APOL1-mediated kidney disease

The APOL1 gene is part of the APOL gene family, which plays a role in innate immunity, our body’s built-in system to fight threats. We all have the APOL1 gene, and it’s present in many tissues, including the kidneys. Over the past 3,000 to 10,000 years, the gene evolved in specific ways in people who lived in Western and Central Africa, to protect them from resistant forms of the parasite that causes African human trypanosomiasis. As people from these regions have migrated around the world, they have taken these certain genetic variants in the APOL1 gene with them. Today, people of African ancestry may carry these APOL1 variants, including people who may identify as Black, African American, Afro-Caribbean and Latino/Latina.  

Having two APOL1 risk variants is associated with an increased risk of this form of kidney disease, known as APOL1-mediated kidney disease (AMKD).

What is AMKD? AMKD is a genetic kidney disease caused by having two APOL1 risk variants. The disease can lead to kidney cell injury, cell death, and damage to glomeruli (which filter blood to the kidney). This leads to abnormal amounts of protein in the urine (or proteinuria) and decreased ability of the kidney to function. AMKD often progresses rapidly and silently, and patients may not notice any symptoms until their disease has progressed significantly. AMKD can have various clinical presentations, including, but not limited to, focal segmental glomerulosclerosis (FSGS), hypertension-associated kidney disease, HIV-associated nephropathy and lupus nephritis.

There are currently no approved treatments that address the underlying cause of AMKD. Even with treatment, people with AMKD often progress to kidney failure. Kidney failure is treated with dialysis or a kidney transplant. Both require lifelong treatment and follow-up and carry a high mortality risk.

How is AMKD diagnosed? Tests to diagnose kidney disease usually include blood and urine tests (to check for proteinuria and to measure kidney function). A kidney biopsy may be required to better understand the nature of the kidney injury. A definitive diagnosis of AMKD requires a genetic test to confirm  whether a person has the two APOL1 risk variants.

What is the underlying cause of disease? In people living with two APOL1 variants, an inflammatory exposure (like an injury or infection) can increase the toxic activity of the APOL1 protein in the kidney, which can lead to kidney cell injury, cell death and damage to the glomeruli (which filter blood in the kidney). This leads to abnormal amounts of protein in the urine (or proteinuria) and decreased ability of the kidney to function.

These programs are investigating treatments or outcomes that have not received approval from a health authority. The information presented is not intended to convey conclusions of safety or efficacy. There is no guarantee that the outcome of these studies will result in approval by a health authority.

For more information about our AMKD studies in the U.S., visit the clinical trials website. For information about non-U.S. sites, visit clinicaltrials.gov.