Targeting the Unequal Burden of Kidney Disease on Black Americans


“I was all for it,” Malcolm said. Martin too.

When tested, the brothers were told they had the variants and that the variants, not lupus, were most likely damaging their kidneys. They barely knew how to react.

“I always try to tackle it,” Malcolm said.

But Dr. Olabisi was not surprised. The researchers believe that the variants cause kidney disease only when there is a secondary factor. One of the main candidates is the body’s own antiviral response, interferon, which is produced in abundance in people with lupus.

High levels of interferon also occur in people with untreated HIV. As happens in people with Covid-19, they can experience an unusual and catastrophic collapse of their kidneys if they have the variants. Other viral infections, some of which may go unnoticed, can cause interferon surges that can trigger APOL1 variants. Interferon is also used as a medicine to treat certain diseases including cancer and has been tested as a treatment for Covid patients.

Right now, Malcolm and Martin can’t do much except take medicine to control their lupus.

Martin said he understands all of that, but he’s glad he learned he has the variants. Now he knows what he could face.

“I’m the type of person who likes to plan,” he says. “It makes a difference.”

While Dr. Olabisi waits to begin his study, a pharmaceutical company, Vertex, has continued its own research. But there was no agreement on how APOL1 variants caused kidney disease, so it was unclear what a drug was meant to block.

“If you don’t understand the mechanism, that means you can’t measure the effects in a lab,” said Dr. David Altshuler, chief scientific officer of Vertex. “And if you can’t measure the effects in the lab, that means you can’t fix them.”

It was known how the APOL1 protein protected against sleeping sickness – it drilled holes in pathogenic trypanosomes, causing them to swell with fluid and burst.


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