Tissue factor pathway inhibitor (TFPI) release after heparin stimulation is increased in Type 1 diabetic patients with albuminuria

Translational science in albuminuria: a new view of de novo albuminuria under chronic RAS suppression

The development of de novo albuminuria during chronic renin–angiotensin system (RAS) suppression is a clinical entity that remains poorly recognized in the biomedical literature. It represents a clear increment in global cardiovascular (CV) and renal risk that cannot be counteracted by RAS suppression. Although not specifically considered, it is clear that this entity is present in most published and ongoing trials dealing with the different forms of CV and renal disease. In this review, we focus on the mechanisms promoting albuminuria, and the predictors and new markers of de novo albuminuria, as well as the potential treatment options to counteract the excretion of albumin. The increase in risk that accompanies de novo albuminuria supports the search for early markers and predictors that will allow practising physicians to assess and prevent the development of de novo albuminuria in their patients.

Release of endothelium-associated proteins into blood by injection of heparin in normal subjects and in patients with Type 1 diabetes

AIMS

Disturbances in heparan sulphate proteoglycans in patients with diabetic nephropathy might contribute to the pathogenesis of vascular disease in these patients. To investigate this possible link, we measured the heparin-induced, immediate release of eight proteins with heparan sulphate binding properties in patients with nephropathy.

METHODS

We studied three groups, Type 1 diabetic patients with (n = 10) or without (n = 15) albuminuria and matched controls (n = 12). Blood samples were obtained before and 5 min after the injection of 40 anti-Xa IU low molecular weight heparin/kg body weight.

RESULTS

Lipoprotein lipase increased more in diabetic patients without albuminuria than in controls and patients with albuminuria [261 (170-293) vs. 177 (103-438), P < 0.05 and 203 (159-280) mU/ml, P < 0.05]. Total tissue factor pathway inhibitor increased more in the diabetic patients [284 (198-449) and 275 (243-399)] than in the controls [221 (169-289) ng/ml, P < 0.005]. Vitronectin increased significantly only in the diabetic patients with albuminuria. The remaining proteins did not increase significantly (antithrombin, von Willebrand factor, fibronectin) or increased equally in the three investigated groups (extracellular superoxid dismutase and platelet factor 4).

CONCLUSIONS

The different release of lipoprotein lipase and vitronectin in diabetic subjects with and without albuminuria may reflect novel aspects of vascular derangement in patients with albuminuria.