Spatial metabolomics and multiomics integration for breakthroughs in precision medicine for kidney disease.

Precision medicine is now a feasible prospect for nephrologists as numerous therapeutic options are available for various forms of kidney disease. However, implementation of this strategy will require high-dimensional diagnostic approaches to identify patients who will respond to an intervention and monitor mechanisms of action relevant to the underlying disease process. With the advent of spatial omics, comprehensive and thorough molecular analysis of biological samples is now possible. In particular, spatial metabolomics analysis of kidney biopsy samples could have an important role in facilitating precision medicine for kidney diseases. Spatial metabolomics can be used to monitor changes in the functional outcomes of genes and proteins in specific anatomical compartments such as the glomeruli, tubules, blood vessels and interstitial spaces. Spatial metabolomics studies have identified adenine in regions of interstitial fibrosis and arteriosclerosis in diabetic kidney disease, provided new insights into the regulation of N-glycans in glomeruli from patients with diabetes, and enabled a new metabolomic classification of kidney cancer subtypes. Use of computational informatic platforms to integrate genomics, transcriptomics, proteomics and epigenomics with metabolomics will further enhance the value of spatial metabolomics for clinical applications.