ReviewFrontiers in endocrinology2026
Therapeutic monoclonal antibodies for diabetic kidney disease: a narrative review from basic mechanisms to clinical evidence.
Review in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Introduction: Diabetic kidney disease (DKD) remains a leading cause of end-stage kidney disease despite advances with renin-angiotensin system blockade, sodium-glucose cotransporter 2 inhibitors, finerenone, and glucagon-like peptide-1 receptor agonists. Therapeutic monoclonal antibodies may offer a targeted strategy to modulate inflammatory, fibrotic, metabolic, and vascular pathways involved in DKD. This review summarizes the mechanistic rationale, clinical evidence, translational barriers, and future prospects of antibody-based therapies for DKD. Methods: We conducted a narrative literature review using PubMed, the Cochrane Library, and ClinicalTrials.gov from database inception to March 31, 2026. We prioritized peer-reviewed preclinical studies, clinical trials, and high-quality reviews addressing mAb-based strategies targeting DKD-related pathways, including TGF-β1, VEGF-B, CTGF, suPAR, integrin αvβ8, signal regulatory protein α, and PCSK9. Results: Phase II studies of anti-TGF-β1 and anti-VEGF-B antibodies failed to show meaningful renal benefit, highlighting challenges such as pathway redundancy, delayed intervention, insufficient intrarenal target engagement, and off-kidney toxicity. Anti-CTGF therapy showed an early signal of albuminuria, whereas anti-suPAR remains under clinical evaluation. Emerging preclinical targets, including integrin αvβ8 and signal regulatory protein α, may provide more kidney-focused modulation of fibrotic and inflammatory pathways. PCSK9 monoclonal antibodies, particularly evolocumab and alirocumab, appear promising because they may confer renal benefit through lipid lowering and kidney-intrinsic effects on lipotoxicity, oxidative stress, AMPK signaling, and profibrotic pathways. Conclusion: Monoclonal antibodies represent a biologically compelling but clinically underdeveloped strategy for DKD. Future progress will require earlier biomarker-informed patient selection, confirmation of intrarenal target engagement, appropriate renal endpoints, and rational combination with established kidney-protective therapies.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.