Mesangial pathology in glomerular disease: targets for therapeutic intervention.

The glomerulus is the filtration unit of the kidney. Disruption of glomerular function may be caused by primary glomerular pathology or secondary to systemic diseases. The mesangial, endothelial and epithelial cells of the glomerulus are involved in most pathologic processes. Animal models provide an understanding of the molecular basis of glomerular disease. These studies show that mesangial cells are critical players in the initiation and progression of disease. Therefore, modulation of mesangial cell responses offers a novel therapeutic approach. The complex architecture of the kidney, specifically the renal glomerulus, makes targeted drug delivery especially challenging. Targeted delivery of therapeutic agents reduces dose of administration and minimises unwanted side effects caused by toxicity to other tissues. The currently available modalities demonstrating the feasibility of mesangial cell targeting are discussed.