Mechanistic Pathogenesis of Endothelial Dysfunction in Diabetic Nephropathy and Retinopathy

Nailfold capillary abnormalities as indicators of diabetic nephropathy progression: a cross-sectional study in type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (DM) leads to chronic hyperglycemia and microvascular complications, including diabetic nephropathy (DN). Nailfold videocapillaroscopy (NVC) is a non-invasive method for assessing the microvascular abnormalities and may aid in early DN detection. This study investigates the correlation between DN and nailfold capillary abnormalities in type 2 DM.

METHODS

This prospective cross-sectional study involved 453 participants with type 2 DM, divided into 3 groups based on estimated glomerular filtration rate (eGFR) or albumin-to-creatinine (A/C) ratio. Chronic kidney disease (CKD) risk categories based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Participants underwent structured interviews, clinical assessments, and laboratory tests. NVC was performed to assess capillary morphology, distribution, density, and blood flow.

RESULTS

Significant differences in NVC measurements were observed across eGFR groups, with higher NVC scores and more severe capillary abnormalities noted in lower eGFR groups. The 'comma-like' capillary distribution pattern (23.08%, p = 0.016), more ratio of ramified capillaries (p = 0.0137) were observed in the eGFR <30 ml/min/1.73m2 group. Reduced fundus transparency (p = 0.0015) and impaired visibility of the sub-venous plexus (p = 0.0016) were noted in the lower eGFR groups. Capillary lengths, both input and mean, were shorter in the A/C ratio > 300 mg/g group (p = 0.0382 and p = 0.0478, respectively). The NVC score was higher in the A/C ratio > 300 mg/g groups (p = 0.0028).

CONCLUSION

Nailfold capillary abnormalities correlate with DN severity, indicating their potential as a non-invasive biomarker for early DN detection and monitoring in type 2 DM.

Association between the difference in estimated GFR based on cystatin C versus creatinine in coronary artery diseases

BACKGROUND

The difference in estimated glomerular filtration rate (eGFR) derived from creatinine and cystatin C (eGFRdiff) has been noticed recently and the relationship with poor cardiovascular prognosis has been proven. However, primary prevention of the risk of coronary artery disease (CAD) is equally important but there is a lack of studies specifically investigating this implication.

METHODS

This prospective cohort study utilized data from the UK Biobank, including 437,536 participants without CAD at baseline. The primary outcome was defined as CAD. The eGFRdiff was calculated by subtracting creatinine-based eGFR from cystatin C-based eGFR. Participants were then categorized into a negative, intermediate range, and positive group based on thresholds of -15 mL/min/1.73 m2 and 15 mL/min/1.73 m2. Cox proportional risk models were used to evaluate the associations of eGFRdiff with CAD and the relationship among different genetic risks of CAD.

RESULTS

During a median follow-up of 13.8 years, CAD occurred in 36,797 participants. In the fully adjusted model, compared to midrange eGFRdiff, participants with a positive eGFRdiff had a lower risk of CAD (HR 0.717, 95%CI 0.675-0.762), while with a negative eGFRdiff had a higher risk (HR 1.433, 95%CI 1.399-1.468). When eGFRdiff was treated as a continuous variable, a statistically significant trend toward a lower risk of CAD as eGFRdiff increased (HR 0.982, 95% CI 0.981-0.982). Moreover, this relationship is independent of genetic susceptibility.

CONCLUSIONS

eGFRdiff was associated with CAD risk, where a high eGFRdiff corresponded to a decreased likelihood of CAD onset no matter genetic susceptibility.

Ferroptosis-related LncRNAs in diseases

Ferroptosis is a form of regulated cell death (RCD) caused by the accumulation of intracellular iron and lipids and is involved in many pathological processes, including neurodegenerative and cardiovascular diseases, and cancer. Long non-coding RNAs (lncRNAs), RNA molecules exceeding 200 nt in length that do not possess protein coding function can interfere with ferroptosis by binding ferroptosis-related miRNAs or proteins. Recently, ferroptosis-related lncRNAs (FRlncRNAs) have been identified in cancer and non-malignant disease models, including inprediction of drug resistance, intra-tumoral immune infiltration, metabolic reprogramming and mutation landscape. Here, we review FRlncRNAs in cancer and non-malignant diseases, from prognosis to treatment.

MAP4K4 aggravates microvascular anomalies in diabetic retinopathy in a YTHDF2-dependent manner

AIMS/HYPOTHESIS

Signalling pathways that regulate endothelial cell (EC) dysfunction, ischaemia and inflammation play a crucial role in retinal microangiopathy such as diabetic retinopathy. MAP4K4 is highly expressed in ECs. However, the involvement of MAP4K4 in retinal vasculopathy of diabetic retinopathy remains unclear.

METHODS

We analysed publicly available single-cell RNA sequencing (scRNA-seq) data from fibrovascular membranes (FVMs) from eight individuals with proliferative diabetic retinopathy (PDR) and normal retinas from 11 individuals without diabetes. Using db/db mice and human primary retinal endothelial cells (HRMECs), we further investigated the effects of MAP4K4 on retinal microangiopathy and endothelial dysfunction to explore the underlying regulatory mechanisms.

RESULTS

The scRNA-seq analysis revealed that MAP4K4 was predominantly expressed in retinal ECs, with elevated expression in FVMs from individuals with PDR compared with normal retinas from individuals without diabetes. This finding was confirmed at the protein level, with MAP4K4 expression and activity being upregulated in both the FVMs of individuals with PDR and the retinas of db/db mice. Inhibition of MAP4K4 using DMX-5804 alleviated retinal microvascular leakage by enhancing the expression and integrity of junctional proteins in both ECs from db/db mice and HRMECs. Additionally, DMX-5804 reduced retinal angiogenesis by inhibiting EC migration and vascular sprouting. Mechanistically, MAP4K4 regulated EC characteristics through NF-κB signalling pathway activity. The exacerbating effect of recombinant MAP4K4 on diabetic retinopathy in db/db mice was mitigated by a p65 inhibitor, confirming the involvement of NF-κB. Moreover, MAP4K4 expression was regulated by YTH N6-methyladenosine RNA-binding protein 2 (YTHDF2), which modulates the stability of MAP4K4 mRNA.

CONCLUSIONS/INTERPRETATION

Our study highlights the critical role of MAP4K4 in EC dysfunction and diabetic retinal microangiopathy, providing new insights into its molecular pathogenesis. Targeting MAP4K4, particularly through modulation of the YTHDF2/MAP4K4/NF-κB axis, may provide a novel therapeutic strategy for diabetic retinopathy.

Association between hemodialysis and surgical outcomes of pars plana vitrectomy in patients with chronic renal failure and proliferative diabetic retinopathy: a retrospective analysis

BACKGROUND

To investigate the association between Hemodialysis (HD) and postoperative outcomes in patients diagnosed with chronic renal failure (CRF) who underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR).

METHODS

This was a retrospective study. Fifty-three eyes were divided into HD (25 eyes) and non-HD (28 eyes) groups. Follow-up assessments were performed preoperatively and at 1 week, 2 weeks, 1 month, 2 months, 4 months, 8 months and 12 months postoperatively. Independent risk factors affecting visual recovery following PPV were also determined.

RESULTS

The HD group exhibited significantly lower intraocular pressure (IOP) from 1 week to 2 months postoperatively compared to the non-HD group (P < 0.05). While non-HD patients had better preoperative best-corrected visual acuity (BCVA), HD patients achieved superior BCVA at 2 months (P < 0.05), with higher rates of visual improvement at 12 months (84.00% vs. 78.57%). Prolonged diabetes duration and elevated total cholesterol levels negatively correlated with postoperative VA prognosis (P < 0.05). The preoperative eye conditions, lens status, postoperative complications were not significantly different (P > 0.05).

CONCLUSIONS

Preoperative HD is associated with short-term reductions in IOP and improvements in BCVA after PPV, with long-term data correlating HD to better visual acuity outcomes. However, unmeasured confounders may influence these results. Prolonged diabetes duration and elevated total cholesterol levels also appear associated with slower visual recovery, warranting further validation.

VEGF in Diabetic Retinopathy and Age-Related Macular Degeneration

Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis throughout the human body, influencing countless physiological and pathological processes, including tumor growth, preeclampsia, and retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). In DR, VEGF promotes retinal neovascularization and intraretinal fluid accumulation, leading to complications like diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Regular intravitreal anti-VEGF injections are commonly used to manage PDR and DME, though repeated treatments are often required, and efficacy can be limited. AMD, a major cause of vision loss in older adults, is characterized by either dry or wet forms. While the dry form has not been shown to be influenced by VEGF, the choroidal neovascularization of wet AMD has strong associations with VEGF. Current treatment for wet AMD consists primarily of anti-VEGF injections, the gold standard of care, but is limited by varying patient responses, as treatments are often repeated every 4-8 weeks indefinitely. This review explores the pathogenic role of VEGF in both DR and AMD, discussing the molecular mechanisms underlying these diseases and the therapeutic approaches targeting VEGF. Despite advancements, the variability in treatment responses highlights the need for continued research to develop more effective therapies to prevent vision loss and blindness associated with these retinal diseases.

Potential mechanisms of epigenetic regulation in diabetic retinopathy from the perspectives of multi-omics

PURPOSE

Diabetic retinopathy (DR) is a significant complication of diabetes, with complex pathogenesis involving epigenetic modifications. This study aimed to explore the epigenetic regulatory mechanisms contributing to DR.

METHODS

DR-related data, including DNA methylation, mRNA, and miRNA expression datasets, were obtained from the Gene Expression Omnibus database. Differential gene expression analysis was performed to identify differentially methylated genes and expressed mRNAs and miRNAs. Cross-analysis established the methylation-expression and miRNA-mRNA regulatory networks. A comprehensive DR-related epigenetic regulatory network was constructed, identifying hub genes. The expression characteristics of these hub genes in various immune cells were examined using single-cell RNA sequencing.

RESULTS

We identified 10,716 differentially methylated genes, 1,181 differentially expressed mRNAs, and 615 differentially expressed miRNAs in DR. The methylation-expression regulatory network was associated with pathways such as TGF-beta and ErbB signaling. The miRNA regulatory network was linked to pathways related to cellular senescence, adherents junctions, and endocytosis. Five hub genes were identified: TFRC, AP2M1, AP2A1, DAB2, and PPP1CB. Single-cell RNA sequencing revealed specific expression of these genes in particular immune cells, highlighting their potential roles in DR pathogenesis.

CONCLUSION

This study constructed a comprehensive epigenetic regulatory network for DR and identified key regulatory genes, offering new insights into the molecular mechanisms underlying DR and potential therapeutic targets for diagnosis and treatment.

Targeting long non-coding RNA RP11-502I4.3 inhibits the trend of angiogenesis in diabetic retinopathy

Diabetic retinopathy (DR) is a leading cause of blindness. We hypothesised that the long non-coding RNA RP11-502I4.3 may be involved in angiogenesis associated with DR. We investigated the role of RP11-502I4.3 in DR by examining its regulation of vascular endothelial growth factor (VEGF). We assessed differences in RP11-502I4.3 expression between the control group and streptozotocin-induced diabetic rats or high glucose (HG)-stimulated human retinal microvascular endothelial cells (HRMECs). VEGF expression was measured with and without lentiviral vectors overexpressing RP11-502I4.3. We analysed the structural alterations related to DR after overexpressing RP11-502I4.3. Our analysis revealed that RP11-502I4.3 expression was lower in the retinas of diabetic rats and HG-stimulated HRMECs compared with normal glucose conditions. Overexpressing of RP11-502I4.3 resulted in decreased VEGF levels. Diabetic rats exhibited retinopathy characterised by thinning of the retinal layer thickness, structural changes in the inner and outer nuclear layers, a reduced count of retinal ganglion cells, and the presence of acellular capillaries. The proliferative activity, migration count, and tube formation ability of HG-treated HRMECs were significantly higher than those of the control group. However, these changes were inhibited by RP11-502I4.3 overexpression. Overexpression RP11-502I4.3 might inhibit retinopathy of diabetic rats and HG-induced angiogenesis by downregulating VEGF expression.

Ginsenoside in the treatment of type 2 diabetes and its complications: a promising traditional chinese medicine

Type 2 diabetes mellitus (T2DM), a chronic condition commonly observed in adults, particularly among the elderly, is characterized by a dysfunctional insulin response that impairs blood glucose regulation, resulting in persistent hyperglycemia. Ginseng, a medicinal plant with significant economic value and a longstanding history of therapeutic use in Asia, has shown efficacy against various diseases. Extensive clinical and experimental studies highlight ginsenosides, its primary bioactive compounds, for their multiple therapeutic effects across a range of conditions, including endocrine, cardiovascular, and central nervous system disorders. Various ginsenoside types have demonstrated potential in lowering blood glucose levels, reducing insulin resistance, and alleviating complications through the modulation of key protein targets and signaling pathways. This review consolidates the pharmacological actions and mechanisms of distinct ginsenosides in managing diabetes and its complications, offering a theoretical foundation for further pharmacological research and novel drug development for T2DM treatment, while also providing robust theoretical support for future clinical applications.

CAVIN3 deficiency promotes vascular normalization in ocular neovascular disease via ERK/JAG1 signaling pathway

Multiple members of the caveolae-associated protein (Cavin) family are implicated in angiogenesis. However, the specific role of CAVIN3 in pathological angiogenesis within the eye remains unclear. The present study demonstrated that CAVIN3 knockdown in endothelial cells (ECs) promoted vascular normalization in ocular pathological neovascularization. Elevated CAVIN3 expression was observed in the ECs of retinal pigment epithelium/choroid complexes from patients with neovascular age-related macular degeneration and fibrovascular membranes from patients with proliferative diabetic retinopathy. Additionally, upregulated Cavin3 expression was detected in laser-induced choroidal neovascularization (CNV) and oxygen-induced retinopathy (OIR) mouse models. In both OIR and CNV mice, Cavin3 knockdown inhibited pathological neovascularization. Cavin3 deficiency further disrupted EC proliferation and vascular sprouting, thereby promoting vascular normalization by partially restoring microenvironmental hypoxia and reestablishing pericyte-EC interactions. Mechanistically, we demonstrated that zinc finger E-box-binding homeobox 1 (ZEB1) regulated CAVIN3 transcription in ECs under hypoxic conditions. CAVIN3 deficiency modulated pathological vascularization by inhibiting ERK phosphorylation, which downregulated jagged 1 (JAG1) expression. Conclusively, this study elucidated the protective role of endothelial CAVIN3 deficiency in pathological neovascularization models, addressing a gap in understanding the regulatory role of Cavins in angiogenesis. These findings suggested a therapeutic direction for ocular neovascular diseases.

Isoquercetin Alleviates Diabetic Retinopathy Via Inhibiting p53-Mediated Ferroptosis

Diabetic retinopathy (DR) is a retinal vasculopathy stemming from diabetes mellitus, characterized by microvascular changes in the retina that can lead to visual impairment or even blindness. Ferroptosis, a form of regulated cell death driven by iron accumulation and lipid peroxidation, has been implicated in the progression of DR. Isoquercetin (IQC), a flavonoid compound, has been shown to inhibit cellular ferroptosis and apoptosis, yet its specific role and underlying mechanisms in DR remain to be elucidated. The present study aimed to investigate the effects of IQC on DR and to delineate its protective mechanisms, particularly focusing on whether these effects are mediated through p53. We employed streptozotocin-induced diabetic C57BL/J mouse models and high glucose (HG)-induced human retinal capillary endothelial cells (HRCECs) models for both in vivo and in vitro experiments. Pathological damage was assessed using hematoxylin and eosin staining, while cell apoptosis rates was detected by TUNEL staining and FITC/PI flow cytometry. Mitochondrial damage was evaluated using transmission electron microscopy. Additionally, we measured levels of reactive oxygen species (ROS) and glutathione (GSH) to assess lipid peroxidation and quantified ferrous ions (Fe2+). Protein expression was detected by immunofluorescence and western blot analysis, and mRNA levels were determined by real-time quantitative PCR. Our findings revealed that IQC mitigated retinal damage in diabetic mice, and in vitro studies further demonstrated that this effect was mediated by the inhibition of p53. In HG-induced HRCECs, we observed decreased cell viability, lipid peroxidation, and ferroptosis. IQC alleviated HG-induced ferroptosis in HRCECs by modulating the p53 pathway, which exhibited varying responses following p53 inhibition or activation. In summary, IQC downregulated the p53 signaling pathway, thereby reducing ferroptosis and apoptosis, and effectively ameliorated the damage associated with DR. These discoveries offer novel insights into the protective mechanisms of IQC in DR.

Indole metabolism and its role in diabetic macrovascular and microvascular complications

Tryptophan (Trp), an essential amino acid obtained through dietary sources, plays a crucial role in various physiological processes. The metabolism of Trp branches into three principal pathways: the serotonin pathway, the kynurenine pathway, and the indole pathway. The kynurenine and serotonin pathways are host pathways while the indole pathway is solely the result of bacterial metabolism. Trp metabolites extend their influence beyond protein biosynthesis to affect a spectrum of pathophysiological mechanisms including, but not limited to, neuronal function, immune modulation, inflammatory responses, oxidative stress regulation, and maintenance of intestinal health. This review focuses on indole derivatives and their impact on vascular health. Trp-containing dipeptides are highlighted as a targeted nutraceutical approach to modulate Trp metabolism, enhance beneficial metabolite production, and mitigate risk factors for vascular diseases. The importance of optimizing Trp intake and dietary strategies to harness the benefits of Trp-derived metabolites for vascular health is underscored, bringing to light the need for further research to refine these therapeutic approaches.

Andrographolide as a Multi-Target Therapeutic Agent in Diabetic Nephropathy: Insights into STAT3/PI3K/Akt Pathway Modulation

Diabetic nephropathy (DN) remains a leading cause of end-stage renal disease (ESRD), driven by chronic inflammation, oxidative stress, and apoptosis. Current therapies targeting glycemic and blood pressure control fail to address the underlying molecular mechanisms of DN. This study investigates the therapeutic potential of andrographolide (AD), a diterpenoid lactone from Andrographis paniculata, in mitigating DN by modulating key molecular pathways. Through integrative network pharmacology, molecular docking, and in vivo/in vitro experiments, 107 overlapping DN-related targets were identified, with STAT3, PI3K, and AKT1 emerging as core nodes. Molecular docking revealed high binding affinities between AD and these targets, supporting its modulatory potential. In vivo, AD significantly improved renal function in streptozotocin-induced DN rats, reducing proteinuria, glomerular hypertrophy, and renal fibrosis. AD also attenuated oxidative stress, decreased pro-inflammatory cytokine levels, and enhanced antioxidant enzyme activities, demonstrating systemic anti-inflammatory and antioxidative effects. In vitro studies further confirmed that AD alleviates podocyte oxidative stress and apoptosis under high glucose conditions by suppressing the RAGE-NF-κB and STAT3/PI3K/Akt pathways. Histological analyses revealed substantial improvements in renal architecture, including reductions in fibrosis and mesangial expansion. These results underscore AD's multi-target mechanism, directly addressing DN's core pathological drivers, including inflammation, oxidative stress, and apoptosis. As a natural compound with notable safety and efficacy, AD holds promise as an adjunct or standalone therapeutic agent for DN. This study establishes a robust preclinical foundation for AD, warranting further exploration in clinical trials and its potential application in other diabetic complications.

High Serum Levels of Irisin, Visfatin and Adiponectin as Potential Independent Risk Factors for Diabetic Nephropathy Progression in Patients With Type 2 Diabetes Mellitus

BACKGROUND/AIM

Diabetic nephropathy (DN) is a common devastating complication in type 2 diabetes mellitus (T2DM). In order to investigate novel DN biomarkers, we evaluated serum levels of irisin, adiponectin, visfatin and interleukin 4 (IL-4) in patients with T2DM with normo-, micro- and macro-albuminuria and compared their means with non-diabetic controls.

PATIENTS AND METHODS

Clinical data and routine laboratory parameters of metabolic and renal function status were determined in blood and urine samples obtained from 169 participants, divided into four groups according to the presence of diabetes and albuminuria using appropriate biochemical assays/calculations. Serum levels of irisin, adiponectin, visfatin and interleukin 4 (IL4) were assessed using enzyme-linked immunosorbent assay. Means of all tested parameters and biomarkers were compared using appropriate statistical methods. Logistic regression was used to determine albuminuria risk factors in T2DM as an indicator for DN.

RESULTS

All tested parameters differed significantly among T2DM groups and controls (p<0.001). Irisin, adiponectin, visfatin and IL4 significantly increased in T2DM patients with significant increasing albuminuria. Along with hemoglobin A1C, irisin was the most highly significant risk factor for development and progression of albuminuria (p<0.001). Adiponectin was also a significant independent risk factor (p=0.009), whilst visfatin and IL4 conferred no significant risk.

CONCLUSION

High irisin levels in normo-albuminuric patients indicates their potential to develop DN even prior to detectable albuminuria. Both irisin and adiponectin may be considered as potential biomarkers indicating risk for DN progression in T2DM that might be therapeutically targeted.

The rs3844492/ARHGAP22 and rs741301/ELMO1 polymorphisms are associated with changes in laboratory markers of renal damage among patients with type 2 diabetes mellitus

OBJECTIVE

To investigate the association between the rs3844492/ARHGAP22 and rs741301/ELMO1 polymorphisms and diabetic kidney disease in patients with type 2 diabetes mellitus.

METHODS

The sample consisted of 740 patients with type 2 diabetes mellitus and diabetic kidney disease (cases) and 303 patients with type 2 diabetes mellitus, but no diabetic kidney disease (controls). The genotyping of the polymorphisms was conducted using real-time polymerase chain reaction with Taqman probes.

RESULTS

The frequency of the rs3844492/ARHGAP22 G/G genotype was 16.8% in the control group and 15.7% in cases (p = 0.069). After adjusting for covariables, the presence of the G allele was associated with risk for diabetic kidney disease (OR = 1.435, 95% CI 1.023 - 2.011; p = 0.036), as well as with a decreased estimated glomerular filtration rate (p = 0.012) and elevated creatinine levels (p = 0.009). No difference was observed in the rs741301/ELMO1 genotype frequencies between groups (p = 0.800). However, the presence of the C allele appears to be associated with higher creatinine levels in patients with type 2 diabetes mellitus (p = 0.064).

CONCLUSION

The rs3844492/ARHGAP22 and rs741301/ELMO1 polymorphisms are associated with alterations in renal function markers among patients with type 2 diabetes mellitus.

The Effect of Autologous Dendritic Cell Therapy on Renal Perfusion in Diabetic Kidney Disease: Analysis of Doppler Ultrasound and Angiogenesis Biomarkers

BACKGROUND

Diabetes mellitus (DM) is a global health challenge with a severe health burden. Approximately 40% of diabetic patients develop diabetic kidney disease (DKD), leading to kidney failure. Autologous dendritic cell therapy may enhance renal function by modulating vascular markers.

METHODS

Involving 35 patients, this quasi-experimental study assessed the pulsatility index (PI), resistive index (RI), vascular endothelial growth factor (VEGF), and endothelin levels before and four weeks following autologous dendritic cell administration.

RESULTS

A significant reduction in median PI was found from 1.61 ± 0.63 to 1.21 ± 0.26 (p < 0.001). The increase in mean RI was insignificant from 0.74 ± 0.07 to 0.75 ± 0.06 (p = 0.17). The median VEGF showed a slight reduction from 522.10 ± 608.6 to 473.70 ± 550 (p = 0.589) and endothelin from 1.74 ± 0.71 to 1.63 ± 0.76 (p = 0.554).

CONCLUSIONS

This study shows that autologous dendritic cell therapy may improve kidney perfusion in DKD patients, indicated by a significant reduction in the PI. These findings suggest potential therapeutic benefits for renal perfusion in DKD.

Using blood biomarkers and ophthalmological indicators of optical coherence tomography and angiography for the diagnosis of fundus lesions in patients with diabetes mellitus

Purpose

To assess long-term ophthalmic and clinical blood test changes in patients with different severities of diabetic retinopathy (DR).

Methods

We performed a longitudinal case-control study of 130 patients with diabetes mellitus (DM) and 67 controls, including visual acuities from 2,201 eye clinic visits and 44,833 blood tests. We also analyzed optic disc and macular structure and vasculature using optical coherence tomography (OCT) and angiography (OCTA).

Results

Ninety-one percent of eyes in diabetic patients had stable visual acuity (better than 20/40) over 7 years. Cluster analysis revealed most prominent blood test changes in the DM included elevated glucose and hemoglobin A1c and evidence of nephropathy. Optic disc OCTA was most correlated with OCT in the superior and inferior quadrants. Notably, peripapillary and macular OCTA measurements revealed evidence of microvascular drop out even in those with DR grade 0.

Conclusions

Majority of patients with DM monitored by physicians maintained good visual acuity over years. Ophthalmic imaging revealed evidence of early vascular changes even in patients without evidence of DR on clinical exam and color fundus imaging. In addition to ophthalmic functional and structural assessments, clinical blood tests for renal function are also important early biomarkers of end organ damage in DM.

Research progress of non-coding RNA regulating the role of PANoptosis in diabetes mellitus and its complications

Diabetes is a chronic metabolic disease that is endemic worldwide and is characterized by persistent hyperglycemia accompanied by multiple severe complications, including cardiovascular disease, kidney dysfunction, neuropathy, and retinopathy. The pathogenesis of diabetes mellitus and its complications is multifactorial, involving various molecular and cellular pathways. In recent years, research has indicated that mechanisms of cell death play a significant role in the advancement of diabetes and its complications. PANoptosis is a complex phenomenon caused by three cell death pathways: programmed apoptosis, necroptosis and pyroptosis. The contribution of PANoptosis to diabetes and its complications remains incompletely understood. Non-coding RNA, an important molecule in gene expression regulation, has shown significant regulatory functions in a variety of diseases. This paper reviews the underlying mechanisms of diverse types of non-coding RNAs (including lncRNA, miRNA and circRNA) in regulating PANoptosis and their specific contributions in diabetes, aiming to explore how non-coding RNAs influence PANoptosis and their effects in diabetes.

Effects of Naringin and Zinc Treatment on Biochemical, Molecular, and Histological Alterations in Stomach and Pancreatic Tissues of STZ-Induced Diabetic Rats

Diabetes mellitus is a chronic metabolic disorder that affects multiple organs, including the stomach. This research examines the effects of naringin and/or zinc on stomach and pancreatic tissues of streptozotocin-induced diabetic rats. Type 2 diabetes is induced by intraperitoneal injection of nicotinamide and streptozotocin. Three weeks after diabetes induction, rats receive eight weeks of treatment. Malondialdehyde and total antioxidant capacity are estimated colorimetrically. Asprosin and P-selectin levels are assessed via ELISA. Quantitative RT-PCR analysis of nuclear factor kappa B (NF-кB), peroxisome proliferator-activated receptor gamma (PPAR γ), and nuclear factor erythroid 2-related factor 2 (Nrf-2) genes is carried out. Tumor necrosis factor-alpha (TNF-α) is assessed immunohistochemically, and stomach and pancreatic tissues are examined histologically. Combined naringin and zinc treatment significantly reduces gastric Malondialdehyde, serum asprosin, and P-selectin levels in serum, stomach, and pancreas compared to diabetic rats. Additionally, gastric NF-кB expression is significantly lower, while PPAR γ and Nrf-2 expressions are significantly higher compared to diabetic rats. Immunohistochemical analysis and histopathological examination confirm these findings. In conclusion, combined naringin and zinc treatment significantly improves gastric alterations in diabetic rats by reducing oxidative stress and inflammation. Nonetheless, it shows no additional impacts on pancreatic tissue compared to naringin or zinc alone.

Growth Arrest-specific 1 Inhibits Keap1/Nrf2 Signaling Transduction in the Activation of the Ferroptosis Program in Retinal Müller Cells

BACKGROUND

Diabetes retinopathy (DR) represents a microvascular disease in diabetes. Growth arrest-specific 1 (GAS1) is differentially expressed in rat retinal Müller cells under high glucose (HG) conditions, and its promotion of ferroptosis contributes to retinal cell death. However, the influence of GAS1 in DR is elusive. Herein, we aimed to investigate the effect and potential mechanism based on GAS1-mediated ferroptosis on DR.

METHODS

After HG treatment, the differentially expressed genes in rat retinal Müller cells were analyzed by transcriptome sequencing followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses; finally, GAS1 was selected. The effects of GAS1 knockdown/overexpression and nuclear factor erythroid 2-related factor (Nrf2) silencing on viability, apoptosis, lipid peroxidation, Fe2+, and oxidative stress levels in HG-induced/transfected Müller cells were measured by Cell Counting Kit-8 (CCK-8) assay, flow cytometry, and commercial reagent kits. The potential effects of GAS1 and Nrf2, especially on GAS1, Nrf2, and Kelch-like ECH-associated protein 1 (Keap1) expressions in cells, were determined by quantitative real-time polymerase chain reaction (qRT-PCR) or Western blot.

RESULTS

HG treatment decreased cell viability and glutathione (GSH) levels and increased apoptosis, lipid reactive oxygen species (ROS), glutathione disulfide (GSSG), malondialdehyde (MDA), oxidative stress, and Fe2+ levels in Müller cells (p < 0.01). HG treatment also upregulated GAS1, Keap1, and total Nrf2 expressions while downregulating nuclear Nrf2 in Müller cells (p < 0.001). GAS1 downregulation enhanced cell viability, GSH levels, and nuclear Nrf2 expression while reducing the levels of apoptosis, lipid ROS, GSSG, MDA, Fe2+, Keap1, and total Nrf2 in HG-treated Müller cells (p < 0.001), whereas GAS1 overexpression had the opposite effects. Additionally, Nrf2 silencing reversed the impact of GAS1 overexpression in HG-treated Müller cells (p < 0.05).

CONCLUSION

GAS1 inhibits Keap1/Nrf2 signaling transduction in activating ferroptosis in retinal Müller cells; thus, this study can aid in setting the stage for novel treatment methods against DR.

The association between the C-reactive protein-to-albumin-to-lymphocyte index and retinopathy: insights from a population-based study

Introduction

Retinopathy is a multifactorial disease influenced by metabolism, immunity, inflammation, and other factors. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional score that has shown promise in various health contexts. This study aims to investigate the association between the CALLY index and retinopathy risk, and to compare its predictive performance with other established inflammatory markers.

Methods

Data from 5,439 participants in the 2005-2008 National Health and Nutrition Examination Survey (NHANES) were utilized. Multivariable-weighted logistic regression was employed to assess the association between the CALLY index and retinopathy risk. Additionally, the predictive performance of the CALLY index was compared with other inflammatory markers. Mediation analysis was conducted to explore potential mediating factors in the association between the CALLY index and retinopathy.

Results

Multivariable-weighted logistic regression revealed a significant inverse association between the CALLY index and retinopathy risk (OR = 0.96, 95% CI = 0.94-0.98, P = 0.002). Participants in the highest CALLY index quartile exhibited a markedly lower risk of retinopathy (P < 0.001). The CALLY index demonstrated superior predictive performance compared to other inflammatory markers, with an area under the curve (AUC) of 0.672 (95% CI = 0.643-0.701). Mediation analysis indicated that high-density lipoprotein (HDL) levels partially mediated the association between the CALLY index and retinopathy.

Discussion

These findings highlight the CALLY index as a reliable, independent biomarker for retinopathy risk assessment, outperforming traditional inflammatory markers and oering potential clinical value for early identification of retinopathy in individuals with chronic diseases.

FTO-mediated Nrf2 demethylation alleviates high glucose-induced oxidative stress and apoptosis in retinal pigment epithelial cells

BACKGROUND

N6-methyladenosine (m6A) modification contributes to the development of diabetic retinopathy (DR). This study aimed to reveal the role and downstream regulatory signaling of an m6A demethylase fat mass and obesity-associated gene (FTO) in high glucose-induced damage of retinal pigment epithelial cells.

METHODS AND RESULTS

By stimulating ARPE-19 cells with different concentrations of glucose (0 mM-50 mM), we observed that FTO expression was significantly downregulated, while m6A modification level was upregulated in a glucose concentration-dependent manner in ARPE-19 cells. Then, ARPE-19 cells were transfected with FTO knockdown or overexpression vector, and administrated with high glucose (25mM) to perform functional verification experiments. FTO overexpression recovered cell viability, inhibited cell apoptosis, elevated GSH/GSSG ratio, but reduced MDA and ROS levels in high glucose-induced cells, while FTO knockdown further exacerbated high glucose-triggered oxidative stress and apoptotic cell death. Additionally, FTO overexpression upregulated the expression of NF-E2-related factor 2 (Nrf2) and activated the antioxidant heme oxygenase 1 (HO-1) signal through m6A demethylation on Nrf2 in high glucose-treated ARPE-19 cells. Finally, we proved that knockdown of Nrf2 or HO-1 reversed the protective effects of FTO overexpression on high glucose-treated ARPE-19 cells.

CONCLUSION

Altogether, the study demonstrated that FTO ameliorates high glucose-triggered oxidative stress and cell apoptosis through activating the Nrf2/HO-1 signaling pathway in an m6A-dependent manner.

Microbiota and Inflammatory Markers: A Review of Their Interplay, Clinical Implications, and Metabolic Disorders

The human microbiota, a complex ecosystem of microorganisms, plays a pivotal role in regulating host immunity and metabolism. This review investigates the interplay between microbiota and inflammatory markers, emphasizing their impact on metabolic and autoimmune disorders. Key inflammatory biomarkers, such as C-reactive protein (CRP), interleukin-6 (IL-6), lipopolysaccharides (LPS), zonulin (ZO-1), and netrin-1 (Ntn1), are discussed in the context of intestinal barrier integrity and chronic inflammation. Dysbiosis, characterized by alterations in microbial composition and function, directly modulates the levels and activity of these biomarkers, exacerbating inflammatory responses and compromising epithelial barriers. The disruption of microbiota is further correlated with increased intestinal permeability and chronic inflammation, serving as a precursor to conditions like type 2 diabetes (T2D), obesity, and non-alcoholic fatty liver disease. Additionally, this review examines therapeutic strategies, including probiotics and prebiotics, designed to restore microbial balance, mitigate inflammation, and enhance metabolic homeostasis. Emerging evidence positions microbiota-targeted interventions as critical components in the advancement of precision medicine, offering promising avenues for diagnosing and treating inflammatory and metabolic disorders.

Transcriptome and single-cell profiling of the mechanism of diabetic kidney disease

BACKGROUND

The NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome may play an important role in diabetic kidney disease (DKD). However, the exact link remains unclear.

AIM

To investigate the role of the NLRP3 inflammasome in DKD.

METHODS

Using datasets from the Gene Expression Omnibus database, 30 NLRP3 inflammasome-related genes were identified. Differentially expressed genes were selected using differential expression analysis, whereas intersecting genes were selected based on overlapping differentially expressed genes and NLRP3 inflammasome-related genes. Subsequently, three machine learning algorithms were used to screen genes, and biomarkers were identified by overlapping the genes from the three algorithms. Potential biomarkers were validated by western blotting in a db/db mouse model of diabetes.

RESULTS

Two biomarkers, sirtuin 2 (SIRT2) and caspase 1 (CASP1), involved in the Leishmania infection pathway were identified. Both biomarkers were expressed in endothelial cells. Pseudo-temporal analysis based on endothelial cells showed that DKD mostly occurs during the mid-differentiation stage. Western blotting results showed that CASP1 expression was higher in the DKD group than in the control group (P < 0.05), and SIRT2 content decreased (P < 0.05).

CONCLUSION

SIRT2 and CASP1 provide a potential theoretical basis for DKD treatment.

Natural remedies proposed for the management of diabetic retinopathy (DR): diabetic complications

Diabetic retinopathy (DR) represents a significant and serious complication associated with diabetes mellitus (DM), often resulting in considerable visual impairment or even blindness. The intricate pathological processes underlying DR complicate the effectiveness of current treatment modalities. Studies have highlighted the potential of natural products in the treatment of DR via several beneficial effects including anti-inflammatory, antioxidant, anti-neovascular, and anti-apoptotic properties. Flavonoids, saponins, saccharides, and alkaloids exhibited various beneficial effects in DR in in vivo and in vitro studies. However, the clinical utilization of these natural compounds is hindered by issues such as inadequate specificity, low bioavailability, and potential toxicity. Therefore, there is a pressing need for rigorous clinical studies to confirm the efficacy of natural products in preventing or mitigating the progression of DR.

Inhibition of complement system-related gene ITGB2 attenuates epithelial-mesenchymal transition and inflammation in diabetic nephropathy

PURPOSE

Emerging evidences have indicated a role of the complement system in the pathogenesis of diabetic nephropathy (DN). Thus, this study was conducted to explore the complement system-related key biomarkers for patients with DN.

METHODS

DN microarray datasets were downloaded from the GEO database, followed by differentially expressed genes (DEGs) screening. Complement system-related genes (CSRGs) were searched from various databases. Weighted Gene Co-expression Network Analysis (WGCNA) was employed to screen the DN-related genes, then the differential CSRGs (DCSRGs) were identified, followed by protein-protein interaction (PPI) network construction. In addition, key biomarkers were acquired by two machine learning algorithms, then immune infiltration analysis, Gene Set Enrichment Analysis (GSEA), and potential drugs screening were conducted. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and western blotting were utilized to detect the ITGB2 expression. Then the cell viability, inflammatory factors, and the expression of epithelial-mesenchymal transition (EMT) and fibrosis markers were determined by using Cell Counting Kit-8 (CCK-8) assay, enzyme linked immunosorbent assay (ELISA), western blotting assays, respectively.

RESULTS

In total, 1012 DEGs and 974 DN-related genes were screened, and intersection analysis of the three (DN-related genes, DEGs and CSRGs) yielded 13 intersection genes, which were considered as the DCSRGs. Subsequently, 2 key biomarkers were identified by machine learning, namely VWF and ITGB2. The VWF and ITGB2 were both enriched in the pathways of chemokine signaling pathway, CAMs, focal adhesion and natural killer cell-mediated cytotoxicity, and significantly correlated with the activated mast cells, resting NK cells, and macrophages. Also, VWF and ITGB2 were significantly related to the clinical features, including age, serum creatinine level, and GFR (MDRD). Besides, mRNA and protein expression levels of ITGB2 in HG-treated HK-2 cells were remarkably elevated. Moreover, the viability of HK-2 cells, expression of TNF-α, IL-6, IL-12, α-SMA, E-cadherin and vimentin in HK-2 cells changed by HG administration were reversed by ITGB2-silence.

CONCLUSION

Complement system-related gene ITGB2 was overexpressed in DN, and inhibition of ITGB2 attenuated EMT and inflammation in DN.

Single-cell atlas of human pancreatic islet and acinar endothelial cells in health and diabetes

Characterization of the vascular heterogeneity within the pancreas has previously been lacking. Here, we develop strategies to enrich islet-specific endothelial cells (ISECs) and acinar-specific endothelial cells (ASECs) from three human pancreases and corroborate these findings with three published pancreatic datasets. Single-cell RNA sequencing reveals the unique molecular signatures of ISECs, including structural genes COL13A1, ESM1, PLVAP, UNC5B, and LAMA4, angiocrine genes KDR, THBS1, BMPs and CXCR4, and metabolic genes ACE, PASK and F2RL3. ASECs display distinct signatures including GPIHBP1, CCL14, CD74, AQP1, KLF4, and KLF2, which may manage the inflammatory and metabolic needs of the exocrine pancreas. Ligand-receptor analysis suggests ISECs and ASECs interact with LUM+ fibroblasts and RGS5+ pericytes and smooth muscle cells via VEGF-A:VEGFR2, CXCL12:CXCR4, and LIF:LIFR pathways. Comparative expression and immunohistochemistry indicate disruption of endothelial-expressed CD74, ESM1, PLVAP, THBD, VWA1, and VEGF-A cross-talk among vascular and other cell types in diabetes. Thus, our data provide a single-cell vascular atlas of human pancreas, enabling deeper understanding of pancreatic pathophysiology in health and disease.

Comparative analysis of retinal vascular structural parameters in populations with different glucose metabolism status based on color fundus photography and artificial intelligence

Objective

Measure and analyze retinal vascular parameters in individuals with varying glucose metabolism, explore preclinical retinal microstructure changes related to diabetic retinopathy (DR), and assess glucose metabolism's impact on retinal structure.

Methods

The study employed a cross-sectional design encompassing a 4-year period from 2020 to 2024. Fundus photographs from 320 individuals (2020-2024) were categorized into non-diabetes, pre-diabetes, type 2 diabetes mellitus (T2DM) without DR, and T2DM with mild-to-moderate non-proliferative DR (NPDR) groups. An artificial intelligence (AI)-based automatic measurement system was used to quantify retinal blood vessels in the fundus color photographic images, enabling inter-group parameter comparison and analysis of significant differences.

Results

Between January 2020 and June 2024, fundus color photographs were collected from 320 individuals and categorized into four groups: non-diabetes (n = 54), pre-diabetes (n = 71), T2DM without overt DR (n = 144), and T2DM with mild-to-moderate NPDR (n = 51). In pairwise comparisons among individuals with pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly different (P < 0.05). Within the T2DM population, FBG, HbA1c, age, SBP, and DBP were significant predictors for mild-to-moderate NPDR (P < 0.05). Average venous branching number (branch_avg_v) was significantly different among pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR groups. In patients with T2DM with mild-to-moderate NPDR, Average length of arteries (length_avg_a) and average length of veins (length_avg_v) increased, whereas branch_avg_v, average venous branching angle (angle_avg_v), average venous branching asymmetry (asymmetry_avg_v),overall length density (vessel_length_density), and vessel area density (vessel_density) decreased significantly (P < 0.05). Logistic regression analysis identified length_avg_a, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density as independent predictors of mild-to-moderate NPDR in patients with T2DM. Receiver Operating Characteristic (ROC) curve analysis demonstrated that length_avg_a, length_avg_v, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density had diagnostic value for mild-to-moderate NPDR (P < 0.05).

Conclusion

In individuals diagnosed with T2DM, specific retinal vascular parameters, such as branch_avg_v and vessel_density, demonstrate a significant correlation with mild-to-moderate NPDR. These parameters hold promise as preclinical biomarkers for detecting vascular abnormalities associated with DR.

Endothelial Markers in Type 2 Diabetic Patients with Acute Decompensated Heart Failure: A Pilot Study

BACKGROUND

Impaired endothelial function has been associated with vascular complications in type 2 diabetes (T2D), but its role in T2D-related heart failure (HF) remains indeterminate. The aim of this study was to assess selected markers of endothelial function in T2D patients with acute decompensated HF.

METHODS

A pilot prospective study on patients with acute decompensated HF requiring in-hospital admission was carried out. The vascular endothelial growth factor (VEGF), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) were assessed at admission and after decongestion. Subsequently, differences in these markers between T2D and non-diabetic (ND) patients were studied.

RESULTS

In total, 39 patients (21 with T2D and 18 ND patients) were enrolled. Twenty-eight patients presented with preserved ejection fraction (EF), and 11 presented with reduced EF. Looking at the VEGF levels in T2D patients, on admission, a median of 233.0 pg/mL (1.7-598 pg/mL) was found compared to 106.0 pg/mL (1.7-888 pg/mL) in ND individuals; the differences reached statistical significance (p = 0.04). There were no significant differences in VEGF levels after decongestion, and in VCAM-1 (2237 ± 1195 vs. 2699 ± 1093 ng/mL, p = 0.37) and ICAM-1 (596 ± 268 vs. 638 ± 437 ng/mL, p = 0.79) levels between T2D and ND patients upon admission and after decongestion. The value of EF (preserved or reduced) affected the VEGF levels upon admission.

CONCLUSIONS

This study identified significantly higher VEGF levels upon admission due to acute decompensated HF in T2D patients.

Capsiate Improves Glucose Metabolism by Improving Insulin Sensitivity in Diabetic Retinopathy Mice

PURPOSE

Capsiate (cap) is a metabolite that affects a number of biological processes, and diabetic retinopathy (DR) is now known to be the primary cause of end-stage eye illness.

METHODS

In order to examine the effects of the cap intervention on body weight, nutritional intake, changes in body weight composition, glucose metabolism levels, retinopathy, and oxidative stress levels, we proposed using a mouse model of diabetic retinopathy caused by STZ.

RESULTS

Our findings demonstrated that, in addition to increasing lean body mass and lowering fat body mass content, cap intervention significantly improved body weight and dietary consumption in STZ mice. Additionally, our results on glucose metabolism revealed that cap had a significant impact on insulin resistance and the stabilization of OGTT levels. In conclusion, we examined the levels of oxidative stress and retinopathy. We discovered that the cap intervention greatly reduced the levels of MDA and significantly improved the levels of VEGF and retinopathy. In contrast, the STZ group's levels of SOD, CAT, and GSH were significantly higher.

CONCLUSIONS

According to our research, the Cap intervention improved the damage caused by diabetic retinopathy by reversing the levels of oxidative stress and the disrupted state of glucose metabolism, which in turn decreased the levels of VEGF.

Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China

BACKGROUND

Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk.

METHODS

Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011-2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011-2015) and new stroke incidence (2015-2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings.

RESULTS

In the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09-1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05-2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01-1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21-2.24) in T2 and 1.54 (95% CI: 1.08-2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups.

CONCLUSIONS

Elevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies.

Characterization of diabetic kidney disease in 235 patients: clinical and pathological insights with or without concurrent non-diabetic kidney disease

BACKGROUND

This study aimed to explore the clinical and pathological features of patients with diabetic kidney disease (DKD), with and without non-diabetic kidney disease (NDKD), through a retrospective analysis. The objective was to provide clinical insights for accurate identification.

METHODS

A retrospective analysis of 235 patients admitted to the Department of Nephrology at Hangzhou Hospital of Traditional Chinese Medicine was conducted between July 2014 and December 2022. These patients underwent renal biopsy and received a pathology-based diagnosis of DKD. They were categorized into the DKD alone group (93 cases) and the DKD + NDKD group (142 cases).

RESULTS

In the DKD alone group, gender distribution was even, with ages mainly between 50 and 59 years, and a disease duration of less than 5 years, primarily presenting nodular diabetic glomerulosclerosis. In contrast, the DKD + NDKD group had a higher male incidence, a wider age range, longer disease duration, and prevalent diffuse diabetic glomerulosclerosis. Acute and chronic tubulointerstitial lesions and IgA nephropathy were the predominant types of combined NDKD, accounting for 40.14% and 35.21%, respectively. Clinical correlation analysis revealed associations between glomerular grading, tubulointerstitial lesions, renal arteriolar vitelliform lesions, renal vascular atherosclerosis, and clinical parameters such as 24-hour urine protein, hemoglobin, and urinary specific gravity. Multifactorial logistic regression analysis identified independent factors affecting DKD + NDKD, including body mass index, blood creatinine level, microscopic erythrocyte grade, urinary immunoglobulin G/creatinine ratio, and serum immunoglobulin A.

CONCLUSION

The research underscores distinctions in age, gender distribution, disease duration, and renal pathology between DKD alone and DKD + NDKD groups. Additionally, significant discriminative factors including BMI, blood creatinine level, microscopic erythrocyte grade, UIgG/urine creatinine ratio, and serum IgA levels help differentiate DKD from NDKD, thereby enabling personalized treatment approaches. Furthermore, the study highlights the role of RASi as the most commonly used drug in the treatment of both DKD and NDKD, with emerging drugs such as SGLT2 inhibitors showing promising renal protective effects.

Mediation of endothelial activation and stress index in the association between vitamin B6 turnover rate and diabetic retinopathy: an analysis of the National Health and Nutrition Examination Survey

Aim

This study aimed to explore the association between the ratio of 4-pyridoxine (4-PA) to pyridoxal 5'-phosphate (PLP) (4-PA/PLP) and diabetic retinopathy (DR) and further assess the mediating effect of Endothelial Activation and Stress Index (EASIX) on the association between 4-PA/PLP and DR.

Methods

In this cross-sectional study, 1,698 patients with diabetes from the National Health and Nutrition Examination Survey were included. According to the median, 4-PA/PLP was categorized into a high-level group (≥0.89) and a low-level group (<0.89). As the EASIX had a skewed distribution, it was log-transformed before analysis. Weighted logistic regression models were used to investigate the association of 4-PA/PLP with EASIX and DR and the mediating effect of EASIX on the association between 4-PA/PLP and DR. The distribution-of-product method was adopted to assess the mediating effect. Subgroup analysis was performed based on the age and duration of diabetes.

Results

A total of 362 diabetic patients were classified as having DR. After adjusting for all covariates, a higher level of 4-PA/PLP was associated with an increased level of log EASIX [odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.06-2.30]. A higher ratio of 4-PA/PLP was associated with increased odds of DR compared to the reference group with lower levels of 4-PA/PLP (OR = 1.94, 95%CI: 1.40-2.67). In addition, we found that log EASIX may play a mediating role in the 4-PA/PLP and DR, with a 95% CI of distribution of product of 0.31 (95% CI: 0.02-0.67). The proportion of mediation was 69.06%. The mediating effect of log EASIX was also observed in individuals with diabetes who were aged≥60 years (proportion of mediation: 50.63%) or had a duration of diabetes ≥10 years (proportion of mediation: 71.83%).

Conclusion

This study found a positive association between high levels of 4-PA/PLP and an increased risk of DR, with the relationship being partially mediated by log EASIX.

Vulnerable parafoveal microcirculation quadrant in patients with type 2 diabetes mellitus

Diabetic retinopathy (DR) is a leading cause of vision loss among adults. This study evaluates Optical Coherence Tomography Angiography (OCTA) vessel density (VD) as a marker for DR in diabetes mellitus (DM) patients. An observational study was conducted with 47 type 2 DM patients and 21 healthy controls. OCTA measured superficial and deep retinal VD in the parafoveal region. Statistical analyses, including logistic regression and ROC curve analysis, were used to assess the association between VD and DR presence. Results showed that DM patients had lower parafoveal superficial (46.73 vs. 52.37%, p = 0.002) and deep VD (50.35 vs. 54.26%, p = 0.019) compared to controls. Within the DM group, DR patients had lower VD in the superior parafoveal superficial layer (p = 0.042) and temporal parafoveal deep layer (p = 0.035). ROC analysis identified a cutoff of 51.86% for the temporal deep parafoveal VD, with an AUC of 0.697 (p = 0.035) and 81.8% sensitivity for DR discrimination. Reduced VD in the temporal deep parafoveal region is linked to a higher DR likelihood. OCTA-derived VD metrics offer promise for early DR detection and underscore the importance of monitoring vascular changes in DM patients.

Interactive effect of phenylalanine with duration of diabetes on the risk of small vessel disease in Chinese patients with T2DM

Aims

Few prior studies have explored the relationship between phenylalanine and diabetic small vessel disease (SVD) in patients with different durations of type 2 diabetes mellitus(T2DM). Our study aimed to explore whether phenylalanine is associated with the risk of SVD and to further explore whether phenylalanine interacted with the duration of T2DM to alter the risk of SVD.

Materials and methods

A total of 1,032 T2DM patients were enrolled using the Liaoning Medical University First Affiliated Hospital (LMUFAH) system. SVD was defined as patients with diabetic nephropathy (DN) or diabetic retinopathy (DR) alone, or both. Serum amino acids were measured by mass spectrometry (MS) technology. A binary logistic regression model was used to examine associations of phenylalanine with SVD risk. Restricted cubic spline (RCS) regression was used to draw the odds ratio curves of plasma phenylalanine for SVD. Additive interaction analysis was employed to test the interaction of low phenylalanine with a long duration of T2DM for SVD.

Results

Among the 1,032 T2DM patients, 286 (27.7%) had SVD. Phenylalanine <42μmol/L was associated with a markedly increased risk of SVD (OR 1.76, 95%CI 1.23 to 2.51), which was enhanced by a duration of T2DM of ≥5 years to 4.83 (95%CI 2.97-7.87) with significant additive interactions. The inclusion of phenylalanine and duration of T2DM into a traditional risk factor model substantially increased the area under the receiver operating characteristic curve from 0.67 to 0.71 (95% CI 0.70 to 0.75) (P <0.05).

Conclusions

In Chinese patients with T2DM, phenylalanine <42μmol/L was associated with an increased risk of SVD, which was further amplified by a duration of T2DM of ≥5 years.

Prevalence of cognitive impairment and its associated factors in type 2 diabetes mellitus patients with hypertension in Hunan, China: a cross-sectional study

Background

Individuals with both type 2 diabetes mellitus (T2DM) and hypertension have an increased risk of cognitive impairment (CI) compared to those with either T2DM or hypertension. Therefore, this study aims to identify the prevalence of CI and its associated factors in T2DM patients with hypertension in Hunan, China.

Methods

This cross-sectional study included T2DM patients with hypertension admitted to the Department of Endocrinology of Yuanjiang People's Hospital in Hunan Province from July 2022 to February 2023. Data on sociodemographic, lifestyle, disease-related characteristics, and cognitive function were collected through face-to-face interviews. Cognitive function was assessed using the Mini-Mental State Examination. Backward stepwise multivariable logistic regression analysis was used to identify factors associated with CI. The predictive power was examined using the receiver operating characteristic (ROC) curve.

Results

A total of 475 participants were included. The prevalence of CI was 38.9% (95% confidence interval [95% CI]: 34.5%-43.3%). Multivariable logistic regression analysis showed that advanced age (odds ratio [OR]=3.21, 95% CI: 1.74-5.93), elementary school or below (OR=3.51, 95% CI: 1.19-10.31), per capita monthly household income ≤2000 RMB (OR=5.29, 95% CI: 2.66-10.51), not current reading books or newspapers (OR=4.48, 95% CI: 1.26-15.99), not current playing cards or mahjong (OR=3.52, 95% CI: 1.91-6.47), current average time of physical activity ≤30 minutes per day (OR=8.66, 95% CI: 4.65-16.12), diabetic nephropathy (OR=1.95, 95% CI: 1.05-3.61) and stroke (OR=7.41, 95% CI: 3.41-16.11) were associated with a higher risk of CI in T2DM patients with hypertension. The area under the ROC curve of this model was 0.925 (95% CI: 0.902-0.949).

Conclusions

The prevalence of CI was high in T2DM patients with hypertension in Hunan, China. Age, educational level, household income, current reading books or newspapers status, current playing cards or mahjong status, current average time of physical activity per day, diabetic nephropathy, and stroke were associated with CI in T2DM patients with hypertension.

Multi-omics in exploring the pathophysiology of diabetic retinopathy

Diabetic retinopathy (DR) is a leading global cause of vision impairment, with its prevalence increasing alongside the rising rates of diabetes mellitus (DM). Despite the retina's complex structure, the underlying pathology of DR remains incompletely understood. Single-cell RNA sequencing (scRNA-seq) and recent advancements in multi-omics analyses have revolutionized molecular profiling, enabling high-throughput analysis and comprehensive characterization of complex biological systems. This review highlights the significant contributions of scRNA-seq, in conjunction with other multi-omics technologies, to DR research. Integrated scRNA-seq and transcriptomic analyses have revealed novel insights into DR pathogenesis, including alternative transcription start site events, fluctuations in cell populations, altered gene expression profiles, and critical signaling pathways within retinal cells. Furthermore, by integrating scRNA-seq with genetic association studies and multi-omics analyses, researchers have identified novel biomarkers, susceptibility genes, and potential therapeutic targets for DR, emphasizing the importance of specific retinal cell types in disease progression. The integration of scRNA-seq with metabolomics has also been instrumental in identifying specific metabolites and dysregulated pathways associated with DR. It is highly conceivable that the continued synergy between scRNA-seq and other multi-omics approaches will accelerate the discovery of underlying mechanisms and the development of novel therapeutic interventions for DR.

Logic-Based Modeling of Inflammatory Macrophage Crosstalk with Glomerular Endothelial Cells in Diabetic Kidney Disease

Diabetic kidney disease is a complication in one out of three patients with diabetes. Aberrant glucose metabolism in diabetes leads to structural and functional damage in glomerular tissue and a systemic inflammatory immune response. Complex cellular signaling is at the core of metabolic and functional derangement. Unfortunately, the mechanism underlying the role of inflammation in glomerular endothelial cell dysfunction during diabetic kidney disease is not fully understood. Mathematical models in systems biology allow the integration of experimental evidence and cellular signaling networks to understand mechanisms involved in disease progression. This study developed a logic-based ordinary differential equations model to study inflammatory crosstalk between macrophages and glomerular endothelial cells during diabetic kidney disease progression using a protein signaling network stimulated with glucose and lipopolysaccharide. This modeling approach reduced the biological parameters needed to study signaling networks. The model was fitted to and validated against available biochemical data from \textit{in vitro} experiments. The model identified mechanisms for dysregulated signaling in macrophages and glomerular endothelial cells during diabetic kidney disease. In addition, the influence of signaling interactions on glomerular endothelial cell morphology through selective knockdown and downregulation was investigated. Simulation results showed that partial knockdown of VEGF receptor 1, PLC-γ, adherens junction proteins, and calcium partially recovered the intercellular gap width between glomerular endothelial cells. These findings contribute to understanding signaling and molecular perturbations that affect the glomerular endothelial cells in the early stage of diabetic kidney disease.

Scoring and validation of a simple model for predicting diabetic retinopathy in patients with type 2 diabetes based on a meta-analysis approach of 21 cohorts

AIM

To develop and validate a model for predicting diabetic retinopathy (DR) in patients with type 2 diabetes.

METHODS

All risk factors with statistical significance in the DR prediction model were scored by their weights. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve, Kaplan-Meier curve, calibration curve and decision curve analysis. The prediction model was externally validated using a validation cohort from a Chinese hospital.

RESULTS

In this meta-analysis, 21 cohorts involving 184,737 patients with type 2 diabetes were examined. Sex, smoking, diabetes mellitus (DM) duration, albuminuria, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and TG were identified to be statistically significant. Thus, they were all included in the model and scored according to their weights (maximum score: 35.0). The model was validated using an external cohort with median follow-up time of 32 months. At a critical value of 16.0, the AUC value, sensitivity and specificity of the validation cohort are 0.772 ((95% confidence interval (95%CI): 0.740-0.803), p < .01), 0.715 and 0.775, respectively. The calibration curve lied close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated that the model had notably higher net benefits. The external validation results proved the reliability of the risk prediction model.

CONCLUSIONS

The simple DR prediction model developed has good overall calibration and discrimination performance. It can be used as a simple tool to detect patients at high risk of DR.

Impact of fluorosis on molecular predictors in pathogenesis of type 2 diabetes associated microvascular complications

AIM

This review presents specific insights on the molecular underpinnings of the connection between fluorosis, type 2 diabetes, and microvascular complications, along with the novel biomarkers that are available for early detection.

SUMMARY

Fluoride is an essential trace element for the mineralization of teeth and bones in humans. Exposure to higher concentrations of fluoride has harmful effects that significantly outweigh its advantageous ones. Dental fluorosis and skeletal fluorosis are the common side effects of exposure to fluoride, which affect millions of individuals globally. Alongside, it also causes non-skeletal fluorosis, which affects the population suffering from non-communicable diseases like diabetes by impacting the soft tissues and causing diabetic microvascular complications. Previous studies reported the prevalence range of these diabetic complications of neuropathy (3-65 %), nephropathy (1-63 %), and retinopathy (2-33 %). Fluoride contributes to the development of these complications by causing oxidative stress, cellular damage, degrading the functioning capability of mitochondria, and thickening the retinal vein basement.

CONCLUSION

Early diagnosis is a prompt way of prevention, and for that, biomarkers have emerged as an innovative and useful technique. This allows healthcare practitioners and policymakers in endemic areas to comprehend the molecular complexities involved in the advancement of diabetic microvascular problems in the context of high fluoride exposure.

Cardiovascular health metrics and diabetic nephropathy: a nationally representative cross-sectional study

BACKGROUND

The pathogenesis of diabetic nephropathy is well-documented to be multifactorial. However, research available on the association between cardiovascular health and diabetic nephropathy is limited. Thus, this study aimed to investigate these potential associations and provide guidance for disease prevention.

METHODS

We applied Life's Essential 8 (LE8) identified by the American Heart Association, which integrates multiple health behaviors and health factors to measure cardiovascular health. This study covered 4207 adults with diabetes from the National Health and Nutrition Examination Survey spanning 2007-2018. Weighted regression models assessed the estimated effect of LE8 score on the prevalence of diabetic nephropathy as well as their corresponding clinical indicators. Weighted restricted cubic spline models discussed the possible nonlinear dose-response relationships further. Subgroup analyses clarified the effects of other covariates on correlations.

RESULTS

After adjusting for all covariates, participants with moderate or high cardiovascular health showed a decreased prevalence of diabetic nephropathy (odds ratio [OR]:0.52; 95% confidence interval [CI]:0.42-0.63), and also a decrease in the urinary albumin-to-creatinine ratio [UACR] (β: - 0.83; 95% CI:- 1.00 to - 0.65). The prevalence of diabetic nephropathy and the level of UACR tended to decrease linearly as the total LE8 score increased (P for nonlinear > 0.05). Subgroup analyses showed that the effects of increased overall LE8 score and the specific cardiovascular health construct varied across age and obesity strata.

CONCLUSION

Elevated overall LE8 score was significantly associated with a lower prevalence of diabetic nephropathy in U.S. adults, and the effects of the specific cardiovascular health construct on diabetic nephropathy and their corresponding clinical indicators varied. In all, maintaining good cardiovascular health by refining LE8 metrics may help reduce the adverse effects.

A semantic segmentation method to analyze retinal vascular parameters of diabetic nephropathy

Introduction

By using spectral domain optical coherence tomography (SD-OCT) to measure retinal blood vessels. The correlation between the changes of retinal vascular structure and the degree of diabetic nephropathy is analyzed with a full-pixel Semantic segmentation method.

Methods

A total of 120 patients with diabetic nephropathy who were treated in the nephrology department of Quzhou People's Hospital from March 2023 to March 2024 were selected and divided into three groups according to the urinary albumin creatinine ratio (UACR). The groups included simple diabetes group (UACR < 30 mg/g), microalbuminuria group (30 mg/g ≤ UACR <300 mg/g) and macroalbuminuria group (UACR ≥300 mg/g). SD-OCT was used to scan the arteries and veins in the superior temporal area B of the retina. The semantic segmentation method built into the SD-eye software was used to automatically identify the morphology and structure of the vessels and calculate the parameters of arteriovenous vessels. The parameters of arteriovenous vessels are as follows: outer diameter of the retinal artery (RAOD); inner diameter of the retinal artery (RALD); arterial wall thickness (AWT); arterial wall to lumen ratio (AWLR); cross sectional area of arterial wall (AWCSA); retinal vein outer diameter (RVOD); retinal vein inner diameter (RVLD); vein wall thickness (VWT); vein wall to lumen ratio (VWLR); cross sectional area of vein wall (VWCSA). Statistical analysis software was used to compare and analyze the parameters of retinal arteriovenous vessels of the three groups.

Results

The study revealed statistically significant differences in RAOD and RALD among the three groups (p < 0.05) with the RAOD and RALD of the macroalbuminuria group and microalbuminuria group being lower than those of the simple diabetes group. Conversely, there were no significant differences in AWT, AWLR and AWCSA among the three groups (p > 0.05). Additionally, the differences in RVOD and RVLD among the three groups were found to be statistically significant (p < 0.05) with the RVOD and RVLD of the simple diabetes group being lower than those of the microalbuminuria group and macroalbuminuria group. No significant differences were observed in VWT and VWL among the groups. Additionally, RVOD and RVLD were weakly associated with UACR (R = 0.247, p = 0.007; R = 0.210, p = 0.021). Full-pixel semantic segmentation method combined with OCT images is a new retinal vascular scanning technology, which can be used as a new method for early diagnosis of diabetic nephropathy. The structural changes of retinal vessels can be used to predict the severity of diabetic nephropathy during the development of diabetic nephropathy.

Inhibition of viability of human retinal microvascular endothelial cells by vialinin A under high glucose condition

AIM

To investigate the effects of vialinin A on viability of human retinal endothelial cells (HRECs) under high glucose condition and its potential mechanism.

METHODS

The HRECs were divided into four groups: normal glucose control group (NG, 5 mmol/L D-glucose), high glucose group (HG, 30 mmol/L D-glucose), HG+1 µmol/L vialinin A group, and HG+5 µmol/L vialinin A group. The cell viabilities were measured with cell counting kit-8 (CCK-8) assay for proliferation, with scratch assay for migration, and tube formation, for evaluation of the impact of vialinin A on cellular behaviour. Real-time PCR and Western blotting were used to determine the expression level of vascular endothelial growth factor (VEGF).

RESULTS

The proliferative capacity and migration of HRECs was reduced by 5 µmol/L vialinin A in high glucose environment (both P<0.05). Vialinin A also inhibited high-glucose-induced tube formation of HRECs. The expression level of VEGF and PI3K in HRECs was also significantly decreased by vialinin A (P<0.05).

CONCLUSION

Vialinin A inhibits the cell viability of HRECs. It may serve as a potential target for anti-angiogenic therapy.

Early Diagnosis and Treatment of Kidney Injury: A Focus on Urine Protein

The kidney, an essential excretory organ of the body, performs a series of crucial physiological functions such as waste removal, maintenance of electrolyte and acid-base balance, and endocrine regulation. Due to its rich blood flow and high metabolic activity, the kidney is susceptible to damage. Currently, kidney injury is classified into acute kidney injury (AKI) and chronic kidney disease (CKD), both of which are associated with high rates of morbidity and mortality on a global scale. The current clinical diagnosis of renal injury relies on the assessment of renal filtration function using creatinine and urea nitrogen as "gold-standard" markers. However, the delayed response time, limited specificity, and reduced accuracy of creatinine and urea nitrogen in evaluating kidney injury have significantly hindered advancements in diagnostic methods for kidney injury. Urinary protein is widely utilized as a biomarker for the early diagnosis of kidney injury due to the selectivity of the glomerular filtration system determining whether proteins can pass through the filtration barrier based on their size and charge. Therefore, as a complex biological sample with varying charges and particle sizes, urinary protein is considered an ideal indicator for monitoring the progression of kidney disease. Exploring the relationship between urinary protein and the advancement of kidney injury based on differences in particle size and charge offers a new perspective for assessing and treating such injuries. Hence, we conducted a comprehensive review of 74 relevant studies to gain a thorough understanding of the physiological mechanism and significance of proteinuria production. The aim was to explore the challenges and opportunities in clinical urine protein detection, as well as to discuss strategies targeting glomerular filtration barriers in order to effectively reduce urine protein levels and treat kidney injury, which could provide a new perspective for identifying the progression of kidney injury.

The emerging modulators of non-coding RNAs in diabetic wound healing

Diabetic wound healing is a complex physiological process often hindered by the underlying metabolic dysfunctions associated with diabetes. Despite existing treatments, there remains a critical need to explore innovative therapeutic strategies to improve patient outcomes. This article comprehensively examines the roles of non-coding RNAs (ncRNAs), specifically microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), in regulating key phases of the wound healing process: inflammation, angiogenesis, re-epithelialization, and tissue remodeling. Through a deep review of current literature, we discuss recent discoveries of ncRNAs that have been shown to either promote or impair the wound healing process in diabetic wound healing, which were not covered in earlier reviews. This review highlights the specific mechanisms by which these ncRNAs impact cellular behaviors and pathways critical to each healing stage. Our findings indicate that understanding these recently identified ncRNAs provides new insights into their potential roles in diabetic wound healing, thereby contributing valuable knowledge for future research directions in this field.

Exploring potential targets for natural product therapy of DN: the role of SUMOylation

Diabetic nephropathy (DN) is a common and serious micro-vascular complication of diabetes and a leading cause of end-stage renal disease globally. This disease primarily affects middle-aged and elderly individuals, especially those with a diabetes history of over 10 years and poor long-term blood glucose control. Small ubiquitin-related modifiers (SUMOs) are a group of reversible post-translational modifications of proteins that are widely expressed in eukaryotes. SUMO proteins intervene in the progression of DN by modulating various signaling cascades, such as Nrf2-mediated oxidative stress, NF-κB, TGF-β, and MAPK pathways. Recent advancements indicate that natural products regulating SUMOylation hold promise as targets for intervening in DN. In a previous article published in 2022, we reviewed the mechanisms by which SUMOylation intervenes in renal fibrosis and presented a summary of some natural products with therapeutic potential. Therefore, this paper will focus on DN. The aim of this review is to elucidate the mechanism of action of SUMOylation in DN and related natural products with therapeutic potential, thereby summarising the targets and candidate natural products for the treatment of DN through the modulation of SUMOylation, such as ginkgolic acid, ginkgolide B, resveratrol, astragaloside IV, etc., and highlighting that natural product-mediated modulation of SUMOylation is a potential therapeutic strategy for the treatment of DN as a potential therapeutic strategy.

Early use of SGLT2 inhibitors reduces the progression of diabetic kidney disease: a retrospective cohort study

OBJECTIVE

To evaluate the potential of sodium-glucose cotransporter 2 (SGLT2) inhibitors in preventing the progression of diabetic kidney disease and to provide guidance for clinical practice to improve renal health management strategies for diabetic patients.

METHODS

A retrospective analysis was conducted on 178 patients with diabetic kidney disease admitted to Baoji High Tech Hospital from March 2023 to March 2024. Of these, 88 patients who received early treatment with the SGLT2 inhibitor dapagliflozin were included in the early SGLT2-i group, while 90 patients receiving later treatment with SGLT2 inhibitor dapagliflozin were included in the late SGLT2-i group. Clinical data, overall effectiveness, adverse reactions, blood glucose, renal function, lipid levels, and inflammatory markers were compared between the two groups.

RESULTS

Prior to treatment, there were no differences in blood glucose indicators between the two groups (all P > 0.05). Following treatment, both groups showed reductions in 2-hour postprandial blood glucose (2hPG), fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA1c), with the early SGLT2-i group demonstrating significantly lower values compared to the late SGLT2-i group (all P < 0.05). Similarly, there were no differences in renal function indicators between the two groups before treatment (all P > 0.05). However, following treatment, the early SGLT2-i group showed more noticeable improvements compared to the late SGLT2-i group (P < 0.05). Inflammatory markers and lipid levels followed similar patterns. The overall effectiveness of the early SGLT2-i group was higher than that of the late SGLT2-i group (92.05% vs. 78.89%, P < 0.05), while the incidence of adverse reactions did not differ statistically between the two groups (6.82% vs. 10.00%, P > 0.05).

CONCLUSION

Early use of SGLT2 inhibitors in diabetic kidney disease patients effectively controls blood glucose and lipid levels, improves renal function, reduces inflammatory responses, and exhibits a low incidence of adverse reactions. This demonstrates high safety and an important role in delaying disease progression. Therefore, it is worth considering clinical promotion and use for this patient population.

Causal role of immune cells in diabetic nephropathy: a bidirectional Mendelian randomization study

Background

Diabetic nephropathy (DN) stands as a pervasive chronic renal disease worldwide, emerging as the leading cause of renal failure in end-stage renal disease. Our objective is to pinpoint potential immune biomarkers and evaluate the causal effects of prospective therapeutic targets in the context of DN.

Methods

We employed Mendelian randomization (MR) analysis to examine the causal associations between 731 immune cell signatures and the risk of DN. Various analytical methods, including inverse-variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode, were employed for the analysis. The primary analytical approach utilized was the inverse-variance weighted (IVW) method. To ensure the reliability of our findings, we conducted comprehensive sensitivity analyses to assess the robustness, heterogeneity, and presence of horizontal pleiotropy in the results. Statistical powers were also calculated. Ultimately, a reverse Mendelian randomization (MR) analysis was conducted to assess the potential for reverse causation.

Results

After Benjamini & Hochberg (BH) correction, four immunophenotypes were identified to be significantly associated with DN risk: HLA DR on Dendritic Cell (OR=1.4460, 95% CI = 1.2904~1.6205, P=2.18×10-10, P.adjusted= 1.6×10-7), HLA DR on CD14+ CD16- monocyte (OR=1.2396, 95% CI=1.1315~1.3580, P=3.93×10-6, P.adjusted = 0.00143). HLA DR on CD14+ monocyte (OR=1.2411, 95% CI=1.12957~1.3637, P=6.97×10-6, P.adjusted=0.0016), HLA DR on plasmacytoid Dendritic Cell (OR=1.2733, 95% CI= 1.1273~1.4382, P= 0.0001, P.adjusted = 0.0183). Significant heterogeneity of instrumental variables was found in the four exposures, and significant horizontal pleiotropy was only found in HLA DR on Dendritic Cell. The bidirectional effects between the immune cells and DN were not supported.

Conclusion

Our research illustrated the intimate association between immune cells and DN, which may contribute to a deeper understanding of the intricate mechanisms underlying DN and aid in the identification of novel intervention target pathways.

Circular RNA HMGCS1 sponges MIR4521 to aggravate type 2 diabetes-induced vascular endothelial dysfunction

Noncoding RNA plays a pivotal role as novel regulators of endothelial cell function. Type 2 diabetes, acknowledged as a primary contributor to cardiovascular diseases, plays a vital role in vascular endothelial cell dysfunction due to induced abnormalities of glucolipid metabolism and oxidative stress. In this study, aberrant expression levels of circHMGCS1 and MIR4521 were observed in diabetes-induced human umbilical vein endothelial cell dysfunction. Persistent inhibition of MIR4521 accelerated development and exacerbated vascular endothelial dysfunction in diabetic mice. Mechanistically, circHMGCS1 upregulated arginase 1 by sponging MIR4521, leading to decrease in vascular nitric oxide secretion and inhibition of endothelial nitric oxide synthase activity, and an increase in the expression of adhesion molecules and generation of cellular reactive oxygen species, reduced vasodilation and accelerated the impairment of vascular endothelial function. Collectively, these findings illuminate the physiological role and interacting mechanisms of circHMGCS1 and MIR4521 in diabetes-induced cardiovascular diseases, suggesting that modulating the expression of circHMGCS1 and MIR4521 could serve as a potential strategy to prevent diabetes-associated cardiovascular diseases. Furthermore, our findings provide a novel technical avenue for unraveling ncRNAs regulatory roles of ncRNAs in diabetes and its associated complications.

Comparison of Machine Learning Algorithms and Nomogram Construction for Diabetic Retinopathy Prediction in Type 2 Diabetes Mellitus Patients

INTRODUCTION

The aim of this study was to compare various machine learning algorithms for constructing a diabetic retinopathy (DR) prediction model among type 2 diabetes mellitus (DM) patients and to develop a nomogram based on the best model.

METHODS

This cross-sectional study included DM patients receiving routine DR screening. Patients were randomly divided into training (244) and validation (105) sets. Least absolute shrinkage and selection operator regression was used for the selection of clinical characteristics. Six machine learning algorithms were compared: decision tree (DT), k-nearest neighbours (KNN), logistic regression model (LM), random forest (RF), support vector machine (SVM), and XGBoost (XGB). Model performance was assessed via receiver-operating characteristic (ROC), calibration, and decision curve analyses (DCAs). A nomogram was then developed on the basis of the best model.

RESULTS

Compared with the five other machine learning algorithms (DT, KNN, RF, SVM, and XGB), the LM demonstrated the highest area under the ROC curve (AUC, 0.894) and recall (0.92) in the validation set. Additionally, the calibration curves and DCA results were relatively favourable. Disease duration, DPN, insulin dosage, urinary protein, and ALB were included in the LM. The nomogram exhibited robust discrimination (AUC: 0.856 in the training set and 0.868 in the validation set), calibration, and clinical applicability across the two datasets after 1,000 bootstraps.

CONCLUSION

Among the six different machine learning algorithms, the LM algorithm demonstrated the best performance. A logistic regression-based nomogram for predicting DR in type 2 DM patients was established. This nomogram may serve as a valuable tool for DR detection, facilitating timely treatment.