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Ekelund C, Dereke J, Nilsson C, Landin-Olsson M. Are soluble E-selectin, ICAM-1, and VCAM-1 potential predictors for the development of diabetic retinopathy in young adults, 15-34 years of age? A Swedish prospective cohort study. PLoS One 2024; 19:e0304173. [PMID: 38843125 PMCID: PMC11156360 DOI: 10.1371/journal.pone.0304173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
The aim of this study was to determine plasma levels of three adhesion molecules that may contribute to the development of diabetic retinopathy; soluble endothelial selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1), in young adults, aged 15-34 years at diagnosis of diabetes, to find potential predictors for development of retinopathy, and to evaluate their relation to diabetes associated autoantibodies. Participants with type 1 (n = 169) and type 2 diabetes (n = 83) were selected from the complications trial of the Diabetes Incidence Study in Sweden and classified in two subgroups according to presence (n = 80) or absence (n = 172) of retinopathy as determined by retinal photography at follow-up 8-10 years after diagnosis of diabetes. Blood samples were collected at diagnosis in 1987-88. The levels of sE-selectin, sICAM-1, and sVCAM-1 were analysed by enzyme-linked immunosorbent assay and islet cell antibodies by a prolonged two-colour immunofluorescent assay. Mean HbA1c (p<0.001) and clinical characteristics: mean body mass index (p = 0.019), systolic blood pressure (p = 0.002), diastolic blood pressure (p = 0.003), male gender (p = 0.026), and young age at diagnosis of diabetes (p = 0.015) remained associated with development of retinopathy in type 1 diabetes. However, in a multivariate analysis only HbA1c remained as a risk factor. sE-selectin was significantly higher in the group with type 2 diabetes and retinopathy, compared to the group with type 2 diabetes without retinopathy (p = 0.04). Regarding sE-selectin, sICAM-1, and sVCAM-1 in participants with type 1 diabetes, no differences were observed between the groups with or without retinopathy. This trial confirmed the role of HbA1c and clinical characteristics as predictors for development of retinopathy in type 1 diabetes. sE-selectin stands out as a potential predictor for development of retinopathy in type 2 diabetes, whereas a predictive role for sICAM-1 and sVCAM-1 could not be identified neither for type 1 nor type 2 diabetes.
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Affiliation(s)
- Charlotte Ekelund
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonatan Dereke
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Charlotta Nilsson
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Pediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - Mona Landin-Olsson
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
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2
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Nemati M, Hosseinzadeh Z, Nemati F, Koohpeyma F. Improvement effects of transplanting pancreatic islet that previously incubated with biomaterials on the diabetic nephropathy in STZ- diabetic rats. BMC Nephrol 2024; 25:156. [PMID: 38724923 PMCID: PMC11080158 DOI: 10.1186/s12882-024-03572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/05/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Islet transplantation is an effective treatment for diabetes or even its complications. Aim of this study is to investigate efficacy of biomaterial treated islet transplantation on treating diabetic nephropathy. METHODS Male rats were randomly divided into 6 groups; Control, diabetic control, diabetic transplanted with untreated islets, with platelet rich plasma treated islets, with pancreatic islets homogenate treated islets, or with these biomaterials combination treated islets. Islets cultured with biomaterials and transplanted to diabetic rats. After 60 days, biochemical, oxidative stress, and stereological parameters were assessed. RESULTS Serum albumin and BUN concentration, decreased and increased respectively, Oxidative stress of kidney impaired, kidney weight, volume of kidney, cortex, medulla, glomerulus, proximal and distal tubules, collecting ducts, vessels, inflammatory, necrotic and fibrotic tissue in diabetic group increased compared to control group (p < 0.001). In treated groups, especially pancreatic islets homogenate treated islets transplanting animals, there was significant changes in kidney weight, and volume of kidney, proximal and distal tubules, Henle's loop and collecting ducts compared with diabetic group (p = 0.013 to p < 0.001). Combination treated islets animals showed significant increase in vessel volume compared to diabetic group (p < 0.001). Necrotic and fibrotic tissue significantly decreased in islets treated than untreated islet animals, it was higher in pancreatic islets homogenate, and combination treated islets groups (p = 0.001). CONCLUSIONS Biomaterials treated islets transplanting could improve diabetic nephropathy. Improvement of oxidative stress followed by controlling glucose level, and effects of growth factors presenting in biomaterials can be considered as capable underlying mechanism of ameliorating inflammatory, necrotic and fibrotic tissue volume.
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Affiliation(s)
- Marzieh Nemati
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Hosseinzadeh
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Nemati
- School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Farhad Koohpeyma
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Abstract
Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Already during childhood, almost all organs are at risk of being affected by obesity. In this review, we present the current knowledge about diseases associated with childhood obesity and how they are affected by weight loss. One major causative factor is obesity-induced low-grade chronic inflammation, which can be observed already in preschool children. This inflammation-together with endocrine, paracrine, and metabolic effects of obesity-increases the long-term risk for several severe diseases. Type 2 diabetes is increasingly prevalent in adolescents and young adults who have had obesity during childhood. When it is diagnosed in young individuals, the morbidity and mortality rate is higher than when it occurs later in life, and more dangerous than type 1 diabetes. Childhood obesity also increases the risk for several autoimmune diseases such as multiple sclerosis, Crohn's disease, arthritis, and type 1 diabetes and it is well established that childhood obesity also increases the risk for cardiovascular disease. Consequently, childhood obesity increases the risk for premature mortality, and the mortality rate is three times higher already before 30 years of age compared with the normal population. The risks associated with childhood obesity are modified by weight loss. However, the risk reduction is affected by the age at which weight loss occurs. In general, early weight loss-that is, before puberty-is more beneficial, but there are marked disease-specific differences.
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Affiliation(s)
- Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Huang Z, Qiu K, Yi J, Lin H, Zheng D, Huang D, Zhang G, Chen H, Zheng J, Wang Y, Fang D, Chen W. Diabetic retinopathy with extensively large area of capillary non-perfusion: characteristics and treatment outcomes. BMC Ophthalmol 2022; 22:293. [PMID: 35787271 PMCID: PMC9254521 DOI: 10.1186/s12886-022-02508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Capillary non-perfusion is an important characteristic for diabetic retinopathy (DR) indicating microvascular damage and ischemia. Data on the description and treatment outcomes of DR with large area of non-perfusion are lacking to date. We aim to describe the characteristics and treatment outcomes in a series of patients with DR who presented extensively large area of capillary non-perfusion (LACNP). Methods Fundus fluorescein angiograms from medical charts in patients diagnosed with DR between Jan 2017 and Dec 2019 were retrospectively reviewed. Clinical data in eyes with LACNP including imaging and laboratory findings at the first presentation were analyzed. The LACNP was defined as over 70% area of capillary non-perfusion throughout the whole image retina. The mean follow-up duration was 12.4 ± 16.7 months. Follow-up data including extensive pan-retinal photocoagulation and surgical intervention and treatment outcomes were evaluated. Results A total of 43 eyes in 24 patients with LACNP were included, accounting for 3.3% of DR populations in the same period. The overall percentage of non-perfusion area was 79.1 ± 8.1%. All patients received proper control of diabetes and hypertension, and extensive pan-retinal laser photocoagulation. During the follow-up periods, 20 eyes (46.5%) developed severe neovascular complications, of which 15 eyes (34.9%) underwent vitrectomy and/or anti-glaucoma surgeries. Conservative therapies including glycemic control and supplemental laser photocoagulation were conducted in 23 eyes (53.5%) without neovascular complications. In the final follow-up, best corrected visual acuity improved or maintained stable in 19 eyes (44.2%) while deteriorated in 24 eyes (55.8%). Conclusions The presence of LACNP is the hallmark of advanced DR and often indicates a poor visual outcome, although aggressive treatments may slow DR progression and maintain central vision for some time. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02508-6.
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Affiliation(s)
- Zijing Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Kunliang Qiu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Jingsheng Yi
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Hongjie Lin
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Dezhi Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Dingguo Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Guihua Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Jianlong Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Yifan Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Danqi Fang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, 515041, Guangdong, China
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Microencapsulated islet transplantation alleviates podocyte injury in diabetic nephropathy via inhibiting Notch-1 signaling. Transpl Immunol 2022; 72:101579. [PMID: 35278650 DOI: 10.1016/j.trim.2022.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Podocyte injury has a critical role in the pathogenesis of diabetic nephropathy (DN). Microencapsulated islet transplantation (MIT) is identified as an effective method for improving the clinical condition of DN. This study aimed to explore the role and mechanism of MIT in alleviating podocyte injury in DN. METHODS A mouse model of DN was constructed using streptozotocin (STZ). Mice were divided into 3 groups: the untreated diabetic nephropathy group (DN group), the microencapsulated islet transplantation-treated group (MIT group) and the control group. The mice were raised for 6 weeks posterior to islet transplantation to identify the role of MIT. Renal function and structure of glomerular filtration barrier were assessed by urine analysis, histopathological examination, and transmission electron microscopy. The expression levels of several proteins including Caspase-3, Bcl2/Bax, β-galactosidase, Ki-67, synaptopodin, WT-1, Jagged-1, Notch-1, and Hes-1 in renal tissues were identified via immunohistochemistry (IHC), immunofluorescence (IF), and western blotting techniques. RESULTS Compared with the DN group, the MIT group presented decreased levels of blood glucose, urinary albumin/creatinine, urea nitrogen, and serum creatinine while their body weight gradually increased. Glomerular injury in the MIT group was significantly better than that in the DN group. The MIT group indicated significantly decreased expression of Caspase-3, β-galactosidase, Bax/Bcl-2, and Ki-67 when compared with DN group, while the proportion of synaptopodin- and WT-1-positive cells was significantly increased (P < 0.05). The protein expression of Jagged-1, Notch-1, and Hes-1 in the glomerulus of the MIT group was significantly lower than that in the DN group (P < 0.05). CONCLUSION MIT alleviates podocyte injury induced by DN by inhibiting Notch-1 signaling. The identification of signaling pathways influencing podocyte restoration can help evaluate personalized medicine efficacy for patients treated with islet transplantation.
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An S, Li Y, Jia X, Yang Y, Jia X, Jia X, Xue W. Ponicidin attenuates streptozotocin‐induced diabetic nephropathy in rats via modulating hyperlipidemia, oxidative stress, and inflammatory markers. J Biochem Mol Toxicol 2022; 36:e22988. [PMID: 35187780 DOI: 10.1002/jbt.22988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Shuqiang An
- Kidney Transplantation The First Affiliated Hospital of Xi'an Jiaotong University Xi'an City China
- Department of Nephropathy Shijiazhuang Pingan Hospital Shijiazhuang City China
| | - Yang Li
- Kidney Transplantation The First Affiliated Hospital of Xi'an Jiaotong University Xi'an City China
| | - Xiaojing Jia
- Department of Internal Medicine Zhaoxian Industrial Park Hospital Shijiazhuang City China
| | - Yaqin Yang
- Department of Blood Purification The First Affiliated Hospital of Hebei North University Zhangjiakou City China
| | - Xiaojuan Jia
- Department of Internal Medicine Zhaoxian Industrial Park Hospital Shijiazhuang City China
| | - Xiaozhao Jia
- Department of Internal Medicine Zhaoxian Industrial Park Hospital Shijiazhuang City China
| | - Wujun Xue
- Kidney Transplantation The First Affiliated Hospital of Xi'an Jiaotong University Xi'an City China
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Kristófi R, Bodegard J, Norhammar A, Thuresson M, Nathanson D, Nyström T, Birkeland KI, Eriksson JW. Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study. Diabetes Care 2021; 44:1211-1218. [PMID: 33653822 PMCID: PMC8132335 DOI: 10.2337/dc20-2839] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular (CV) and renal disease (CVRD) compared with diabetes-free populations. Direct comparisons between T1D and T2D are scarce. We examined this by pooling full-population cohorts in Sweden and Norway. RESEARCH DESIGN AND METHODS A total of 59,331 patients with T1D and 484,241 patients with T2D, aged 18-84 years, were followed over a mean period of 2.6 years from 31 December 2013. Patients were identified in nationwide prescribed drug and hospital registries in Norway and Sweden. Prevalence and event rates of myocardial infarction (MI), heart failure (HF), stroke, chronic kidney disease (CKD), all-cause death, and CV death were assessed following age stratification in 5-year intervals. Cox regression analyses were used to estimate risk. RESULTS The prevalence of CV disease was similar in T1D and T2D across age strata, whereas CKD was more common in T1D. Age-adjusted event rates comparing T1D versus T2D showed that HF risk was increased between ages 65 and 79 years, MI between 55 and 79 years, and stroke between 40 and 54 years (1.3-1.4-fold, 1.3-1.8-fold, and 1.4-1.7-fold, respectively). CKD risk was 1.4-3.0-fold higher in T1D at all ages. The all-cause death risk was 1.2-1.5-fold higher in T1D at age >50 years, with a similar trend for CV death. CONCLUSIONS Adult patients with T1D compared with those with T2D had an overall greater risk of cardiorenal disease (HF and CKD) across ages, MI and all-cause death at middle-older ages, and stroke at younger ages. The total age-adjusted CVRD burden and risks were greater among patients with T1D compared with those with T2D, highlighting their need for improved prevention strategies.
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Affiliation(s)
- Robin Kristófi
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | | | - Anna Norhammar
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden.,Capio Saint Göran Hospital, Stockholm, Sweden
| | | | - David Nathanson
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
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Yu WC, Huang RY, Chou TC. Oligo-Fucoidan Improves Diabetes-Induced Renal Fibrosis via Activation of Sirt-1, GLP-1R, and Nrf2/HO-1: An In Vitro and In Vivo Study. Nutrients 2020; 12:E3068. [PMID: 33049944 PMCID: PMC7650749 DOI: 10.3390/nu12103068] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/20/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Fucoidan extracted from brown algae has multiple beneficial functions. In this study, we investigated the effects of low-molecular-weight fucoidan (oligo-FO) on renal fibrosis under in vitro and in vivo diabetic conditions, and its molecular mechanisms. Advanced glycation product (AGE)-stimulated rat renal proximal tubular epithelial cells (NRK-52E) and diabetic mice induced by high-fat diet and intraperitoneal injection of streptozotocin and nicotinamide were used. Oligo-FO treatment significantly inhibited anti-high mobility group box 1 (HMGB1)/RAGE/ anti-nuclear factor-kappa B (NF-κB)/transforming growth factor-β1 (TGF-β1)/TGF-β1R/Smad 2/3/fibronectin signaling pathway and HIF-1α activation in AGE-stimulated NRK-52E cells. Conversely, the expression and activity of Sirt-1; the levels of ubiquitin-specific peptidase 22 (USP22), p-AMPK, glucagon-like peptide-1 receptor (GLP-1R), and heme oxygenase-1 (HO-1); and Nrf2 activation were remarkably increased by oligo-FO in AGE-stimulated cells. However, the above effects of oligo-FO were greatly diminished by inhibiting Sirt-1, HO-1, or GLP-1R activity. Similar changes of these pro-fibrotic genes in the kidney and a marked attenuation of renal injury and dysfunction were observed in oligo-FO-treated diabetic mice. These findings indicated that the inhibitory effects of the oligo-FO on diabetes-evoked renal fibrosis are mediated by suppressing TGF-β1-activated pro-fibrogenic processes via Sirt-1, HO-1, and GLP-1R dependence. Collectively, fucoidan-containing foods or supplements may be potential agents for ameliorating renal diseases due to excessive fibrosis.
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Affiliation(s)
- Wen-Chun Yu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Tz-Chong Chou
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Pharmacology, National Defense Medical Center, Taipei 11490, Taiwan
- China Medical University Hospital, China Medical University, Taichung 404332, Taiwan
- Department of Biotechnology, Asia University, Taichung 41354, Taiwan
- Cathay Medical Research Institute, Cathay General Hospital, New Taipei City 22174, Taiwan
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9
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Pihlaskari AK, Anderson BJ, Eshtehardi SS, McKinney BM, Marrero DG, Thompson D, Hilliard ME. Diabetes disclosure strategies in adolescents and young adult with type 1 diabetes. PATIENT EDUCATION AND COUNSELING 2020; 103:208-213. [PMID: 31447195 DOI: 10.1016/j.pec.2019.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Adolescence and young adulthood have social and developmental challenges that can impact type 1 diabetes (T1D) management. New relationships (e.g. friends, schoolmates, dating partners, teachers, employers) introduce opportunities for disclosure of T1D status. Characterizing how adolescents and young adults (AYAs) disclose having T1D to others may help inform clinical strategies to help AYAs ensure their safety by obtaining social support. METHODS As part of a study about diabetes health-related quality of life across the lifespan, transcriptions of semi-structured qualitative interviews with AYAs with T1D (n = 16, age 12-25 years, mean age 18.7 ± 4.9, 38% female) were coded to derive themes related to T1D disclosure. RESULTS Participants described three disclosure strategies: (1) Open Disclosure: shares T1D status in straightforward, direct manner and readily requests diabetes-related support; (2) Disclosure Hesitancy: reluctant to tell others about or actively hides having T1D; (3) Passive Disclosure: discloses T1D via other people (e.g., parents) or through others' observation of T1D management tasks. CONCLUSION AYAs may benefit from guidance in approaches to informing others about having T1D in different contexts. Identifying individuals' use of these strategies can inform education and intervention strategies aimed at engaging AYAs in healthy T1D-related disclosure to seek and receive support.
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Affiliation(s)
- Andrea K Pihlaskari
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Sahar S Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Brett M McKinney
- Diabetes Translational Research Center, Indiana University School of Medicine, 410 West 10th St. Suite 2000A, Indianapolis, IN 46202, United States.
| | - David G Marrero
- Diabetes Translational Research Center, Indiana University School of Medicine, 410 West 10th St. Suite 2000A, Indianapolis, IN 46202, United States.
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, United States.
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
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10
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Elhefnawy KA, Elsayed AM. Prevalence of diabetic kidney disease in patients with type 2 diabetes mellitus. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_113_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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11
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Choy SW, Fraser SA, Katerelos M, Galic S, Kemp BE, Mount PF, Power DA. Absence of the β1 subunit of AMP-activated protein kinase reduces myofibroblast infiltration of the kidneys in early diabetes. Int J Exp Pathol 2019; 100:114-122. [PMID: 31025787 DOI: 10.1111/iep.12313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 01/23/2023] Open
Abstract
Activation of the heterotrimeric energy-sensing kinase AMP-activated protein kinase (AMPK) has been reported to improve experimental diabetic kidney disease. We examined the effect of type 1 diabetes in wild-type (WT) mice and mice lacking the β1 subunit of AMPK (AMPK β1-/- mice), which have reduced AMPK activity in kidneys and other organs. Diabetes was induced using streptozotocin (STZ) and the animals followed up for 4 weeks. Hyperglycaemia was more severe in diabetic AMPK β1-/- mice, despite the absence of any difference in serum levels of insulin, adiponectin and leptin. There was no change in AMPK activity in the kidneys of diabetic WT mice by AMPK activity assay, or phosphorylation of either the αT172 activation site on the α catalytic subunit of AMPK or the AMPK-specific phosphosite S79 on acetyl CoA carboxylase 1 (ACC1). Phosphorylation of the inhibitory αS485 site on the α subunit of AMPK was significantly increased in the WT diabetic mice compared to non-diabetic controls. Despite increased plasma glucose levels in the diabetic AMPK β1-/- mice, there were fewer myofibroblasts in the kidneys compared to diabetic WT mice, as evidenced by reduced α-smooth muscle actin (α-SMA) protein by Western blot, mRNA by qRT-PCR and fewer α-SMA-positive cells by immunohistochemical staining. Albuminuria was also reduced in the AMPK β1-/- mice. In contrast to previous studies, therefore, myofibroblasts were reduced in the kidneys of AMPK β1-/- diabetic mice compared to diabetic WT mice, despite increased circulating glucose, suggesting that AMPK can worsen renal fibrosis in type 1 diabetes.
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Affiliation(s)
- Suet-Wan Choy
- Kidney Laboratory, Institute for Breathing and Sleep, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Nephrology, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Austin Health and St. Vincent's Hospital, Heidelberg, Victoria, Australia
| | - Scott A Fraser
- Kidney Laboratory, Institute for Breathing and Sleep, University of Melbourne, Heidelberg, Victoria, Australia
| | - Marina Katerelos
- Kidney Laboratory, Institute for Breathing and Sleep, University of Melbourne, Heidelberg, Victoria, Australia
| | - Sandra Galic
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
| | - Bruce E Kemp
- Department of Medicine, University of Melbourne, Austin Health and St. Vincent's Hospital, Heidelberg, Victoria, Australia.,St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, VIC, Australia
| | - Peter F Mount
- Kidney Laboratory, Institute for Breathing and Sleep, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Nephrology, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Austin Health and St. Vincent's Hospital, Heidelberg, Victoria, Australia
| | - David A Power
- Kidney Laboratory, Institute for Breathing and Sleep, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Nephrology, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Austin Health and St. Vincent's Hospital, Heidelberg, Victoria, Australia
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12
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Dapagliflozin attenuates early markers of diabetic nephropathy in fructose-streptozotocin-induced diabetes in rats. Biomed Pharmacother 2018; 109:910-920. [PMID: 30551545 DOI: 10.1016/j.biopha.2018.10.100] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/02/2018] [Accepted: 10/20/2018] [Indexed: 12/13/2022] Open
Abstract
Early detection and clinical interference are major challenges for the prevention of diabetic nephropathy (DN) progression. This study investigated the effects of dapagliflozin, a sodium glucose co-transporter 2 inhibitor, on some early markers for DN in fructose-streptozotocin (Fr-STZ)-induced diabetes in rats. Fr-STZ rats were treated with either dapagliflozin (1 mg/kg p.o. daily), metformin (350 mg/kg p.o. daily), or their combination for 6 weeks. Fr-STZ rats displayed marked early tubular renal damage and glomerular podocyte injury as evidenced by renal KIM-1, NGAL, cystatin C, and vanin-1 mRNA, as well as urinary NAG elevation and nephrin mRNA suppression, associated with the development of marked renal interstitial fibrosis and glomerulosclerosis despite the presence of normoalbuminuria. Propagation of oxidative, inflammatory, fibrotic, and apoptotic reactions was obvious in the setting of renal glucose overload. Dapagliflozin significantly attenuated the renal tubular injury makers namely KIM-1, NGAL, vanin-1 and urinary NAG. In addition, it restored glomerular nephrin expression and reversed renal histopathological changes. Oxidative, inflammatory, and fibrotic processes were also alleviated. This study suggests that dapagliflozin exerts a renoprotective effect against early features of DN in rats presumably by inhibition of diabetes-induced renal tubular and glomerular injury thereby modulating oxidative, inflammatory, and fibrotic as well as apoptotic mechanisms elicited during hyperglycemia.
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Aberrant activation of Notch-1 signaling inhibits podocyte restoration after islet transplantation in a rat model of diabetic nephropathy. Cell Death Dis 2018; 9:950. [PMID: 30237561 PMCID: PMC6148077 DOI: 10.1038/s41419-018-0985-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
Signaling abnormalities play important roles during podocyte injury and have been indicated as crucial events for triggering many glomerular diseases. There is emerging evidence demonstrating significant improvements in preventing renal injury and restoring podocytes after islet transplantation. However, whether signaling abnormalities affect the therapeutic efficacy of islet transplantation remain unclear. This study was established to investigate the impact of Notch-1 signaling activation on renal injury and podocyte restoration after islet transplantation. Experiments were performed in vivo and in vitro under conditions of diabetic nephropathy and high-glucose medium, respectively. Podocyte injury in vitro was induced by high-glucose concentration, and expression levels of genes associated with the Notch-1 pathway were also regulated by Jagged-1/FC and N-[N-(3,5-Difluorophenacetyl)-L-alanyl]- S-phenylglycine t-butyl ester (DAPT). Podocytes were co-cultured with islets to investigate the protective effect of islets in high-glucose conditions. Histopathological staining and transmission electron microscopy were performed to assess pathological changes in podocytes in glomeruli. The results from this study showed that Notch-1 signaling in podocytes was significantly decreased by functional islet cells in vivo and in vitro. Compared with the co-cultured group and transplanted group, highly activated Notch-1 signaling significantly moderated the effect of islets in affecting podocyte restoration and renal injury. Renal damage and podocyte injury were alleviated after DAPT treatment. Furthermore, the balance between apoptosis and autophagy was diverse under different treatments. All the data in this study showed that highly activated Notch-1 signaling could affect the therapeutic efficacy of islet transplantation on renal injury and podocyte restoration in high-glucose conditions. The balance between apoptosis and autophagy was also closely associated with the degree of podocyte restoration. This finding may suggest that the in vivo microenvironment plays a critical role in podocyte restoration after islet transplantation, which provides a promising and individual assessment and targeting treatment for different diabetic nephropathy patients after islet transplantation into the future.
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14
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Klessens CQF, Zandbergen M, Wolterbeek R, Bruijn JA, Rabelink TJ, Bajema IM, IJpelaar DHT. Macrophages in diabetic nephropathy in patients with type 2 diabetes. Nephrol Dial Transplant 2018; 32:1322-1329. [PMID: 27416772 DOI: 10.1093/ndt/gfw260] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/30/2016] [Indexed: 12/17/2022] Open
Abstract
Background Inflammation plays a role in the development of diabetic nephropathy (DN) in type 2 diabetes. Although macrophages have been found in experimental models of DN, little is known regarding the presence of macrophages in patients with DN. Therefore, we investigated the presence and phenotype of glomerular and interstitial macrophages in relation to clinical and histopathological parameters in patients with DN. Methods Renal autopsy samples were obtained from 88 type 2 diabetic patients with histologically proven DN and stained for CD68 and CD163 as general and M2/anti-inflammatory markers of macrophages. Renal damage was scored based on histopathological classification of DN. Control renal autopsy samples were obtained from patients without renal abnormalities and from diabetic patients without DN. Positive cells per glomerulus were counted. Interstitial macrophages were counted semi-quantitatively. Results Macrophages were present in all groups. In the DN group, the mean number of CD68+ cells per glomerulus and CD163+ cells per glomerulus was 4.2 (range 0-19) and 2.1 (range 0-14.47), respectively. The distribution was similar between all histopathological classes. Glomerular CD163+ macrophages were positively associated with DN class, interstitial fibrosis and tubular atrophy, and glomerulosclerosis. Interstitial CD68+ macrophages were correlated with glomerular filtration rate stage and albuminuria. Conclusions Our results demonstrate that macrophages are present in the glomeruli and interstitium of type 2 diabetic patients with DN and of controls. Although patients and controls had similar numbers of glomerular macrophages, glomerular anti-inflammatory CD163+ macrophages were associated with pathological lesions in DN. Taken together with the correlation between interstitial macrophages and interstitial fibrosis and tubular atrophy, DN class, and renal function, this finding suggests that macrophages may play a role in DN progression. Therefore, targeting macrophages may be a promising new therapy for inhibiting the progression of DN.
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Affiliation(s)
- Celine Q F Klessens
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Malu Zandbergen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ron Wolterbeek
- Department of Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan A Bruijn
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daphne H T IJpelaar
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Costacou T, Orchard TJ. Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset. Diabetes Care 2018; 41:426-433. [PMID: 28931542 PMCID: PMC5829956 DOI: 10.2337/dc17-1118] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A common belief is that only a minority of patients with type 1 diabetes (T1D) develop advanced kidney disease and that incidence is higher among men and lower in those diagnosed at a younger age. However, because few patients with T1D survived to older ages until recently, long-term risks have been unclear. RESEARCH DESIGN AND METHODS We examined the 50-year cumulative kidney complication risk in a childhood-onset T1D cohort diagnosed during 1950-80 (n = 932; mean baseline age 29 years, duration 19 years). Participants comprised 144 who died prior to baseline, 130 followed with periodic surveys, and 658 followed with biennial surveys and a maximum of nine examinations for 25 years. Micro- and macroalbuminuria were defined as an albumin excretion rate of 20-199 and ≥200 μg/min, respectively, and end-stage renal disease (ESRD) was defined as dialysis or kidney transplantation. Cumulative incidence was estimated at 10-year intervals between 20 and 50 years, duration and compared by calendar year of diabetes onset. RESULTS By 50 years, T1D duration, ESRD affected 60% of the cohort; macroalbuminuria, 72%; and microalbuminuria, 88%. Little evidence existed for declines in cumulative incidence in recent cohorts, except for ESRD (microalbuminuria 3% increase, macroalbuminuria no change; ESRD 45% decrease by 40 years of T1D duration). Onset before age 6 years was associated with the lowest risk; incidence generally did not differ by sex. CONCLUSIONS Some degree of kidney disease in T1D is virtually universal at long durations and not declining, which has major implications for formulating health care and research strategies. ESRD has declined, but continues to affect >25% of the population by 40 years, duration.
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Affiliation(s)
- Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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16
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Zabeen B, Nahar J, Islam N, Azad K, Donaghue K. Risk Factors Associated with Microalbuminuria in Children and Adolescents with Diabetes in Bangladesh. Indian J Endocrinol Metab 2018; 22:85-88. [PMID: 29535943 PMCID: PMC5838918 DOI: 10.4103/ijem.ijem_269_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Diabetic nephropathy is leading cause of morbidity and mortality of type 1 diabetes mellitus (DM). Microalbuminuria is the first clinical sign of nephropathy. METHODS This was a cross-section study with longitudinal evaluation of urinary albumin xcretion in 199 children with type 1 diabetes attending CDiC Clinic in BIRDEM over a period of two years. The aim of the study was to assess the frequency of microalbuminuria and to determine other risk factors. We collected blood and early morning spot urinary sample and analyzed for HbA1c by Clover A1c and urinary microalbumin by a DCA analyzer. Children had urinary microalbumin 30-300 mg/L on at least two occasions were categorized as having persistent microalbuminuria. Demographic and clinical data were recorded including age at onset of diabetes, age during registration, gender and duration of diabetes which were compared between patients without microalbuminuria and with microalbuminuria. RESULT Microalbuminuria developed in forty nine children and adolescents (25%). Among them 24% were Type 1, 27% were with Fibrocalculous pancreatic diabetes (FCPD) and 68% were Type 2 diabetes. Median HbA1c was higher 10.8 [9.4-12.4] vs 9.5 [8.0-11.2] (P.006) in adolescents with microalbuminuria. On logistic regression univariate analysis independent predictors of microalbuminuria were older age, systolic blood pressure, BMI SDS and mean HbA1c which remained significant in multivariate analysis as predictors of microalbuminuria. CONCLUSION We found high prevalence of microalbuminuria which was associated with higher age, systolic blood pressure, BMI SDS and HbA1c.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Jebun Nahar
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Nasreen Islam
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Kishwar Azad
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Perinatal Care Project, BIRDEM, Dhaka 1000, Bangladesh
| | - Kim Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead Sydney, Westmead, NSW, Australia
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Tyrberg M, Nyström L, Arnqvist HJ, Bolinder J, Gudbjörnsdottir S, Landin-Olsson M, Eriksson JW, Svensson MK. Overweight, hyperglycemia and tobacco use are modifiable risk factors for onset of retinopathy 9 and 17years after the diagnosis of diabetes - A retrospective observational nation-wide cohort study. Diabetes Res Clin Pract 2017; 133:21-29. [PMID: 28888147 DOI: 10.1016/j.diabres.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aims of this study were to estimate the risk for diabetic retinopathy (DR) and to identify risk factors. We investigated a nationwide population-based cohort with diabetes diagnosed at age 15-34years. PATIENTS AND METHODS Of 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) 444 (56%) patients with retinal photos available for classification of retinopathy participated in a follow-up study 15-19 (median 17) years after diagnosis. Mean age was 42.3±5.7years, BMI 26.1±4.1kg/m2, 62% were male and 91% had type 1 diabetes. A sub-study was performed in 367 patients with retinal photos from both the 9 and 17year follow up and the risk for development of retinopathy between 9 and 17years of follow up was calculated. RESULTS After median 17years 324/444 (73%, 67% of T1D and 71% of T2D), had developed any DR but only 5.4% proliferative DR. Male sex increased the risk of developing retinopathy (OR 1.9, 95% CI 1.2-2.9). In the sub-study obesity (OR 1.2, 95% CI 1.04-1.4), hyperglycemia (OR 2.5, 95% CI 1.6-3.8) and tobacco use (OR 2.9, 95% CI 1.1-7.3) predicted onset of retinopathy between 9 and 17years after diagnosis of diabetes. CONCLUSION The number of patients with severe retinopathy after 17years of diabetes disease was small. The risk of developing retinopathy with onset between 9 and 17years after diagnosis of diabetes was strongly associated to modifiable risk factors such as glycemic control, obesity and tobacco use.
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Affiliation(s)
- M Tyrberg
- Department of Ophthalmology, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - L Nyström
- Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden
| | - H J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - J Bolinder
- Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital Huddinge, Karolinska Institutet, Sweden
| | - S Gudbjörnsdottir
- Department of Medicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - M Landin-Olsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - J W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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18
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Samuelsson M, Dereke J, Svensson MK, Landin-Olsson M, Hillman M. Soluble plasma proteins ST2 and CD163 as early biomarkers of nephropathy in Swedish patients with diabetes, 15-34 years of age: a prospective cohort study. Diabetol Metab Syndr 2017; 9:41. [PMID: 28559931 PMCID: PMC5445394 DOI: 10.1186/s13098-017-0240-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/17/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate plasma levels of sST2 and sCD163 to determine whether they at an early stage could predict development of diabetic nephropathy and/or diabetic retinopathy in patients at clinical onset. METHODS Patients diagnosed with diabetes mellitus at age 15-34 years between 1987 and 1988 (n = 220) were included. Data such as BMI, smoking, HbA1c and islet cell antibodies were collected at time of diagnosis. Within the 10 year follow-up period, 112 patients (51%) developed following diabetes related complications; retinopathy (n = 91), nephropathy (n = 12) or both (n = 9). Plasma concentrations of sST2 and sCD163 were measured at time of diagnosis and levels compared between different complication groups. RESULTS Plasma levels of sST2 were significantly higher in patients who later developed nephropathy (n = 21; 1012 [773-1493] pg/ml) compared to those who did not (n = 199; 723 [449-1084] pg/ml; p = 0.006). A tendency for higher plasma levels of sCD163 was observed but not statistically significant (p = 0.058). CONCLUSIONS sST2 and sCD163 show promise as potential biomarkers for the development of nephropathy already at clinical onset. sST2 and/or sCD163 could possibly be part of a biomarker panel aimed to find patients at high risk of developing nephropathy. Both markers need to be investigated in a larger prospective study.
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Affiliation(s)
- My Samuelsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
| | - Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
| | | | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
- Department of Endocrinology, Skåne University Hospital Lund, Lund, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
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Samra YA, Said HS, Elsherbiny NM, Liou GI, El-Shishtawy MM, Eissa LA. Cepharanthine and Piperine ameliorate diabetic nephropathy in rats: role of NF-κB and NLRP3 inflammasome. Life Sci 2016; 157:187-199. [PMID: 27266851 DOI: 10.1016/j.lfs.2016.06.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023]
Abstract
AIMS Hyperglycemia leads to elevation of oxidative stress and proinflammatory cytokines which are the main causes of diabetic nephropathy (DN). NLRP3 inflammasome and thioredoxin-interacting protein (TXNIP) are recently assumed to participate in the development of DN. We aimed to investigate the effects of Cepharanthine (CEP), Piperine (Pip) and their combination in streptozotocin (STZ)-induced DN focusing on their role to modulate NLRP3 and TXNIP induced inflammation. MAIN METHODS Diabetic rats were treated with intraperitoneal (i.p.) injection of CEP (10mg/kg/day), Pip (30mg/kg/day) or their combination for 8weeks. Nuclear factor kappa B (NF-κB), tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) were assessed by ELISA technique. TXNIP and NLRP3 genes expressions were evaluated by real time-PCR. KEY FINDINGS Diabetic rats showed significant increase in renal TXNIP and NLRP3 expression. CEP, Pip or their combination significantly decreased TXNIP and NLRP3 expression in diabetic kidneys. Hyperglycemia induced NF-κB activation leading to increased IL-1β and TNF-α levels. CEP, Pip or their combination showed significant inhibition of NF-κB together with decreased IL-1β and TNF-α levels in diabetic rats. Also, diabetic rats showed significant decrease in creatinine clearance and increase in blood glucose, serum creatinine, blood urea nitrogen, malondialdehyde, proteinuria, and kidney weight to body Weight ratio. All of these changes were reversed by CEP, Pip or their combination. SIGNIFICANCE The antioxidant and anti-inflammatory effects of CEP and Pip which were accompanied by inhibition of NF-κB and NLRP3 activation might be helpful mechanisms to halt the progression of DN.
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Affiliation(s)
- Yara A Samra
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Heba S Said
- Department of Microbiology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Nehal M Elsherbiny
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Gregory I Liou
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
| | - Mamdouh M El-Shishtawy
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Laila A Eissa
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
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20
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Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies. Curr Diab Rep 2016; 16:11. [PMID: 26803647 PMCID: PMC5841446 DOI: 10.1007/s11892-015-0708-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
- Department of Medicine, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
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21
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He Y, Xu Z, Zhou M, Wu M, Chen X, Wang S, Qiu K, Cai Y, Fu H, Chen B, Zhou M. Reversal of Early Diabetic Nephropathy by Islet Transplantation under the Kidney Capsule in a Rat Model. J Diabetes Res 2016; 2016:4157313. [PMID: 27725943 PMCID: PMC5048050 DOI: 10.1155/2016/4157313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 12/24/2022] Open
Abstract
Objective. Diabetic nephropathy (DN) is a common microvascular complication of diabetes mellitus, and insulin therapy has many side effects in the treatment of DN. Islet transplantation has emerged as a promising therapy for diabetic patients. This study was established to investigate its advantageous effects in a rat model of early DN. Methods. Streptozotocin was administered to the rats to induce diabetes. Twelve weeks later, the diabetic rats were divided into 3 groups: the islet-transplanted group (IT group), the insulin-treated group (IN group), and the untreated group (DN group). Renal injury and kidney structure were assessed by urinalysis and transmission electron microscopy (TEM) detection. Immunohistochemical staining and western blotting were performed to assess renal fibrosis levels. Results. The early DN features were reversed and the glomerular filtration barrier and basement membrane structures were improved at 4 weeks after islet transplantation. The urine microalbumin-to-creatinine ratio (ACR), protein-to-creatinine ratio, and mean thickness of the glomerular basement membrane (GBM) were significantly decreased in the IT group. The expression of renal fibrotic factors was also significantly decreased. Conclusions. These data suggest that early DN can be reversed after islet transplantation, and they may facilitate the development of a clinical therapeutic strategy for human diabetes mellitus.
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Affiliation(s)
- Yunqiang He
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ziqiang Xu
- Department of Transplantation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
| | - Mingshi Zhou
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Minmin Wu
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xuehai Chen
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Silu Wang
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Kaiyan Qiu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
| | - Yong Cai
- Department of Transplantation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
| | - Hongxing Fu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
| | - Bicheng Chen
- Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- *Bicheng Chen: and
| | - Mengtao Zhou
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- *Mengtao Zhou:
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22
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Hou Y, Li S, Wu M, Wei J, Ren Y, Du C, Wu H, Han C, Duan H, Shi Y. Mitochondria-targeted peptide SS-31 attenuates renal injury via an antioxidant effect in diabetic nephropathy. Am J Physiol Renal Physiol 2015; 310:F547-59. [PMID: 26719366 DOI: 10.1152/ajprenal.00574.2014] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/28/2015] [Indexed: 12/17/2022] Open
Abstract
Oxidative stress is implicated in the pathogenesis of diabetic kidney injury. SS-31 is a mitochondria-targeted tetrapeptide that can scavenge reactive oxygen species (ROS). Here, we investigated the effect and molecular mechanism of mitochondria-targeted antioxidant peptide SS-31 on injuries in diabetic kidneys and mouse mesangial cells (MMCs) exposed to high-glucose (HG) ambience. CD-1 mice underwent uninephrectomy and streptozotocin treatment prior to receiving daily intraperitoneal injection of SS-31 for 8 wk. The diabetic mice treated with SS-31 had alleviated proteinuria, urinary 8-hydroxy-2-deoxyguanosine level, glomerular hypertrophy, and accumulation of renal fibronectin and collagen IV. SS-31 attenuated renal cell apoptosis and expression of Bax and reversed the expression of Bcl-2 in diabetic mice kidneys. Furthermore, SS-31 inhibited expression of transforming-growth factor (TGF)-β1, Nox4, and thioredoxin-interacting protein (TXNIP), as well as activation of p38 MAPK and CREB and NADPH oxidase activity in diabetic kidneys. In vitro experiments using MMCs revealed that SS-31 inhibited HG-mediated ROS generation, apoptosis, expression of cleaved caspase-3, Bax/Bcl-2 ratio, and cytochrome c (cyt c) release from mitochondria. SS-31 normalized mitochondrial potential (ΔΨm) and ATP alterations, and inhibited the expression of TGF-β1, Nox4, and TXNIP, as well as activation of p38 MAPK and CREB and NADPH oxidase activity in MMCs under HG conditions. SS-31 treatment also could reverse the reduction of thioredoxin (TRX) biologic activity and upregulate expression of thioredoxin 2 (TRX2) in MMCs under HG conditions. In conclusion, this study demonstrates a protective effect of SS-31 against HG-induced renal injury via an antioxidant mechanism in diabetic nephropathy.
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Affiliation(s)
- Yanjuan Hou
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | - Shuangcheng Li
- Department of Human Anatomy, Hebei Medical University, Shijiazhuang, China; and
| | - Ming Wu
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | - Jinying Wei
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
| | - Yunzhuo Ren
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
| | - Chunyang Du
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
| | - Haijiang Wu
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | - Caili Han
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
| | - Huijun Duan
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
| | - Yonghong Shi
- Department of Pathology, Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Kidney Diseases, Shijiazhuang, China
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Aldahmash BA, El-Nagar DM, Ibrahim KE, Metwaly MS. Biotin amelioration of nephrotoxicity in streptozotocin-induced diabetic mice. Saudi J Biol Sci 2015; 22:564-9. [PMID: 26288559 PMCID: PMC4537877 DOI: 10.1016/j.sjbs.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/18/2015] [Accepted: 03/05/2015] [Indexed: 12/14/2022] Open
Abstract
The current study was carried out to investigate the protective role of biotin in kidney injury and oxidative stress in diabetic mice type 1. Male Swiss albino mice were randomly divided into 3 groups. Control group received saline. Diabetes type 1 was induced in second and third groups by intraperitoneal injection of streptozotocin as a single dose (150 mg/kg). Second group remained as the untreated diabetic group and the third group received 15 mg/kg daily oral dose of biotin for 12 successive days. Biochemical results showed significant elevation in blood glucose and urea levels in both diabetic groups. Also, there is an increase in glomerular areas and decrease in glomerular cellularity in both diabetic groups. Histopathological results showed severe alterations in the untreated diabetic group represented by distorted glomeruli, inflammatory cells, and giant macrophages. In addition, there was an intense immune-reaction response toward acrolein indicator of oxidative damage. Upon biotin administration of diabetic mice, the above mentioned histopathological changes were reduced and also acroline reaction of oxidative damage was diminished. Our findings prove that biotin has a protective role against streptozotocin-induced oxidative damage in kidneys of laboratory mice.
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Affiliation(s)
- Badr A Aldahmash
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Doaa M El-Nagar
- Department of Zoology, College of Girls for Science, Arts and Education, Ain Shams University, Cairo, Egypt
| | - Khalid E Ibrahim
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud S Metwaly
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
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Svensson MK, Tyrberg M, Nyström L, Arnqvist HJ, Bolinder J, Östman J, Gudbjörnsdottir S, Landin-Olsson M, Eriksson JW. The risk for diabetic nephropathy is low in young adults in a 17-year follow-up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors. Diabetes Metab Res Rev 2015; 31:138-46. [PMID: 25044633 DOI: 10.1002/dmrr.2574] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/17/2014] [Indexed: 12/14/2022]
Abstract
AIMS The main objective of this study was to estimate the occurrence of diabetic nephropathy in a population-based cohort of patients diagnosed with diabetes as young adults (15-34 years). METHODS All 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19 years after diagnosis, and 468 (58%) participated. Analysis of islet antibodies was used to classify type of diabetes. RESULTS After median 17 years of diabetes, 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with diabetic nephropathy. Ninety-one percent had microalbuminuria and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1 kg/m²), a near-significant predictor of development of diabetic nephropathy. Age at onset of diabetes (p = 0.041), BMI (p = 0.012) and HbA1c (p < 0.001) were significant predictors of developing diabetic nephropathy between 9 and 17 years of diabetes. At 17 years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1 mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.05 1.12 per 1 mmHg increase) were associated with DN. CONCLUSIONS Patients with T2DM diagnosed as young adults seem to have an increased risk to develop diabetic nephropathy compared with those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers for development of diabetic nephropathy. In addition, poor glycaemic control but not systolic blood pressure at 9 years of follow-up was a risk marker for later development of diabetic nephropathy.
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Affiliation(s)
- M K Svensson
- Department of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Fekete A, Vannay Á. [Importance of diabetic nephropathy in childhood. Clinical findings and basic research in recent decades]. Orv Hetil 2014; 155:141-50. [PMID: 24440726 DOI: 10.1556/oh.2014.29814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past decades diabetes mellitus is becoming a global pandemic affecting more than 371 million people worldwide. Parallel with the increasing prevalence of type 1 diabetes, there is a growing number of type 2 diabetes cases among children and adolescents that poses new challenges to pediatricians. Diabetic nephropathy is one of the major causes of end stage renal disease, developing in approximately 30% of diabetic patients. However, overt nephropathy is rare in childhood; screening and ongoing assessment for the earliest manifestation of renal injury is extremely important in this young population, as well. Although in the past decades intensive research activity focused on understanding of the pathomechanism of diabetic nephropathy and invention of new therapeutic approaches, prevention and definitive care are still urgently needed. The clinical section of the article summarizes the present state of epidemiology, diagnosis and current therapies of childhood diabetic nephropathy. Then, the authors discuss the state of basic research and show a few promising targets for drug development.
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Affiliation(s)
- Andrea Fekete
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika, MTA-SE Lendület Diabétesz Kutatócsoport Budapest Bókay J. u. 53. 1083
| | - Ádám Vannay
- MTA-SE Gyermekgyógyászati és Nephrologiai Kutatócsoport Budapest
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Ali A, Taj A, Amin MJ, Iqbal F, Iqbal Z. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients. Pak J Med Sci 2014; 30:511-4. [PMID: 24948969 PMCID: PMC4048496 DOI: 10.12669/pjms.303.5042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 02/19/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. OBJECTIVES To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. METHODS One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. RESULTS Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. CONCLUSION The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients.
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Affiliation(s)
- Alia Ali
- Dr. Alia Ali, FCPS, Senior Registrar, Department of Medicine, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
| | - Azeem Taj
- Dr. Azeem Taj, FCPS, Associate Professor, Department of Medicine, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
| | - Muhammad Joher Amin
- Dr. Muhammad Joher Amin, FCPS, Assistant Professor of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
| | - Farrukh Iqbal
- Prof. Farrukh Iqbal, FRCP, Professor, Department of Medicine, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
| | - Zafar Iqbal
- Prof. Zafar Iqbal, FRCP, Professor & Chairman, Department of Medicine, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
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Abstract
The occurrence and progression of nephropathy associated with early onset type 2 diabetes (T2D) is a consequence of the ongoing epidemic of childhood obesity. Minimal evidence regarding treatment effectiveness of renovascular comorbidities in youth with early onset T2D is available, due to the relatively recent emergence of T2D in youth and young adults. Extrapolation of adult therapy guidelines is not an ideal approach to making therapeutic decisions in this population. Evolving management and intervention strategies are based on accumulating longitudinal data from cohorts of well characterized youth and young adults with T2D. The degree of similarity in histologic findings and disease specific characteristics of kidney disease in patients with early onset T2D and albuminuria compared with affected adults is not well characterized. Early aggressive therapies to minimize the impact of nephropathy are indicated as the evidence for best therapies in youth with T2D are further explored.
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Affiliation(s)
- Carolina Solis-Herrera
- Resident, Internal Medicine, Texas Tech University Health Science Center at Permian Basin, 5075 East 52 St. #J305, Odessa, TX 79762, Phone: 210-619-3264
| | - Curtis L. Triplitt
- Texas Diabetes Institute, Clinical Assistant Professor, Department of Medicine, Div. of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, Phone:210-358-7228, Fax:210-358-7235
| | - Jane L. Lynch
- Professor of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr. (MS 7806), San Antonio, TX 78229, Phone: 210-567-5213, Fax: 210-567-0492
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Johnson B, Elliott J, Scott A, Heller S, Eiser C. Medical and psychological outcomes for young adults with Type 1 diabetes: no improvement despite recent advances in diabetes care. Diabet Med 2014; 31:227-31. [PMID: 23952498 DOI: 10.1111/dme.12305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
AIM To assess medical and psychological outcomes among young people with Type 1 diabetes and to compare medical outcomes with a previous audit. METHODS An observational study in two diabetes clinics for young adults (aged 16-21 years) in Sheffield, UK. Young people (n = 96: 81.4% response rate) with Type 1 diabetes (diagnosed > 6 months) completed measures of depressive symptoms, anxiety and disordered eating and consented for their medical records to be consulted. RESULTS Mean HbA1c (86 ± 23 mmol/mol; 10.0 ± 2.1%); was comparable with that reported previously and considerably higher than recommended (< 58 mmol/mol or 7.5%). Screening rates were improved and non-attendance was lower than previously reported, but levels of non-proliferative retinopathy have increased. Microvascular complications are present in 46.9% of those diagnosed more than 7 years. Elevated levels of disordered eating were reported by 35.1%. Those scoring above cut-off levels for clinical anxiety (26.6%) and depression (10.9%) are comparable with other work with young people with Type 1 diabetes. CONCLUSIONS Despite technological advances and improvements to delivery of care, HbA1c remain above recommended levels in a significant proportion of young people, many of whom already have microvascular complications. We need to learn from European centres who achieve better results, improve transition from paediatric care, integrate mental health support with diabetes care provision and take into account young people's views about clinic.
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Affiliation(s)
- B Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK; NIHR CLAHRC for South Yorkshire, Sheffield, UK
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Demirel F, Tepe D, Kara Ö, Esen İ. Microvascular complications in adolescents with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2013; 5:145-9. [PMID: 24072081 PMCID: PMC3814528 DOI: 10.4274/jcrpe.994] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Screening of complications is an important part of diabetes care. The aim of this study was to investigate diabetic complications and related risk factors in adolescents with type 1 diabetes mellitus (T1DM). METHODS This cross-sectional study was conducted on type 1 diabetics who were over 11 years of age or had a diabetes duration of 2 years and included 155 adolescents with T1DM (67 male, 88 female). The mean age of the patients was 14.4±2.1 years. Mean diabetes duration was 6.3±2.9 years. The patients were screened for diabetic nephropathy, retinopathy and peripheral neuropathy. RESULTS Mean glycosylated hemoglobin (HbA1c) level of the study group was 8.4%. The frequency of microalbuminuria and peripheral neuropathy were 16.1% and 0.6%, respectively. None of the patients had diabetic retinopathy. Dyslipidemia and hypertension rates were 30.3% and 12.3%, respectively. Risk factors associated with microalbuminuria were hypertension, higher HbA1c levels, longer diabetes duration and dyslipidemia. CONCLUSION Early diagnosis and treatment of hypertension and dyslipidemia as well as achieving a better metabolic control are important in prevention or postponement of complications in patients with T1DM. Yearly screening for diabetic nephropathy should be started 2 years after the onset of the diabetes.
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Affiliation(s)
- Fatma Demirel
- Ankara Pediatric Hematology and Oncology Training Hospital, Department of Pediatric Endocrinology, Ankara, Turkey. E-mail:
| | - Derya Tepe
- Ankara Pediatric Hematology and Oncology Training Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Özlem Kara
- Ankara Pediatric Hematology and Oncology Training Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - İhsan Esen
- Ankara Pediatric Hematology and Oncology Training Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
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Abougalambou SSI, Abougalambou AS. Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus outpatients at University Sains Malaysia Hospital. Diabetes Metab Syndr 2013; 7:64-67. [PMID: 23680242 DOI: 10.1016/j.dsx.2013.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Microalbuminuria is early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The objective of this study is to determine the prevalence of microalbuminuria and associated risk factors among type 2 diabetic outpatients, attending a diabetic clinic in University Sains Malaysia Hospital (HUSM). PATIENTS AND METHODS Prospective study design was used in the data collection process. The study sample consists of 1066 type 2 diabetes mellitus outpatients who fit the inclusion criteria. All the patients were recruited from the diabetic outpatient clinics from HUSM. The study period was from January till December 2008. Microalbuminuria was diagnosed if the urinary albumin excretion more than 30 mg/g of creatinine. RESULTS A total of 1661 patients were included in this study. Microalbuminuria was diagnosed in 273 (25.4%) patients. Multivariate logistic regression analysis indicated that microalbuminuria was positively associated with duration of hypertension (P=0.044), HbA1c (P=0.004), systolic blood pressure (<0.001), creatinine clearance (P=0.007) and the presence of neuropathy (P=0.004). CONCLUSION High prevalence of microalbuminuria was in type 2 diabetic outpatients. Predictive factors for microalbuminuria were duration of hypertension, HbA1c, systolic blood pressure, creatinine clearance and the presence of neuropathy. The study suggests the need to screen for microalbuminuria early and the active management of modifiable risk factors in particular, hyperglycemia, hypertension and creatinine clearance, to reduce the burden of end-stage renal disease in the future.
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Gui D, Huang J, Guo Y, Chen J, Chen Y, Xiao W, Liu X, Wang N. Astragaloside IV ameliorates renal injury in streptozotocin-induced diabetic rats through inhibiting NF-κB-mediated inflammatory genes expression. Cytokine 2013; 61:970-7. [PMID: 23434274 DOI: 10.1016/j.cyto.2013.01.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/23/2012] [Accepted: 01/04/2013] [Indexed: 11/15/2022]
Abstract
Accumulating evidence suggests that inflammatory processes are involved in the development of diabetic nephropathy (DN). However, there are no effective interventions for inflammation in the diabetic kidneys. Here, we tested the hypothesis that Astragaloside IV(AS-IV), a novel saponin purified from Astragalus membranaceus (Fisch) Bge, ameliorates DN in streptozotocin (STZ)-induced diabetic rats through anti-inflammatory mechanisms. Diabetes was induced with STZ (65 mg/kg) by intraperitoneal injection in rats. Two weeks after STZ injection, rats were divided into three groups (n=8/each group), namely, diabetic rats, diabetic rats treated with AS-IV at 5 and 10 mgkg(-1)d(-1), p.o., for 8 weeks. The normal rats were chosen as nondiabetic control group (n=8). The rats were sacrificed 10 weeks after induction of diabetes. AS-IV ameliorated albuminuria, renal histopathology and podocyte foot process effacement in diabetic rats. Renal NF-κB activity, as wells as protein and mRNA expression were increased in diabetic kidneys, accompanied by an increase in mRNA expression and protein content of TNF-α, MCP-1 and ICAM-1 in kidney tissues. The α1-chain type IV collagen mRNA was elevated in the kidneys of diabetic rats. All of these abnormalities were partially restored by AS-IV. AS-IV also decreased the serum levels of TNF-α, MCP-1 and ICAM-1 in diabetic rats. These findings suggest that AS-IV, a novel anti-inflammatory agent, attenuated DN in rats through inhibiting NF-κB mediated inflammatory genes expression.
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Affiliation(s)
- Dingkun Gui
- Department of Nephrology and Rheumatology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, PR China
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Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, Flinn SK. Management of type 2 diabetes mellitus in children and adolescents. Pediatrics 2013; 131:e648-64. [PMID: 23359584 DOI: 10.1542/peds.2012-3496] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, "Management of Type 2 Diabetes Mellitus in Children and Adolescents," and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline's recommendations. METHODS A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM's comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist. RESULTS Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.
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Batson YA, Teelucksingh S, Maharaj R, Singh V, Balkaran S, Cockburn B. Screening for diabetes in schoolchildren in Trinidad, West Indies. Paediatr Int Child Health 2013; 33:37-41. [PMID: 23485494 DOI: 10.1179/2046905512y.0000000032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although the epidemic of diabetes in adults is well established and documented, information on the epidemiology of type 2 diabetes mellitus (T2DM) in children and adolescents in Trinidad and Tobago is limited. Anecdotal reports suggest an increase in children and especially adolescents with T2DM amongst clinic attendees. OBJECTIVE To assess the prevalence of diabetes mellitus in schoolchildren screened by mass urinary testing in Trinidad and to determine the effectiveness and cost-effectiveness of this screening method. DESIGN AND METHODS During January to June 2009, a cross-sectional survey was undertaken in schoolchildren aged 5-17 years, in the island of Trinidad only. Children were instructed to collect an early-morning, pre-breakfast urine sample at home and to bring it to school for testing for glycosuria. Those with an initially positive result underwent a second urine test. Those with two consecutively positive urine tests were invited to undertake an oral glucose tolerance test. RESULTS 67,000 (53·6%) children from a school-age population of 125,000 were screened. Twenty-three were found to have persistent glycosuria and 21 agreed to undergo an oral glucose tolerance test. Eight fulfilled the American Diabetes Association's criteria for diabetes and five for pre-diabetes. Of the eight with confirmed diabetes (aged 7-18 years), one (male, age 12 years) was slim and ketotic and required insulin for control. Of the other seven, five were overweight (three females, two males) with a BMI >85th per centile and two females were obese (BMI >95th per centile). Five children (four females, one male) aged 12-14 years were diagnosed as pre-diabetic. There is a prevalence of 10·4/100,000 schoolchildren with T2DM, and 7·5/100,000 with impaired glucose intolerance among schoolchildren in Trinidad. Urine screening had a positive predictive value (PPV) of 65% for detecting T2DM in schoolchildren. The cost of screening 67,000 children was US$55,080, a per capita cost of <US$1. The cost of finding one case was US$4286. Economic analysis revealed that investing to find one case today yields a net present value of >US$7000, representing a 63% saving. CONCLUSION Despite the low PPV of urine glucose testing, our data support the view that mass screening of schoolchildren in Trinidad for T2DM is both feasible and cost-effective.
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Affiliation(s)
- Yvonne Ann Batson
- Departments of Clinical Medical Sciences, The University of the West Indies, Mount Hope, Trinidad and Tobago.
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Abstract
Emerging adults with type 1 diabetes are at risk for poor glycemic control, gaps in medical care, and adverse health outcomes. With the increasing incidence in type 1 diabetes in the pediatric population, there will be an increase in the numbers of teens and young adults transferring their care from pediatric providers to adult diabetes services in the future. In recent years, the topic of transitioning pediatric patients with type 1 diabetes to adult diabetes care has been discussed at length in the literature and there have been many observational studies. However, there are few interventional studies and, to date, no randomized clinical trials. This paper discusses the rationale for studying this important area. We review both observational and interventional literature over the past several years, with a focus on new research. In addition, important areas for future research are outlined.
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Affiliation(s)
- Katharine C. Garvey
- Endocrinology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jessica T. Markowitz
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA 02215, USA
| | - Lori M. B. Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA 02215, USA
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Jardine MJ, Hata J, Woodward M, Perkovic V, Ninomiya T, Arima H, Zoungas S, Cass A, Patel A, Marre M, Mancia G, Mogensen CE, Poulter N, Chalmers J. Prediction of kidney-related outcomes in patients with type 2 diabetes. Am J Kidney Dis 2012; 60:770-8. [PMID: 22694950 DOI: 10.1053/j.ajkd.2012.04.025] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/26/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Tools are needed to predict which individuals with diabetes will develop kidney disease and its complications. STUDY DESIGN An observational analysis of a randomized controlled trial. SETTING & PARTICIPANTS The ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) Study followed up 11,140 participants with type 2 diabetes for 5 years. PREDICTOR Readily available baseline demographic and clinical variables. OUTCOMES (1) Major kidney-related events (doubling of serum creatinine to ≥2.26 mg/dL [≥200 μmol/L], renal replacement therapy, or renal death) in all participants, and (2) new-onset albuminuria in participants with baseline normoalbuminuria. MEASUREMENTS Cox proportional hazard regression models predicting the outcomes were used to generate risk scores. Discrimination of the risk prediction models was compared with that of models based on estimated glomerular filtration rate (eGFR) alone, urinary albumin-creatinine ratio (ACR) alone, and their combination. RESULTS Risk scores for major kidney-related events and new-onset albuminuria were derived from 7- and 8-variable models, respectively. Baseline eGFR and ACR were dominant although models based on the 2 factors, alone or combined, had less discrimination (P<0.05) than the risk prediction models containing additional variables (risk prediction model C statistics of 0.847 [95% CI, 0.815-0.880] for major kidney-related events, and 0.647 [95% CI, 0.637-0.658] for new-onset albuminuria). Novel risk factors for new-onset albuminuria included Asian ethnicity and greater waist circumference, and for major kidney-related events, less education. The risk prediction models had acceptable calibration for both outcomes (modified Hosmer-Lemeshow test, P=0.9 and P=0.06, respectively). LIMITATIONS The follow-up period was limited to 5 years. Results are applicable to people with type 2 diabetes at risk of vascular disease. CONCLUSIONS Risk scores have been developed for early and late events in diabetic nephropathy. Although eGFR and urinary ACR are important components of the prediction models, the extra variables considered add significantly to discrimination and, in the case of new-onset albuminuria, are required to achieve satisfactory calibration.
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Affiliation(s)
- Meg J Jardine
- George Institute for Global Health, Sydney, Australia.
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Oral cholecalciferol decreases albuminuria and urinary TGF-β1 in patients with type 2 diabetic nephropathy on established renin-angiotensin-aldosterone system inhibition. Kidney Int 2011; 80:851-60. [PMID: 21832985 DOI: 10.1038/ki.2011.224] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The anti-inflammatory, antifibrotic, and antiproteinuric properties of vitamin D have been defined in studies using active vitamin D analogs. In this prospective observational study we determined whether nutritional vitamin D repletion can have additional beneficial effects in patients with type 2 diabetic nephropathy already established on renin-angiotensin-aldosterone system inhibition. During a 7-month period, 63 patients were enrolled and those with low levels of 25(OH)D were treated with oral cholecalciferol for 4 months. Baseline serum 25(OH)D and 1,25(OH)(2)D showed no significant correlation with baseline urinary MCP-1, TGF-β1, or albuminuria measured as the urinary albumin-to-creatinine ratio. Of the 63 patients, 54 had insufficient or deficient levels of serum 25(OH)D and 49 complied with cholecalciferol therapy and follow-up. Both 25(OH)D and 1,25(OH)(2)D were significantly increased at 2 and 4 months of treatment. Albuminuria and urinary TGF-β1 decreased significantly at both time points compared to their baseline values, while urinary MCP-1 did not change. Thus, in the short term, dietary vitamin D repletion with cholecalciferol had a beneficial effect in delaying the progression of diabetic nephropathy above that due to established renin-angiotensin-aldosterone system inhibition.
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Soetikno V, Sari FR, Veeraveedu PT, Thandavarayan RA, Harima M, Sukumaran V, Lakshmanan AP, Suzuki K, Kawachi H, Watanabe K. Curcumin ameliorates macrophage infiltration by inhibiting NF-κB activation and proinflammatory cytokines in streptozotocin induced-diabetic nephropathy. Nutr Metab (Lond) 2011; 8:35. [PMID: 21663638 PMCID: PMC3123175 DOI: 10.1186/1743-7075-8-35] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/10/2011] [Indexed: 12/28/2022] Open
Abstract
Background Chronic inflammation plays an important role in the progression of diabetic nephropathy (DN) and that the infiltration of macrophages in glomerulus has been implicated in the development of glomerular injury. We hypothesized that the plant polyphenolic compound curcumin, which is known to exert potent anti-inflammatory effect, would ameliorate macrophage infiltration in streptozotocin (STZ)-induced diabetic rats. Methods Diabetes was induced with STZ (55 mg/kg) by intraperitoneal injection in rats. Three weeks after STZ injection, rats were divided into three groups, namely, control, diabetic, and diabetic treated with curcumin at 100 mg/kg/day, p.o., for 8 weeks. The rats were sacrificed 11 weeks after induction of diabetes. The excised kidney was used to assess macrophage infiltration and expression of various inflammatory markers. Results At 11 weeks after STZ injection, diabetic rats exhibited renal dysfunction, as evidenced by reduced creatinine clearance, increased blood glucose, blood urea nitrogen and proteinuria, along with marked reduction in the body weight. All of these abnormalities were significantly reversed by curcumin. Hyperglycemia induced the degradation of IκBα and NF-κB activation and as a result increased infiltration of macrophages (52%) as well as increased proinflammatory cytokines: TNF-α and IL-1β. Curcumin treatment significantly reduced macrophage infiltration in the kidneys of diabetic rats, suppressed the expression of above proinflammatory cytokines and degradation of IκBα. In addition, curcumin treatment also markedly decreased ICAM-1, MCP-1 and TGF-β1 protein expression. Moreover, at nuclear level curcumin inhibited the NF-κB activity. Conclusion Our results suggested that curcumin treatment protect against the development of DN in rats by reducing macrophage infiltration through the inhibition of NF-κB activation in STZ-induced diabetic rats.
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Affiliation(s)
- Vivian Soetikno
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City, Japan.
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Darisipudi MN, Kulkarni OP, Sayyed SG, Ryu M, Migliorini A, Sagrinati C, Parente E, Vater A, Eulberg D, Klussmann S, Romagnani P, Anders HJ. Dual blockade of the homeostatic chemokine CXCL12 and the proinflammatory chemokine CCL2 has additive protective effects on diabetic kidney disease. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:116-24. [PMID: 21703397 DOI: 10.1016/j.ajpath.2011.03.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 03/16/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
Monocyte/ chemoattractant protein-1/chemokine ligand (CCL) 2 and stromal cell-derived factor-1/CXCL12 both contribute to glomerulosclerosis in mice with type 2 diabetes mellitus, through different mechanisms. CCL2 mediates macrophage-related inflammation, whereas CXCL12 contributes to podocyte loss. Therefore, we hypothesized that dual antagonism of these chemokines might have additive protective effects on the progression of diabetic nephropathy. We used chemokine antagonists based on structured l-enantiomeric RNA (so-called Spiegelmers) ie, the CCL2-specific mNOX-E36 and the CXCL12-specific NOX-A12. Male db/db mice, uninephrectomized at the age of 6 weeks, received injections of Spiegelmer, both Spiegelmers, nonfunctional control Spiegelmer, or vehicle from the age of 4 months for 8 weeks. Dual blockade was significantly more effective than monotherapy in preventing glomerulosclerosis. CCL2 blockade reduced glomerular leukocyte counts and renal-inducible nitric oxide synthase or IL-6 mRNA expression. CXCL12 blockade maintained podocyte numbers and renal nephrin and podocin mRNA expression. Consistently, CXCL12 blockade suppressed nephrin mRNA up-regulation in primary cultures of human glomerular progenitors induced to differentiate toward the podocyte lineage. All previously mentioned parameters were significantly improved in the dual-blockade group, which also suppressed proteinuria and was associated with the highest levels of glomerular filtration rate. Blood glucose levels and body weight were identical in all treatment groups. Dual chemokine blockade can have additive effects on the progression of diabetic kidney disease when the respective chemokine targets mediate different pathomechanisms of disease (ie, inflammation and progenitor differentiation toward the podocyte lineage).
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Affiliation(s)
- Murthy N Darisipudi
- Nephrological Center, Medical Policlinic, University of Munich, Munich, Germany
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An orally active chemokine receptor CCR2 antagonist prevents glomerulosclerosis and renal failure in type 2 diabetes. Kidney Int 2011; 80:68-78. [PMID: 21508925 DOI: 10.1038/ki.2011.102] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The progression of diabetic nephropathy is associated with an infiltration of macrophages expressing different phenotypes. As classically activated chemokine receptor CCR2+ macrophages are thought to drive tissue inflammation and remodeling, we tested whether blocking CCR2 could reduce intrarenal inflammation and prevent glomerulosclerosis in type 2 diabetes. This was achieved with RO5234444, an orally active small-molecule CCR2 antagonist that blocks ligand binding, its internalization, and monocyte chemotaxis. Male type 2 diabetic db/db mice were uninephrectomized to increase glomerular hyperfiltration to accelerate the development of glomerulosclerosis. From 16 weeks until killing at 24 weeks of age, mice were chow fed with or without admixed antagonist to achieve a trough plasma concentration above IC50 for binding in the mouse. CCR2 blockade reduced circulating monocyte levels, but did not affect total leukocyte or neutrophil numbers, and was associated with a reduction in the number of macrophages and apoptotic podocytes in the glomerulus. This treatment resulted in a higher total number of podocytes, less glomerulosclerosis, reduced albuminuria, and a significantly improved glomerular filtration rate. This successful pre-clinical trial suggests that this antagonist may now be ready for testing in humans with the nephropathy of diabetes mellitus.
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Nosadini R, Tonolo G. Role of oxidized low density lipoproteins and free fatty acids in the pathogenesis of glomerulopathy and tubulointerstitial lesions in type 2 diabetes. Nutr Metab Cardiovasc Dis 2011; 21:79-85. [PMID: 21186102 DOI: 10.1016/j.numecd.2010.10.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/02/2010] [Accepted: 10/03/2010] [Indexed: 12/25/2022]
Abstract
Oxidized lipids initiate and modulate the inflammatory cellular events in the arterial wall and the formation of macrophage foam cells. CD36 mediates the cellular uptake of ox-LDL through its recognition of specific truncated fatty acid moieties and oxidized phosphatidylcholine. Evidence has been reported that chemokine CXCL16, rather than CD36, is the main scavenger receptor in human podocytes mediating the uptake of ox-LDL. Ox-LDL induces loss of nephrin expression from cultured podocytes. It has been recently shown that nephrin once phosphorilated associates with PI3K and stimulates the Akt dependent signaling. This pathway plays a critical role in nephrin-actin-dependent cytoskeleton activation and remodeling, in the control of protein trafficking and in podocyte survival. An enhanced FFA uptake by podocytes is mediated by increased C36 scavenger receptor expression, together with a decrease of betaoxidation and in turn intracellular lipid accumulation. Accumulated FFA that is trapped into the mitochondrial matrix leads to mitochondrial ROS production, lipid peroxidation and mitochondrial damage and dysfunction. A disturbed transport and oxidation of FFA, paralleled by an impaired antioxidant response, damages podocyte structure and leads to glomerulopathy in early stages of nephrosis. Increased triglyceride synthesis and ox-and glycated LDL uptake by mesangial cells may also contribute to determine diabetic glomerulopathy. Oxidative processes are pivotal events in injury to renal tubular and epithelial cells exposed to ox-LDL. Notably CXCL16 are the main receptors for the uptake of ox-LDL in podocytes, whereas CD36 plays this role in tubular renal cells. In overt type 2 diabetes Ox-LDL and FFA damage podocyte function, SD-podocyte structure and tubulointerstitial tissue, at least partially, through different pathogenetic mechanisms. Further studies are needed to investigate the role of Ox-LDL and FFA on renal complications in obese, insulin resistant patients before the development of diabetes. The aim of the present review is to briefly elucidate the patterns of systemic lipid metabolism and the individual effects of lipotoxicity at glomerular and tubular level in the kidney of overt type 2 diabetic patients. These findings better elucidate our knowledge of diabetic glomerulopathy, beside and along with previous findings, in vivo and in vitro, on ox-LDL and FFA effects in mesangial cells.
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Affiliation(s)
- R Nosadini
- Cattedra di Endocrinologia e Malattie del Ricambio Universita' di Sassari, Italy
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Salgado PPCDA, Silva IN, Vieira EC, Simões e Silva AC. Risk factors for early onset of diabetic nephropathy in pediatric type 1 diabetes. J Pediatr Endocrinol Metab 2010; 23:1311-20. [PMID: 21714465 DOI: 10.1515/jpem.2010.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Diabetic nephropathy (DN) is a frequent complication in patients with long-standing type 1 diabetes mellitus (DM1). The objective of this study was to assess the prevalence of DN in DM1 patients diagnosed during childhood and its association with clinical and metabolic variables, such as age at diagnosis of DM1, glucose control, dyslipidemia, hypertension and the occurrence of diabetic retinopathy (DR). METHODS The medical records of 205 patients admitted to the Pediatric Endocrinology Division at the Hospital das Clinicas da Universidade Federal de Minas Gerais, in Belo Horizonte, Brazil, were analyzed. For the analysis of survival and prognostic factors, the Kaplan-Meyer method and the COX regression model were used. RESULTS The mean disease duration was 11.32 +/- 4.02 years and the mean age at diagnosis was 6.10 +/- 3.54 years. Microalbuminuria was present in 11.2% of them, proteinuria in 6.8% and end-stage renal disease (ESRD) in 2.9%. There was a significant association between the occurrence of microalbuminuria or proteinuria and poor glucose control (p=0.025 and p=0.005, respectively), higher LDL cholesterol levels (p=0.006 and p=0.004, respectively) and age greater than 6 years at diagnosis (p=0.049 and p=0.05, respectively). Proteinuria was also associated to the occurrence of DR (p=0.016). CONCLUSION Our data showed that the prevalence of DN was higher than expected in this young population studied, especially considering the most severe forms. Clinical and laboratory factors associated to ND were: poor long-term glucose control, higher levels of LDL-C, higher age at diagnosis and the occurrence of DR.
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Afkhami-Ardekani M, Modarresi M, Amirchaghmaghi E. Prevalence of microalbuminuria and its risk factors in type 2 diabetic patients. Indian J Nephrol 2010; 18:112-7. [PMID: 20142916 PMCID: PMC2813138 DOI: 10.4103/0971-4065.43690] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A cross-sectional study was performed from November 2005 to July 2007 to determine the prevalence of microalbuminuria and its risk factors among type 2 diabetic patients.. Two hundred and eighty-eight type 2 diabetic patients (141 males and 147 females) referred to Yazd diabetes research center were randomly recruited for the study. Microalbuminuria was detected by measuring the albumin to creatinine ratio in the early morning urine. Microalbuminuria was diagnosed if this ratio was between 30 and 300 mg/g on two occasions during three months. Prevalence of microalbuminuria was 14.2%. Chi-square analysis revealed that microalbuminuria was correlated with the diastolic blood pressure (P = 0.003) and the duration of diabetes (P = 0.000). No statistically significant correlation was found between microalbuminuria and age, sex, body mass index, levels of fasting blood sugar, glycosylated hemoglobin (HbA1c), serum triglyceride, and serum cholesterol, or systolic blood pressure. For 240 patients for whom the duration of diabetes was known from the answers in their questionnaires, logistic regression was used for analysis. Results showed that two variables including the duration of diabetes and Diastolic Blood Pressure (DBP) play a role in this model and the following Logic association was obtained: g; (x) = -9.233 +/- 0.079 DBP +/- 0.114 duration according to this model, both DBP and duration of diabetes were directly correlated with microalbuminuria. Determination of the urine albumin to creatinine ratio is an easy method for screening of microalbuminuria that is suggested for all diabetic patients, especially diabetic patients with hypertension and long-term diabetes.
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Affiliation(s)
- M Afkhami-Ardekani
- Diabetes Research Center, Sadoughi University of Medical Sciences and Health Services of Yazd, Iran
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Tang SC, Chan LY, Leung JC, Cheng AS, Chan KW, Lan HY, Lai KN. Bradykinin and high glucose promote renal tubular inflammation. Nephrol Dial Transplant 2009; 25:698-710. [DOI: 10.1093/ndt/gfp599] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sayyed SG, Hägele H, Kulkarni OP, Endlich K, Segerer S, Eulberg D, Klussmann S, Anders HJ. Podocytes produce homeostatic chemokine stromal cell-derived factor-1/CXCL12, which contributes to glomerulosclerosis, podocyte loss and albuminuria in a mouse model of type 2 diabetes. Diabetologia 2009; 52:2445-54. [PMID: 19707743 DOI: 10.1007/s00125-009-1493-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 07/06/2009] [Accepted: 07/17/2009] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Chemokine (C-X-C motif) ligand 12 (CXCL12) (also known as stromal cell-derived factor-1 [SDF-1]-alpha) is a homeostatic chemokine with multiple roles in cell homing, tumour metastasis, angiogenesis and tissue regeneration after acute injuries. However, its role in chronic diseases remains poorly defined, e.g. in chronic glomerular diseases like diabetic glomerulosclerosis. We hypothesised that CXCL12 may have a functional role during the evolution of diabetic glomerulosclerosis, either by assisting glomerular repair or by supporting the maladaptive tissue remodelling in response to hyperglycaemia and glomerular hyperfiltration. METHODS To define the functional role of CXCL12 in the progression of glomerular disease, we used the CXCL12-specific inhibitor NOX-A12, an L: -enantiomeric RNA oligonucleotide (Spiegelmer). A mouse model of type 2 diabetes (db/db mice) was used. Male db/db mice, uni-nephrectomised at 6 weeks of age, received subcutaneous injections with a PEGylated form of NOX-A12, non-functional control Spiegelmer or vehicle on alternate days from 4 to 6 months of age. RESULTS Immunostaining localised renal CXCL12 production to glomerular podocytes in db/db mice with early or advanced diabetic nephropathy. CXCL12 inhibition significantly reduced the degree of glomerulosclerosis, increased the number of podocytes, prevented the onset of albuminuria and maintained the peritubular vasculature without affecting blood glucose levels, body weight or glomerular macrophage infiltration. CONCLUSIONS/INTERPRETATION We conclude that podocytes produce CXCL12, which contributes to proteinuria and glomerulosclerosis in our mouse model of type 2 diabetes. This novel pathomechanism provides the first evidence that CXCL12 could be a therapeutic target in (diabetic) glomerulosclerosis.
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Affiliation(s)
- S G Sayyed
- Nephrological Center, Medizinische Poliklinik, Klinikum der Universität München-Innenstadt, Pettenkoferstr 8a, 80336 München, Germany
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Mamoulakis D, Bitsori M, Galanakis E, Vazgiourakis V, Panierakis C, Goulielmos GN. Intron 4 polymorphism of the endothelial nitric oxide synthase eNOS gene and early microangiopathy in type 1 diabetes. Int J Immunogenet 2009; 36:153-7. [PMID: 19490210 DOI: 10.1111/j.1744-313x.2009.00839.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nitric oxide (NO) is an endogenous vasodilator involved in inflammatory and autoimmune response, and in the pathophysiology of diabetic vascular disease. Endothelium-derived NO is formed from L-arginine by endothelial NO synthase (eNOS), and earlier studies have provided evidence for altered NO metabolism and impaired endothelial function in diabetes, probably due to polymorphisms in eNOS gene. In the present study we investigated the association of the eNOS gene intron 4 a/b VNTR polymorphism with diabetic microangiopathy in 61 young individuals with type 1 diabetes (T1D), 35 male and 26 female, aged 5.0-29.1 (mean 15.6) years, and followed up for 3.24-11.4 (mean 7.44) years. Ten patients (16.4%) had developed microalbuminuria, three hypertension and two retinopathy. Wild-type b/b homozygosity for eNOS gene intron 4 VNTR was found in 37 (60.7%) and a/b polymorphism in 24 (39.3%). No significant relationship was demonstrated between eNOS gene intron 4 polymorphisms and microalbuminuria, hypertension or retinopathy in these young individuals. Our findings suggest that a/b polymorphism of the intron 4 eNOS gene is not associated with early onset diabetic microangiopathy.
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Affiliation(s)
- D Mamoulakis
- Department of Paediatrics, University Hospital of Heraklion, Crete, Greece
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Determination and modelling of clinical laboratory data of healthy individuals and patients with end-stage renal failure. Open Med (Wars) 2009. [DOI: 10.2478/s11536-008-0085-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe analyses of 18 biochemical parameters (alanine aminotransferase, albumin, aspartate aminotransferase, calcium, cholesterol, chloride, creatinine, iron, glucose, γ- glutamyl transferase, alkaline phosphatase, phosphorus, potassium, sodium, total protein, triglycerides, uric acid, and urea nitrogen) were performed for 166 healthy individuals and 108 patients with end-stage renal failure (ESRF). The application of cluster analysis proved that there were points of similarity among all 18 biochemical parameters that formed major groups; these groups corresponded to the authors’ assumption of the existence of several overall patterns of biochemical parameters that may be termed “enzyme-specific”; “general health indicator”; “major component excretion”; “blood-specific indicator”; and “protein-specific”. These patterns also appear in the subsets of males and females that were obtained by separation of the general dataset. In addition, the performance of factor analysis similarly proved the validity of this assumption. This projection and modelling method indicated the existence of seven latent factors, which explained 70.05% of the total variance in the system for healthy individuals and more than 72% of the total variance in the system for patients with ESRF. All these results support the probability that a general health indicator could be constructed by taking into account the existing classification groups in the list of biochemical parameters.
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Qian Y, Li S, Ye S, Chen Y, Zhai Z, Chen K, Yang G. Renoprotective effect of rosiglitazone through the suppression of renal intercellular adhesion molecule-1 expression in streptozotocin-induced diabetic rats. J Endocrinol Invest 2008; 31:1069-74. [PMID: 19246972 DOI: 10.1007/bf03345654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To observe the effect of rosiglitazone on serum intercellular adhesion molecule-1 (SICAM-1) level, urinary excretion of ICAM-1, and renal expression of ICAM-1, and investigate its possible renoprotective mechanisms in diabetic rats. METHOD Twenty-four Wistar Rats were divided into 3 groups: non-diabetic control rats (group A, no.=8), streptozotocin-induced diabetic rats (group B, no.=8), and diabetic rats treated with rosiglitazone (group C, no.=8). Rats in group C were treated with rosiglitazone (5 mg x kg(-1) x d(-1)) 1 week after the establishment of diabetic model, group A and B were treated with corresponding sodium chloride. Peripheral blood glucose was tested weekly. Glycosylated hemoglobin (HbA1c) and SICAM-1 as well as urinary albumin excretion rate (UAER), urinary retinol binding-protein (URBP) excretion rate, and urinary ICAM-1 (UICAM- 1) excretion rate were tested at the 8th week, and the renal tissues of all rats were obtained for evaluating kidney/body weight ratio, observing pathologic change via electron microscope, and for examining the expression of ICAM-1 mRNA by reverse transcriptase-PCR. RESULTS At the 8th week, the blood glucose, HbA1c levels, UAER, URBP excretion rate, kidney/body weight ratio and serum, urinary ICAM-1 levels all increased significantly in group B and group C in comparison with group A; however, the above-mentioned parameters in group C (except the blood glucose and HbA1c levels) were much lower than those in group B. In addition, both SICAM-1 and UICAM-1 were highly correlated with the UAER, URBP level, and kidney/body weight ratio in all rats; renal pathological lesions observed by electron microscope in group C were much lighter than those of group B; compared with group A, the expression of ICAM-1 mRNA was markedly up-regulated in group B and group C, and rosiglitazone was able to decrease the expression of ICAM-1 mRNA in the renal tissue. CONCLUSION Rosiglitazone could definitely protect against the renal injury of diabetic rats, which may be partly associated with decreasing the expression of ICAM-1 in the renal tissue, reducing ICAM-1 productions in both serum and urine.
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Affiliation(s)
- Y Qian
- Department of Endocrinology, Anhui Provincial Hospital, Hefei, China
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Moon PG, Hwang HH, Boo YC, Kwon J, Cho JY, Baek MC. Identification of rat urinary glycoproteome captured by three lectins using gel and LC-based proteomics. Electrophoresis 2008; 29:4324-31. [DOI: 10.1002/elps.200800070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Samuel CS, Hewitson TD, Zhang Y, Kelly DJ. Relaxin ameliorates fibrosis in experimental diabetic cardiomyopathy. Endocrinology 2008; 149:3286-93. [PMID: 18388190 DOI: 10.1210/en.2008-0250] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fibrosis (extracellular matrix accumulation) is the final end point in diabetic cardiomyopathy. The current study evaluated the therapeutic effects of the antifibrotic hormone relaxin (RLX) in streptozotocin-treated transgenic mRen-2 rats, which undergo pathological and functional features similar to human diabetes. Twelve-week-old hyperglycemic mRen-2 rats, normoglycemic control rats, and animals treated with recombinant human gene-2 (H2) RLX from wk 10-12 were assessed for various measures of left ventricular (LV) fibrosis, hemodynamics, and function, while the mechanism of RLX's actions was also determined. Hyperglycemic mRen-2 rats had increased LV collagen concentration (fibrosis) and gelatinase activity (all P < 0.05 vs. controls) but equivalent levels of interstitial collagenase and tissue inhibitor of metalloproteinase-1 to that measured in control rats. The increased LV fibrosis associated with diabetic animals led to significant alterations in the E/A wave ratio and E-wave deceleration time (both P < 0.05 vs. controls) in the absence of blood pressure changes, reflective of myocardial stiffness and LV diastolic dysfunction. H2-RLX treatment of diabetic rats led to significant decreases in interstitial and total LV collagen deposition (both P < 0.05 vs. diabetic group), resulting in decreased myocardial stiffness and improved LV diastolic function, without affecting nondiabetic animals. The protective effects of H2-RLX in diabetic rats were associated with a reduction in mesenchymal cell differentiation and tissue inhibitor of metalloproteinase-1 expression in addition to a promotion of extracellular matrix-degrading matrix metalloproteinase-13 (all P < 0.05 vs. diabetic group) but were independent of blood pressure regulation. These findings demonstrate that RLX is an antifibrotic with rapid-occurring efficacy and may represent a novel therapy for the treatment of diabetes.
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Affiliation(s)
- Chrishan S Samuel
- Howard Florey Institute and Department of Biochemistry and Molecular Biology, University of Melbourne, Victoria 3010, Australia.
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Huang EA, Gitelman SE. The effect of oral alpha-lipoic acid on oxidative stress in adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2008; 9:69-73. [PMID: 18221433 DOI: 10.1111/j.1399-5448.2007.00342.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Oxidative stress has been implicated in the pathophysiology of diabetic complications. Alpha-lipoic acid (LA), a potent antioxidant, has been shown to be an effective treatment for diabetic neuropathy when given intravenously. Recently, an oral controlled-release formulation of alpha-lipoic acid (CRLA) was developed, and a pharmacokinetic study demonstrated that CRLA maintained significant plasma levels for 67% longer than a common quick-release formulation. OBJECTIVE To determine if CRLA is an effective antioxidant in type 1 diabetes mellitus (T1D) by measuring its effects on markers of oxidative damage and total antioxidant status. METHODS Forty pubertal and postpubertal adolescents with T1D underwent a double-blind, randomized, placebo-controlled study of CRLA for 3 months. 8-hydroxy-2'-deoxyguanosine, 2-thiobarbituric acid-reactive substances, protein carbonyl, total reactive antioxidant potential, hemoglobin A1c (HbA1c), and spot random urine collected for albumin to creatinine ratio were measured before and after treatment. RESULTS There was no significant change in any measurement of oxidative damage, total antioxidant status, HbA1c, or microalbuminuria prevalence after treatment with either placebo or CRLA. CONCLUSION In this pilot study, CRLA was not an effective treatment for decreasing oxidative damage in T1D, although efficacy may have been limited by issues with compliance.
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Affiliation(s)
- Eric A Huang
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA 94143-0434, USA
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