. A fundamentally new stage in LN management has been the introduction of targeted therapy. This review outlines strategies for selecting anti–B-cell therapy, discusses the implementation of CAR T-cell technologies in clinical practice, and considers the prospects of using biomarkers based on gene-expression patterns and implementing machine-learning (AI) algorithms to enable a personalized approach to selecting targeted therapy for patients with LN.Trofimov E.A., Mazurov V.I., Trofimova A.S., Lila V.A., Leineman Ya.A., Griva A.I.
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About the Authors
Evgeny A. Trofimov, MD, Dr. Sci. (Medicine), professor, head of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195015, Saint Petersburg, 41 Kirochnaya St.E-mail: Evgeniy.trofimov@szgmu.ru
ORCID: https://orcid.org/0000-0003-3236-4485. SPIN: 4358-1663
Vadim I. Mazurov, MD, Dr.Sci. (Medicine), professor, academician of RAS, vice president of RSMSIM, chief scientific advisor, director of the Research institute of rheumatology, head of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia; head of the Center for Autoimmune Diseases, V.A. Nasonova Clinical Rheumatology Hospital No. 25 (Saint Petersburg); chief external expert – rheumatologist at the Healthcare Committee of the Government of Saint Petersburg, Honored Scientist of the Russian Federation. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: maz.nwgmu@yandex.ru
ORCID: https://orcid.org/0000-0002-0797-2051. Scopus Author ID: 16936315400. eLibrary SPIN: 6823-5482
Anna S. Trofimova, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195015, Saint Petersburg, 41 Kirochnaya St.
E-mail: anna.trofimova@szgmu.ru
ORCID: https://orcid.org/0000-0001-5926-7912. SPIN-code: 3083-7996
Victoria A. Lila, MD, PhD (Medicine), assistant at the Department of therapy and rheumatology, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195015, Saint Petersburg, 41 Kirochnaya St.
E-mail: liu_lo@mail.ru
ORCID: https://orcid.org/0000-0001-5006-3358
Yana A. Leineman, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: Yana.Leineman@szgmu.ru
ORCID: https://orcid.org/0000-0003-2538-8112. eLibrary SPIN: 4832-4133
Arina I. Griva, MD, 2nd-year resident doctor-rheumatologist at the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: griva.arina@yandex.ru
ORCID: https://orcid.org/0000-0002-1098-1418. eLibrary SPIN: 1754-3550



