Lipoic acid supplement use is widespread and considered generally safe. Interestingly, no increase in Nell1 expression was observed. Using in vitro cell culture, we further found no NELL1 expression in the renal cell type known to be dysfunctional in NELL1 membranous nephropathy, with or without lipoic acid exposure. These data suggest that lipoic acid does not increase expression of the target self NELL1 antigen in kidneys and may instead contribute to NELL1 membranous nephropathy pathogenesis by modulating immune tolerance in the periphery.
