Urinary proteins detected using modern proteomics intervene in early type 2 diabetic kidney disease – a pilot study

Effectiveness and safety of Tongxinluo capsule for diabetic kidney disease: A systematic review and meta-analysis

BACKGROUND

Diabetic kidney disease (DKD), a common microvascular complication of diabetes mellitus, is the primary cause of end-stage renal disease. Tongxinluo capsule (TXLC), a traditional Chinese medicinal compound, is widely utilized in China for treating DKD.

AIM

To analyze the effectiveness and safety of TXLC for treating DKD.

METHODS

Eight electronic literature databases were retrieved to obtain randomized controlled trials (RCTs) of TXLC for DKD. RevMan 5.3 software was used for data analysis. Evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation System. Publication bias was detected using Stata 16.0 software.

RESULTS

Twenty-two RCTs involving 1941 patients with DKD were identified. Compared with conventional treatment, TXLC combination therapy significantly improved the primary outcomes, including 24-hour urine proteinuria, urine microalbumin, and urinary albumin excretion rate. Regarding secondary outcomes, TXLC combination therapy significantly reduced serum creatinine, blood urea nitrogen, β2-microglobulin, and cystatin C levels; however, it had no significant effect on creatinine clearance rate. In terms of additional outcomes, TXLC combination therapy significantly reduced total cholesterol, triglycerides, low-density lipoprotein cholesterol, fibrinogen, plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity, and endothelin-1 levels, while increasing nitric oxide levels. However, the addition of TXLC treatment did not significantly affect fasting plasma glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, high-density lipoprotein cholesterol, or C-reactive protein levels. The safety of TXLC in DKD remains uncertain due to limited adverse event reporting.

CONCLUSION

TXLC may benefit individuals with DKD by improving various health parameters, such as urinary protein levels, renal function, blood lipids, hemorheology, and vascular endothelial function. However, TXLC did not improve all studied outcomes.

In-depth urinary and exosome proteome profiling analysis identifies novel biomarkers for diabetic kidney disease

Diabetic kidney disease (DKD) is a major microvascular complication of type 2 diabetes mellitus (T2DM). Monitoring the early diagnostic period and disease progression plays a crucial role in treating DKD. In this study, to comprehensively elucidate the molecular characteristics of urinary proteins and urinary exosome proteins in type 2 DKD, we performed large-scale urinary proteomics (n=144) and urinary exosome proteomics (n=44) analyses on T2DM patients with albuminuria in varying degrees. The dynamics analysis of the urinary and exosome proteomes in our study provides a valuable resource for discovering potential urinary biomarkers in patients with DKD. A series of potential biomarkers, such as SERPINA1 and transferrin (TF), were detected and validated to be used for DKD diagnosis or disease monitoring. The results of our study comprehensively elucidated the changes in the urinary proteome and revealed several potential biomarkers reflecting the progression of DKD, which provide a reference for DKD biomarker screening.

Tubular injury in diabetic kidney disease: molecular mechanisms and potential therapeutic perspectives

Diabetic kidney disease (DKD) is a chronic complication of diabetes and the leading cause of end-stage renal disease (ESRD) worldwide. Currently, there are limited therapeutic drugs available for DKD. While previous research has primarily focused on glomerular injury, recent studies have increasingly emphasized the role of renal tubular injury in the pathogenesis of DKD. Various factors, including hyperglycemia, lipid accumulation, oxidative stress, hypoxia, RAAS, ER stress, inflammation, EMT and programmed cell death, have been shown to induce renal tubular injury and contribute to the progression of DKD. Additionally, traditional hypoglycemic drugs, anti-inflammation therapies, anti-senescence therapies, mineralocorticoid receptor antagonists, and stem cell therapies have demonstrated their potential to alleviate renal tubular injury in DKD. This review will provide insights into the latest research on the mechanisms and treatments of renal tubular injury in DKD.

Urinary proteomics for kidney dysfunction: insights and trends

Introduction: Kidney dysfunction poses a high burden on patients and health care systems. Early detection and accurate prediction of kidney disease progression remains a major challenge. Compared to existing clinical parameters, urinary proteomics has the potential to reveal molecular alterations within the kidney that may alter its function before the onset of clinical symptoms. Thus, urinary proteomics has greater prognostic potential for assessment of kidney dysfunction progression.Areas covered: Advances in urinary proteomics for major causes of kidney dysfunction are discussed. The application of urinary extracellular vesicles for studying kidney dysfunction are discussed. Technological advances in urinary proteomics are discussed. The literature was identified using a database search for titles containing 'proteom*' and 'urin*' and published within the past 5 years. Retrieved literature was manually filtered to retain kidney dysfunctions-related studies.Expert opinion: Despite major advances, diagnosis by urinary proteomics has not been fully applied in any clinical settings. This could be attributed to the complex nature of kidney diseases, in addition to the constraints on study power and feasibility of incorporating mass spectrometry techniques in daily routine analysis. Nevertheless, we are confident that advances in urinary proteomics will soon provide superior insights into kidney disease beyond existing clinical parameters.