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Eighteen pediatric participants, including steroid-sensitive and steroid-resistant subgroups, had fatty acid composition assessed by gas chromatography and trough MPA measured by immunometric assay. In steroid-sensitive patients, higher trough MPA correlated with increased endoleukocyte omega-3 and DHA and decreased omega-6. In steroid-resistant subjects, no such correlations or favorable n-6/n-3 shift were detected, even with adequate MPA levels.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/therapeutic-trough-mycophenolic-acid-levels-positively-correlate-with-omega-3-fatty-acids-in-leukocytes-of-children-with-idiopathic-nephrotic-syndrome-a-pilot-study/410225/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/therapeutic-trough-mycophenolic-acid-levels-positively-correlate-with-omega-3-fatty-acids-in-leukocytes-of-children-with-idiopathic-nephrotic-syndrome-a-pilot-study/410225.png","ImageObject",300,407,{"name":92,"@type":93},"Mia  ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What was the aim of this pilot study?","Question",{"text":113,"@type":114},"To investigate how trough blood mycophenolic acid levels relate to endoleukocyte omega-3 and omega-6 fatty acid series in children with idiopathic nephrotic syndrome.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were fatty acids and MPA levels measured?",{"text":118,"@type":114},"Fatty acid profiles were analyzed by gas chromatography, and trough MPA blood levels were evaluated using an immunometric assay.",{"name":120,"@type":111,"acceptedAnswer":121},"What correlations were observed in steroid-sensitive versus steroid-resistant children?",{"text":122,"@type":114},"Steroid-sensitive patients showed a positive correlation between endoleukocyte omega-3 (and DHA) and trough MPA, and a negative correlation between endoleukocyte omega-6 and trough MPA. Steroid-resistant patients showed no correlation with the endoleukocyte n-6/n-3 ratio or trough MPA.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},410225,1791300749,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},687207024478,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","TYPE Original Research PUBLISHED 18 December 2025 DOI 10.3389/fphar.2025.1672304  \nOPEN ACCESS  \nEDITED BY  \nJohan Vande Walle,  \nGhent University, Belgium  \nREVIEWED BY  \nJumpei Saito,  \nNational Center for Child Health and Development (NCCHD), Japan Sudarsan K,  \nJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India  \n*CORRESPONDENCE  \nStefano Turolo,  \n [stefano.turolo@policlinico.mi.it](stefano.turolo@policlinico.mi.it)  \nRECEIVED 24 July 2025  \nREVISED 26 November 2025  \nACCEPTED 11 December 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nTurolo S, Edefonti A, Syren M-L, Bellotti AS, Morello W, Collino F, Agostoni C and Montini G (2025) Therapeutic trough mycophenolic acid levels positively correlate with omega-3 fatty acids in leukocytes of children with idiopathicnephrotic syndrome. a pilot study.  \nFront. Pharmacol. 16:1672304 .  \ndoi: 10.3389/fphar.2025.1672304  \nCOPYRIGHT  \n© 2025 Turolo, Edefonti, Syren, Bellotti, Morello, Collino, Agostoni and Montini. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nTherapeutic trough mycophenolic acid levels positively correlate with omega-3 fatty acids in leukocytes of children with idiopathic nephrotic syndrome. a pilot study  \nStefano Turolo 1*, Alberto Edefonti 1, Marie-Louise Syren 2, Anita S. Bellotti 1, William Morello 1, Federica Collino 2,3, Carlo Agostoni 2,4 and Giovanni Montini 1,2,3  \n1Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico. Pediatric Nephrology, Dialysis and Transplant Unit, Milan, Italy, 2Dipartimento di Scienze Cliniche e di Comunità, Dipartimento di Eccellenza 2023-2027, University of Milano, Milan, Italy, 3Laboratory of Translational Research in Paediatric NephroUrology, and Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca’ Granda IRCCSOspedale Maggiore Policlinico, Milan, Italy, 4Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Immuno-rheumatology Unit, Milan, Italy  \nThe pathogenesis of idiopathic nephrotic syndrome (INS) in most pediatric cases involves immune cell dysfunction, mediated, among other factors, by biologically active polyunsaturated fatty acids-dependent compounds in the blood and cell membranes. The immunosuppressive drug mycophenolate mofetil (MMF) is commonly used to maintain remission in patients with steroid-dependent nephrotic syndrome. The aim of this pilot study was to investigate the effect of trough blood mycophenolic acid (MPA) levels on the endoleukocyte fatty acid omega-3 and omega-6 series. Eighteen pediatric subjects with INS were enrolled, including 12 steroid-sensitive and 6 steroid-resistant children. Fatty acid (FA) profile was analyzed by gas-chromatography, and MPA blood level was evaluated by immunometric assay. Among steroid-sensitive patients, a positive correlation was observed between endoleukocyte omega-3 FA (n-3) and trough blood MPA levels, and a negative correlation was found between endoleukocyte omega-6 FA (n-6) and trough blood MPA levels. In addition, a positive correlation was found between endoleukocyte anti-inflammatory DHA and trough blood MPA levels. In contrast, in steroid-resistant subjects no correlation between endoleukocyte n-6/n-3 ratio and trough blood MPA levels was observed. In conclusion, adequate trough MPA drug levels may have contributed to switch the FA pathway to a more favorable endoleukocyte n-6/n-3 ratio and DHA levels, possibly supporting the natural anti-inflammatory activities of n-3 FA. In steroidresistant NS, despite adequate MPA levels, no promotion of the anti-inflammatory activity of the n-3 series was ","cbCaipKvdbLlmOfH","https://ap.wps.com/l/cbCaipKvdbLlmOfH","pdf",2797981,"English","# Introduction\n## Idiopathic nephrotic syndrome and treatment context\n## Immunological mechanisms and drug targets\n## Mycophenolate mofetil and mycophenolic acid mechanism\n## Fatty acids and immune modulation","[{\"question\":\"What was the aim of this pilot study?\",\"answer\":\"To investigate how trough blood mycophenolic acid levels relate to endoleukocyte omega-3 and omega-6 fatty acid series in children with idiopathic nephrotic syndrome.\"},{\"question\":\"How were fatty acids and MPA levels measured?\",\"answer\":\"Fatty acid profiles were analyzed by gas chromatography, and trough MPA blood levels were evaluated using an immunometric assay.\"},{\"question\":\"What correlations were observed in steroid-sensitive versus steroid-resistant children?\",\"answer\":\"Steroid-sensitive patients showed a positive correlation between endoleukocyte omega-3 (and DHA) and trough MPA, and a negative correlation between endoleukocyte omega-6 and trough MPA. Steroid-resistant patients showed no correlation with the endoleukocyte n-6/n-3 ratio or trough MPA.\"}]","Therapeutic trough mycophenolic acid levels positively correlate with omega-3 fatty acids in leukocytes of children with idiopathic nephrotic syndrome - A pilot study | PDF",1790584699,23]