Focal segmental glomerulosclerosis (FSGS) is a glomerular lesion often associated with nephrotic syndrome. It is also associated with a high risk of progression to end-stage kidney disease. Current treatment of FSGS is limited to systemic corticosteroids or calcineurin inhibition, along with inhibitors of the renin-angiotensin-aldosterone system. FSGS is heterogeneous in etiology, and novel therapies targeting specific, dysregulated molecular pathways represent a major unmet medical need. By leveraging big data, we have generated a network-based molecular model of FSGS pathophysiology using previously established systems biology workflows to allow computational evaluation of compounds for their predicted interference with molecular processes contributing to FSGS. We identified repurposing the anti-platelet drug clopidogrel as a therapeutic option to counterbalance dysregulated FSGS pathways. This prediction of our computational screen was validated by testing clopidogrel in the adriamycin FSGS mouse model. Clopidogrel improved key FSGS outcome parameters and significantly reduced urinary albumin to creatinine ratio (p<0.01) and weight loss (p<0.01), and ameliorated histopathological damage (p<0.05). Clopidogrel is used to treat several cardiovascular diseases linked to chronic kidney disease. Clopidogrel's favorable safety profile and its efficacy in the adriamycin mouse FSGS model thus recommend it as an attractive drug repurposing candidate for clinical trial in FSGS. This proof-of-concept study demonstrates the feasibility of translating compounds from our computational technology platform via pre-clinical verification to clinical phase II readiness.
Gebeshuber Christoph A., Daniel-Fischer Lisa, Regele Heinz, Schachner Helga, Aufricht Christoph, Kornauth Christoph, Ley Matthias, Alper Seth L., Herzog Rebecca, Kratochwill Klaus, Perco Paul. Computational drug repositioning of clopidogrel as a novel therapeutic option for focal segmental glomerulosclerosis. Translational Research. Vol. 259:28–34. 2023. Elsevier BV. [Cross Ref]