Immune-mediated membranous nephropathy: Innovations in pathogenetic modeling and mechanistic insights.

Abstract

Membranous nephropathy (MN), an autoimmune cause of adult nephrotic syndrome, is driven by podocyte-targeting antibodies against PLA2R/THSD7A. Current models fail to fully capture human disease progression. This review evaluates three transformative approaches: (1) Heterologous antibody-induced models enabling acute injury replication; (2) Antigen-driven immunization modeling adaptive immunity; and (3) GBF-on-Chip platforms mimicking filtration barrier dynamics. Collectively, they reveal complement-dependent and direct podocytotoxic injury mechanisms. While antibody-induced models offer rapid injury induction and high reproducibility, their transient phenotype cannot model chronic progression or immune tolerance breakdown. Antigen-driven models recapitulate adaptive immunity but face prolonged timelines and epitope targeting bias diverging from human IgG4 dominance. GFB-on-Chip systems excel in mechanistic dissection of podocyte injury but lack immune microenvironment integration and physiologically accurate glomerular architecture. This review synthesizes strategies for MN model development through antibody-podocyte interaction studies, critically evaluates the strengths of existing platforms, and discusses emerging technologies for probing disease mechanisms and accelerating therapeutic discovery.