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Socioeconomic Determinants Of Health And Well-Being In A Low Resource Setting: A Case Of Older Adults Living In A Rural Setting In Northwestern Cambodia, Kakada Kuy Feb 2025

Socioeconomic Determinants Of Health And Well-Being In A Low Resource Setting: A Case Of Older Adults Living In A Rural Setting In Northwestern Cambodia, Kakada Kuy

Brown School Graduate Student Theses and Dissertations

This dissertation examines the associations between socioeconomic factors, and physical and psychological well-being among older adults in Cambodia. Focusing on subjective and objective socioeconomic status (SES) and the mediating roles of social and welfare support, this dissertation consists of three interrelated chapters that address different facets of the relationships. Paper 1 (Chapter 2) investigates the demographic characteristics, socioeconomic factors, and social support structures among older Cambodians. Findings reveal significant gender and age disparities, with women and the oldest adults more likely to experience lower socioeconomic status and weaker social support. Paper 2 (Chapter 3) explores the associations between subjective and …


Saudi University-Based Language Instructors’ Professional Identity: A Narrative Study, Husam Alharbi Feb 2025

Saudi University-Based Language Instructors’ Professional Identity: A Narrative Study, Husam Alharbi

Language, Literacy, and Sociocultural Studies ETDs

Language instructors’ professional identity involves a multitude of factors and characteristics that explain practices, meanings, and values, particularly pedagogical ones, that contribute to the identification of identity(s) (Block, 2007; Beauchamp & Thomas, 2009; Beijaard et al., 2004; Miller, 2009; Varghese et al., 2005). Guided by narrative approach (Clandinin, 2015; Clandinin & Connelly, 2000; Connelly & Clandinin, 1988, 1990; Oliver, 1998; Riessman, 2008) and communities of practice (CoP) principles (Wenger, 1998), this study employed eight narrative prompts to answer two research questions: (1) how do Saudi university-based EFL language instructors construct their professional identity without their entitled academic privileges and/or accommodations?; …


Spectrum, Volume 54, Issue 2, Sacred Heart University Feb 2025

Spectrum, Volume 54, Issue 2, Sacred Heart University

Newspapers (Obelisk & Spectrum)

Highlights include: SHU Professor Aims to Tackle Global Education Crisis - Students Accepted into Society of Illustrators of Los Angeles - SCMA Professor Receives Global Service Award - The Suite Life on Campus: Housing Selection for 2025-2026 - Take Care of Your Body and Mind with Move To Heal - Cozy Cafes: The Best Spots to Warm Up Near Campus - Three Consecutive Wins for Men’s Volleyball - The Double-Edged Sword of Social Media: The Impact on Teens


Streamlined Production, Protection, And Purification Of Enzyme Biocatalysts Using Virus-Like Particles And A Cell-Free Protein Synthesis System, Seung O. Yang, Joseph P. Talley, Gregory H. Nielsen, Kristen M. Wilding, Bradley Charles Bundy Feb 2025

Streamlined Production, Protection, And Purification Of Enzyme Biocatalysts Using Virus-Like Particles And A Cell-Free Protein Synthesis System, Seung O. Yang, Joseph P. Talley, Gregory H. Nielsen, Kristen M. Wilding, Bradley Charles Bundy

Faculty Publications

Enzymes play an essential role in many different industries; however, their operating conditions are limited due to the loss of enzyme activity in the presence of proteases and at temperatures significantly above physiological conditions. One way to improve the stability of these enzymes against high temperatures and proteases is to encapsulate them in protective shells or virus-like particles. This work presents a streamlined, three-step, cell-free protein synthesis (CFPS) procedure that enables rapid in vitro enzyme production, targeted encapsulation in protective virus-like particles (VLPs), and facile purification using a 6× His-tag fused to the VLP coat protein. This process is performed …


Classification Of Schizophrenia, Bipolar Disorder And Major Depressive Disorder With Comorbid Traits And Deep Learning Algorithms, Xiangning Chen, Yimei Lu, Joan Manuel Cue, Mira V Han, Vishwajit L Nimgaonkar, Daniel R Weinberger, Shizhong Han, Zhongming Zhao, Jingchun Chen Feb 2025

Classification Of Schizophrenia, Bipolar Disorder And Major Depressive Disorder With Comorbid Traits And Deep Learning Algorithms, Xiangning Chen, Yimei Lu, Joan Manuel Cue, Mira V Han, Vishwajit L Nimgaonkar, Daniel R Weinberger, Shizhong Han, Zhongming Zhao, Jingchun Chen

Faculty, Staff and Student Publications

Many psychiatric disorders share genetic liabilities, but whether these shared liabilities can be utilized to classify and differentiate psychiatric disorders remains unclear. In this study, we use polygenic risk scores (PRSs) of 42 traits comorbid with schizophrenia (SCZ), bipolar disorder (BIP), and major depressive disorder (MDD) to evaluate their utilities. We found that combining target specific PRS with PRSs of comorbid traits can improve the classification of the target disorders. Importantly, without inclusion of PRSs from targeted disorders, we can still classify SCZ (accuracy 0.710 ± 0.008, AUC 0.789 ± 0.011), BIP (accuracy 0.782 ± 0.006, AUC 0.852 ± 0.004), …


2025 Sullivan County 4-H Presents Packet, Laurie Field Feb 2025

2025 Sullivan County 4-H Presents Packet, Laurie Field

Advisory Council

No abstract provided.


Distributed Cross-Learning For Equitable Federated Models – Privacy-Preserving Prediction On Data From Five California Hospitals, Tsung-Ting Kuo, Rodney A Gabriel, Jejo Koola, Robert T Schooley, Lucila Ohno-Machado Feb 2025

Distributed Cross-Learning For Equitable Federated Models – Privacy-Preserving Prediction On Data From Five California Hospitals, Tsung-Ting Kuo, Rodney A Gabriel, Jejo Koola, Robert T Schooley, Lucila Ohno-Machado

Faculty, Staff and Student Publications

Quality improvement, clinical research, and patient care can be supported by medical predictive analytics. Predictive models can be improved by integrating more patient records from different healthcare centers (horizontal) or integrating parts of information of a patient from different centers (vertical). We introduce Distributed Cross-Learning for Equitable Federated models (D-CLEF), which incorporates horizontally- or vertically-partitioned data without disseminating patient-level records, to protect patients' privacy. We compared D-CLEF with centralized/siloed/federated learning in horizontal or vertical scenarios. Using data of more than 15,000 patients with COVID-19 from five University of California (UC) Health medical centers, surgical data from UC San Diego, and …


Acute Mecp2 Loss In Adult Mice Reveals Transcriptional And Chromatin Changes That Precede Neurological Dysfunction And Inform Pathogenesis, Sameer S Bajikar, Jian Zhou, Ryan O'Hara, Harini P Tirumala, Mark A Durham, Alexander J Trostle, Michelle Dias, Yingyao Shao, Hu Chen, Wei Wang, Hari Krishna Yalamanchili, Ying-Wooi Wan, Laura A Banaszynski, Zhandong Liu, Huda Y Zoghbi Feb 2025

Acute Mecp2 Loss In Adult Mice Reveals Transcriptional And Chromatin Changes That Precede Neurological Dysfunction And Inform Pathogenesis, Sameer S Bajikar, Jian Zhou, Ryan O'Hara, Harini P Tirumala, Mark A Durham, Alexander J Trostle, Michelle Dias, Yingyao Shao, Hu Chen, Wei Wang, Hari Krishna Yalamanchili, Ying-Wooi Wan, Laura A Banaszynski, Zhandong Liu, Huda Y Zoghbi

Faculty, Staff and Students Publications

Mutations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene cause Rett syndrome, a severe childhood neurological disorder. MeCP2 is a well-established transcriptional repressor, yet upon its loss, hundreds of genes are dysregulated in both directions. To understand what drives such dysregulation, we deleted Mecp2 in adult mice, circumventing developmental contributions and secondary pathogenesis. We performed time series transcriptional, chromatin, and phenotypic analyses of the hippocampus to determine the immediate consequences of MeCP2 loss and the cascade of pathogenesis. We find that loss of MeCP2 causes immediate and bidirectional progressive dysregulation of the transcriptome. To understand what drives gene downregulation, we …


Integral Roles Of The Tgfβ Signaling Pathway In Uterine Function And Disease, Anna Catherine Unser, Diana Monsivais Feb 2025

Integral Roles Of The Tgfβ Signaling Pathway In Uterine Function And Disease, Anna Catherine Unser, Diana Monsivais

Faculty, Staff and Students Publications

The uterus is a complex organ that requires precise signaling networks to mediate functions necessary for homeostasis and reproductive processes. The transforming growth factor β (TGFβ) superfamily regulates integral signaling pathways throughout many physiological processes, including cell proliferation, differentiation, and development. In this review, we summarize the current understanding of how the TGFβ signaling family controls key uterine functions, with a specific focus on the endometrium. These uterine functions include endometrial receptivity, implantation, decidualization, placentation, remodeling, and regeneration. Improving our understanding of the signaling networks that regulate these processes is integral to identifying, diagnosing, and treating uterine and reproductive diseases …


Trokas Duras, William L. Blizek, Monica Blizek Feb 2025

Trokas Duras, William L. Blizek, Monica Blizek

Journal of Religion & Film

This is a review of the short film, Trokas Duras (2025), directed by Jazmin Garcia.


The Power Of Procedure: Uncovering The Gap In U.S. Privacy Rights, Bernard Chao, Mandi Abbott Feb 2025

The Power Of Procedure: Uncovering The Gap In U.S. Privacy Rights, Bernard Chao, Mandi Abbott

Pepperdine Law Review

As Congress faces increasing pressure to adopt comprehensive privacy legislation, this Article seeks to contribute to the ongoing discussions by exploring critical procedural deficiencies in U.S. privacy laws and their implications for domestic privacy rights and international data flows. This Article makes several key contributions to the field. First, it uses a comparative law perspective to highlight the lack of robust procedural rights and remedies in U.S. privacy law. Second, while many have questioned whether the Court of Jus tice for the European Union will strike down the latest U.S.-EU Data Privacy Framework (the primary mechanism for allowing the transatlantic …


The Things You Kill, Sheila Nayar Feb 2025

The Things You Kill, Sheila Nayar

Journal of Religion & Film

This is a film review of The Things You Kill (2024), directed by Alireza Khatami.


Diaz V. United States 144 S.Ct. 1727 (2024), Madison Walsh Feb 2025

Diaz V. United States 144 S.Ct. 1727 (2024), Madison Walsh

Ohio Northern University Law Review

No abstract provided.


Shadows Of Prejudice: The History Of The Right To Counsel And The Strickland's Pursuit Of Justice3 Amidst Forgotten Witnesses And Disregarded Evidence, Reem Haikal J.D., Ll.M Feb 2025

Shadows Of Prejudice: The History Of The Right To Counsel And The Strickland's Pursuit Of Justice3 Amidst Forgotten Witnesses And Disregarded Evidence, Reem Haikal J.D., Ll.M

Ohio Northern University Law Review

In the United States’ criminal justice system, persistent problems with ineffective legal representation reveal significant systemic issues and injustices, underscoring the urgent need for meaningful reform. This paper argues that the United States’ criminal justice system faces deep-rooted problems due to ineffective legal representation, as evidenced by the evolution of the right to counsel, the challenges posed by the Strickland standard, and contemporary criticisms of legal defense practices. Through an analysis of historical developments, landmark legal decisions, and case studies, it becomes evident that meaningful reform is essential to address systemic injustices and ensure the constitutional guarantee of effective assistance …


The Usefulness Of 3d Heart Models As A Tool Of Congenital Heart Disease Education: A Narrative Review, Raghad Abdulaziz Alhojailan, Reghd Husain M Alkhalifah, Bana Albani, Majed Wadi Feb 2025

The Usefulness Of 3d Heart Models As A Tool Of Congenital Heart Disease Education: A Narrative Review, Raghad Abdulaziz Alhojailan, Reghd Husain M Alkhalifah, Bana Albani, Majed Wadi

Journal of the Saudi Heart Association

Objectives: The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods. Methods: A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education. Results: The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve …


British Latino: Investigating Discourse-Stylistic Variables And The Construction Of Persona Within Podcasting, Jonathan A. Pye Feb 2025

British Latino: Investigating Discourse-Stylistic Variables And The Construction Of Persona Within Podcasting, Jonathan A. Pye

International Journal of the Linguistic Association of the Southwest

This study expands upon previous work (McIlwaine et al., 2011; McIlwaine & Bunge, 2016) by analyzing how the Latin American community in the UK constructs identity through podcasting. The sociolinguistic construct of the persona (Campbell-Kibler, 2008; Coupland, 2007; D’Onofrio, 2020; Eckert, 2019; Podesva, 2007) is operationalized to understand how the persona of the British Latino is discursively constructed in the podcast of the British Latino Network. Using qualitative discourse analysis and values coding (Saldaña, 2013), this analysis finds that the British Latino persona is indexed in the podcast as a bricolage of four principal attributes: (1) aspirational, (2) educated, …


Abdominal/Pelvic Ct Scans Ordered Pre-Physical Exam In The Emergency Department, A Pilot Study, Ryanne M. Burke, Hannah Zazulak, Andrea M. Bodine Md Feb 2025

Abdominal/Pelvic Ct Scans Ordered Pre-Physical Exam In The Emergency Department, A Pilot Study, Ryanne M. Burke, Hannah Zazulak, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Computerized tomography (CT) scans are effective for evaluating abdominal pain, a common emergency department (ED) complaint. In ED “physician in triage” (PIT) models, CTs can be ordered in triage. PIT has been shown to have higher clinical yield of abdominal/pelvic CTs than the traditional ED model. We explored the benefit versus radiation risk of abdominal/pelvic CTs ordered in an ED where physicians may order CTs in triage (pre-PE) to determine if results were similar to post physical exam (post PE) CTs.

Methods: In this retrospective study at Berkshire Medical Center in Pittsfield, Massachusetts, 969 patients had abdominal/pelvic CTs in …


Migdal, Ashqelon: The Glass Finds, Natalya Katsnelson Feb 2025

Migdal, Ashqelon: The Glass Finds, Natalya Katsnelson

Qadum: Journal of Excavation Reports from Israel

The salvage excavation at Migdal, Ashqelon, unearthed some 85 glass fragments, including jars, bottles, a bowl, a bowl-shaped oil lamp, bracelets, beads and a windowpane. Most of the glass fragments were found in Ottoman- and British Mandate-period strata (III–I). Several fragments were found in Mamluk-period installations (Stratum IV), and only one fragment could be associated with the Roman–Byzantine period (Stratum V). Given the well-stratified context of the glass fragments, some of the uncovered types allow for more precise dating within the Ottoman period. As our knowledge of Late Islamic and early twentieth-century CE glass from settlements in southern Israel is …


Eng 2000-001 Introduction To Creative Writing, Amie Whittemore Feb 2025

Eng 2000-001 Introduction To Creative Writing, Amie Whittemore

Fall 2024

No abstract provided.


The Role Of Astrocytes In Probabilistic Decision-Making, Julia Pai Feb 2025

The Role Of Astrocytes In Probabilistic Decision-Making, Julia Pai

Arts & Sciences Electronic Theses and Dissertations

To flexibly navigate an uncertain world, animals need to be able to maintain internal representations of the values of good and bad things in the environment and to flexibly update their internal representations from experience. The purpose of this thesis work is to 1) develop tools and methodology to quantitatively study aversion-motivated behavior, and to 2) investigate the role of astrocytes, a non-neuronal brain cell type, in mediating experience-guided decision- making. The first part of this thesis describes a novel paradigm we developed to use dermal laser stimulation as an aversive stimulus for quantitatively studying motivated behavior in rodents and …


Prediction Of Obstructive Coronary Artery Disease Using Coronary Calcification And Epicardial Adipose Tissue Assessments From Ct Calcium Scoring Scans, Juhwan Lee, Tao Hu, Ammar Hoori, Hao Wu, Justin N. Kim, Robert Gilkeson, Sanjay Rajagopalan, David L. Wilson Feb 2025

Prediction Of Obstructive Coronary Artery Disease Using Coronary Calcification And Epicardial Adipose Tissue Assessments From Ct Calcium Scoring Scans, Juhwan Lee, Tao Hu, Ammar Hoori, Hao Wu, Justin N. Kim, Robert Gilkeson, Sanjay Rajagopalan, David L. Wilson

Faculty Scholarship

Background: Low-cost/no-cost non-contrast CT calcium scoring (CTCS) exams can provide direct evidence of coronary atherosclerosis. In this study, using features from CTCS images, we developed a novel machine learning model to predict obstructive coronary artery disease (CAD), as defined by the coronary artery disease-reporting and data system (CAD-RADS). Methods: This study analyzed 1324 patients from the SCOT-HEART trial who underwent both CTCS and CT angiography. Obstructive CAD was defined as CAD-RADS 4A-5, while CAD-RADS 0–3 were considered non-obstructive CAD. We analyzed clinical, Agatston-score-derived, and epicardial fat-omics features to predict obstructive CAD. The most predictive features were selected using elastic net …


Should Positive Airway Pressure Be Continued Uninterrupted After Endoscopic Skull Base Surgery? A Review Of Current Literature, Jayanth Rajan, John Richter, Daniel Karasik, Claudia I. Cabrera, John Gerka Stuyt, Kenneth Rodriguez, Brian D'Anza, Thomaz Fleury Curado, Sanjeet V. Rangarajan Feb 2025

Should Positive Airway Pressure Be Continued Uninterrupted After Endoscopic Skull Base Surgery? A Review Of Current Literature, Jayanth Rajan, John Richter, Daniel Karasik, Claudia I. Cabrera, John Gerka Stuyt, Kenneth Rodriguez, Brian D'Anza, Thomaz Fleury Curado, Sanjeet V. Rangarajan

Faculty Scholarship

Obstructive sleep apnea (OSA) poses unique challenges to the perioperative management of endoscopic skull base surgery (ESBS). Currently, no consensus or guidelines exist on the reintroduction of positive airway pressure (PAP) in these patients. To better clarify the safety of PAP reintroduction after ESBS, the databases Pubmed and Embase were searched in May 2024 for studies on PAP reintroduction after ESBS. Two articles, comprising 15 patients, met the inclusion criteria. All patients resumed PAP the first night after surgery. All patients underwent ESBS for transsphenoidal pituitary resection. Only one patient experienced cerebrospinal fluid leak, and no other complications were reported. …


Improved Open Access Support Through A Popular Open Access Fund, Andrea A. Wirth Feb 2025

Improved Open Access Support Through A Popular Open Access Fund, Andrea A. Wirth

Library Faculty Research

This paper describes results of a 2023 survey of authors who applied to University of Nevada, Las Vegas (UNLV) Open Article Fund, a fund that supports article processing charges (APCs). The survey sought feedback about the fund’s impact, value, and award criteria as well as opinions on other open access topics. Results show that the fund has had a positive impact on open access uptake and opinions of open access. Respondents reported that they participate in other open publishing activities and believe that most publications should be made open access. The results suggest opportunities for better strategic connections between the …


Lab Practical: Rapid Scan Epr, Gareth R. Eaton Feb 2025

Lab Practical: Rapid Scan Epr, Gareth R. Eaton

TeachEPR Submissions

  • To develop an understanding of the rapid scan experiment relative to other EPR methods.
  • To observe the effects of scan rate on samples with differing T2 relaxation times.


Displaced: An Ethnography Of Language And Identity Loss, Ariel Caroline Wilsey-Gopp Feb 2025

Displaced: An Ethnography Of Language And Identity Loss, Ariel Caroline Wilsey-Gopp

Dissertations and Theses

Through ethnography and personal narrative, I explore the language and identity loss of one person, my father, in order to understand the complex issues surrounding the effects of symbolic and structural violence on language and identity development. Through personal narrative, fieldwork, and interviews, I tell the story of one person, born in wartime during Nazi occupied Serbia, and follow the guiding questions: how does language get lost and what are the effects? Drawing on methodology set forth by empirical ethnographical work as well as more recent theory around epigenetics and trauma, my research synthesizes into focus three pillars of understanding …


Variations In Hawaiian Plume Flux Controlled By Ancientmantle Depletion, Paul Béguelin, Andreas Stracke, Maxim D. Ballmer, Shichen Huang, Michael Wilig, Michael Bizimis Feb 2025

Variations In Hawaiian Plume Flux Controlled By Ancientmantle Depletion, Paul Béguelin, Andreas Stracke, Maxim D. Ballmer, Shichen Huang, Michael Wilig, Michael Bizimis

Faculty Publications

Mantle plumes—upwellings of buoyant rock in Earth's mantle—feed hotspot volcanoes such as Hawai‘i. The size of volcanoes along the Hawai‘i–Emperor chain, and thus the magma flux of the Hawaiian plume, has varied over the past 85 million years. Fifteen and two million years ago, rapid bursts in magmatic production led to the emergence of large islands such as Pūhāhonu, Maui Nui and Hawai‘i, but the underlying mechanisms remain enigmatic. Here, we use new radiogenic Ce–Sr–Nd–Hf isotope data of Hawaiian shield lavas to quantify the composition and proportion of the different constituents of the Hawaiian plume over time. We find that …


Culture And Attachment Preference Among Young Adults In Egypt And The United States, Musheera Anis Abdellatif Feb 2025

Culture And Attachment Preference Among Young Adults In Egypt And The United States, Musheera Anis Abdellatif

School of Education Faculty Publications

We explored the relationship between cultural values, recollected early caregiving experiences and young adult attachment preference. Young adults in Egypt (N = 209) and the United States (N = 554) ranked their current attachment preference, rated their collectivist and individualist beliefs, and recalled the relative contributions of their early caregivers. Egyptian students scored higher than US students on collectivism and recalled more involvement from non-parental caregivers. Most participants reported a preference hierarchy (82% Egypt & 84% US). Surprisingly, individualism was negatively associated with maternal attachment ratings and with having a clear principal attachment relationship, whereas higher collectivism predicted …


Behavioral Science-Based “Nudges” Could Increase Physical Activity Among Adolescents With Adhd, Hannah Patnaik, Andrew S. London, Kevin M. Antshel Feb 2025

Behavioral Science-Based “Nudges” Could Increase Physical Activity Among Adolescents With Adhd, Hannah Patnaik, Andrew S. London, Kevin M. Antshel

Population Health Research Brief Series

Children and adolescents with ADHD are more likely to exhibit difficulties in school, have higher rates of injuries and accidents and more family conflicts, and are at higher risk of depression and anxiety. Given the prevalence of ADHD and associated difficulties, there is a substantial need for effective ADHD treatment and symptom management. This brief summarizes findings from a recently completed pilot study testing the efficacy of behavioral interventions aimed at encouraging daily physical activity (i.e., steps measured with an activity tracker) among adolescents with ADHD in the Syracuse, NY area between March 2023 and June 2024. Results show that …


Dataset For Comparative Analysis Of Precision Metagenomics And Traditional Methods In Urinary Tract Infection Diagnostics, Rob E. Carpenter, Sadia Almas, Vaibhav Tamrakar, Rahul Sharma Feb 2025

Dataset For Comparative Analysis Of Precision Metagenomics And Traditional Methods In Urinary Tract Infection Diagnostics, Rob E. Carpenter, Sadia Almas, Vaibhav Tamrakar, Rahul Sharma

Human Resource Development Faculty Publications and Presentations

This study presents a comprehensive dataset comparing three diagnostic methodologies—microbial culture, polymerase chain reaction (PCR), and precision metagenomics (precision metagenomics)—for the detection and classification of uropathogens in urine samples from patients with suspected urinary tract infections (UTIs). While microbial culture remains the gold standard for UTI diagnosis, it has limitations in sensitivity, particularly for fastidious or non-culturable microorganisms. PCR offers higher sensitivity but is restricted to pre-targeted organisms, limiting its diagnostic range. Precision Metagenomics, a target-agnostic sequencing method, provides a more inclusive approach by enabling the identification of a broad spectrum of pathogens, including bacteria, viruses, fungi, and parasites, without …


The Road Ahead: Emerging Therapies For Primary Iga Nephropathy, Edward J. Filippone, Rakesh Gulati, John Farber Feb 2025

The Road Ahead: Emerging Therapies For Primary Iga Nephropathy, Edward J. Filippone, Rakesh Gulati, John Farber

Division of Nephrology Faculty Papers

Primary IgA nephropathy (IgAN) is the most common form of primary glomerulopathy. A slowly progressive disease presenting in the young to middle-aged, most patients with reduced eGFR or proteinuria will progress to end-stage kidney disease (ESKD) in their lifetimes. The pathogenesis involves increased production of galactose-deficient IgA1 (Gd-IgA1) that forms immune complexes that deposit in the glomerulus, eliciting mesangial cell proliferation, inflammation, and complement activation. The backbone of therapy is supportive, including lifestyle modifications, strict blood pressure control, and renin-angiotensin system inhibition targeting proteinuria < 300 mg/day. Sodium-glucose transporter 2 inhibitors are indicated for persisting proteinuria or declining eGFR. Sparsentan is indicated for persisting proteinuria. Immunosuppression should be considered for all patients at risk for progression (persisting proteinuria and/or declining eGFR). To reduce Gd-IgA1 production, targeted-release budesonide is approved. Agents targeting B cell survival factors APRIL or BAFF/APRIL have significantly reduced Gd-IgA1 production and proteinuria in phase 2 trials but await phase 3 data for approval. To reduce inflammation, high-dose steroids are ineffective and toxic in Caucasian patients, although lower-dose regimens may be effective in Chinese patients. Complement inhibition is being actively studied. The factor B inhibitor iptacopan has conditional approval. The terminal pathway inhibitors cemdisiran and ravulizumab show promise in phase 2 studies. Our current approach for those requiring immunosuppression involves combining the reduction of Gd-IgA1 (nefecon) with suppressing the effects of inflammation (iptacopan). The optimal duration of such therapy is uncertain. Clearly, there is more to be learned with many trials underway.