Translating biomarker insights into practice: a path forward in TA-TMA management
Recent advances in the management of transplant-associated thrombotic microangiopathy (TA-TMA) include the harmonization of diagnostic criteria and the identification of high-risk disease features. Individual hematologic and complement biomarkers show moderate specificity when used alone in the dete...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-05-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1550365/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850035660464848896 |
|---|---|
| author | Sonata Jodele Eleni Gavriilaki |
| author_facet | Sonata Jodele Eleni Gavriilaki |
| author_sort | Sonata Jodele |
| collection | DOAJ |
| description | Recent advances in the management of transplant-associated thrombotic microangiopathy (TA-TMA) include the harmonization of diagnostic criteria and the identification of high-risk disease features. Individual hematologic and complement biomarkers show moderate specificity when used alone in the detection of TA-TMA in hematopoietic stem cell transplant (HSCT) recipients, but the identification of endothelial injury due to microangiopathic process can be enhanced using longitudinal monitoring of biomarkers and clinical features. An increase in the sC5b-9 level reflects terminal complement activation, a hallmark of TA-TMA pathogenesis that guides therapeutic interventions. In addition, distinguishing physiologic from pathologic complement activation is essential for timely diagnosis of the disease and selection of targeted interventions. Eculizumab therapy, a biomarker-guided C5 blocker, significantly improves clinical outcomes in severe TA-TMA; however, there is a lack of knowledge on how to select second-line complement inhibitors or combination therapies for cases with a suboptimal response to eculizumab. This article proposes practical approaches to increasing the specificity and attributability of TA-TMA diagnostic biomarkers by integrating clinically available supportive diagnostic tests and provides insights into potential biomarkers for currently available novel complement inhibitors. These findings help ensure timely diagnosis, prevent irreversible organ injury, and improve outcomes in HSCT recipients with TA-TMA. |
| format | Article |
| id | doaj-art-b5e76e8ee5b447a2a9d77690d12e5ce9 |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-b5e76e8ee5b447a2a9d77690d12e5ce92025-08-20T02:57:26ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-05-011210.3389/fmed.2025.15503651550365Translating biomarker insights into practice: a path forward in TA-TMA managementSonata Jodele0Eleni Gavriilaki1Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cancer and Blood Disease Institute, University of Cincinnati College of Medicine, Cincinnati, OH, United States2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, GreeceRecent advances in the management of transplant-associated thrombotic microangiopathy (TA-TMA) include the harmonization of diagnostic criteria and the identification of high-risk disease features. Individual hematologic and complement biomarkers show moderate specificity when used alone in the detection of TA-TMA in hematopoietic stem cell transplant (HSCT) recipients, but the identification of endothelial injury due to microangiopathic process can be enhanced using longitudinal monitoring of biomarkers and clinical features. An increase in the sC5b-9 level reflects terminal complement activation, a hallmark of TA-TMA pathogenesis that guides therapeutic interventions. In addition, distinguishing physiologic from pathologic complement activation is essential for timely diagnosis of the disease and selection of targeted interventions. Eculizumab therapy, a biomarker-guided C5 blocker, significantly improves clinical outcomes in severe TA-TMA; however, there is a lack of knowledge on how to select second-line complement inhibitors or combination therapies for cases with a suboptimal response to eculizumab. This article proposes practical approaches to increasing the specificity and attributability of TA-TMA diagnostic biomarkers by integrating clinically available supportive diagnostic tests and provides insights into potential biomarkers for currently available novel complement inhibitors. These findings help ensure timely diagnosis, prevent irreversible organ injury, and improve outcomes in HSCT recipients with TA-TMA.https://www.frontiersin.org/articles/10.3389/fmed.2025.1550365/fulltransplant-associated thrombotic microangiopathybiomarkerscomplementeculizumabravulizumabnarsoplimab |
| spellingShingle | Sonata Jodele Eleni Gavriilaki Translating biomarker insights into practice: a path forward in TA-TMA management Frontiers in Medicine transplant-associated thrombotic microangiopathy biomarkers complement eculizumab ravulizumab narsoplimab |
| title | Translating biomarker insights into practice: a path forward in TA-TMA management |
| title_full | Translating biomarker insights into practice: a path forward in TA-TMA management |
| title_fullStr | Translating biomarker insights into practice: a path forward in TA-TMA management |
| title_full_unstemmed | Translating biomarker insights into practice: a path forward in TA-TMA management |
| title_short | Translating biomarker insights into practice: a path forward in TA-TMA management |
| title_sort | translating biomarker insights into practice a path forward in ta tma management |
| topic | transplant-associated thrombotic microangiopathy biomarkers complement eculizumab ravulizumab narsoplimab |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1550365/full |
| work_keys_str_mv | AT sonatajodele translatingbiomarkerinsightsintopracticeapathforwardintatmamanagement AT elenigavriilaki translatingbiomarkerinsightsintopracticeapathforwardintatmamanagement |