1
|
Dobrijević Z, Stevanović J, Robajac D, Penezić A, Četić D, Baralić M, Nedić O. Association between nitric oxide synthase (NOS3) gene polymorphisms and diabetic nephropathy: An updated meta-analysis. Mol Cell Endocrinol 2024; 586:112197. [PMID: 38462124 DOI: 10.1016/j.mce.2024.112197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Polymorphisms located within NOS3 gene have been investigated as susceptibility variants for diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) in a large number of studies. However, these previous articles yielded inconsistent results and we aimed at elucidating the impact of NOS3 variants on DN risk in T2DM by conducting an updated systematic data synthesis. A total of 36 studies (12,807 participants) were selected for qualitative data synthesis, while 33 records with 11,649 subjects were included in the meta-analysis. The pooled analysis demonstrated the association of minor alleles of rs2070744 and rs1799983 with an increased susceptibility to DN (P < 0.001 and P = 0.015 for allelic model, respectively). For both of these variants, a significant effect of subgrouping according to ethnicity was found. Rs869109213 displayed an association with DN susceptibility, with pooled effect measures indicating a predisposing effect of the minor allele a (Prec = 0.002, ORrec = 1.960, 95%CI 1.288-2.983; Paavs. bb = 0.001, ORaavs. bb = 2.014, 95%CI 1.316-3.083). These findings support the effects of NOS3 variants on the risk of developing DN in T2DM.
Collapse
Affiliation(s)
- Zorana Dobrijević
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia.
| | - Jovana Stevanović
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia
| | - Dragana Robajac
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia
| | - Ana Penezić
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia
| | - Danilo Četić
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia
| | - Marko Baralić
- University of Belgrade - School of Medicine, Belgrade, Serbia; Department of Nephrology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Olgica Nedić
- University of Belgrade - Institute for the Application of Nuclear Energy, Belgrade, Serbia
| |
Collapse
|
2
|
Fu H, Guo C, Zhang J, Xu L, Jiang S, Guo S, Sheng Q, Zhao J, Liao L. Associations between the polymorphisms of main components in PI3K/Akt pathway and risk of diabetic kidney disease: A meta-analysis. IUBMB Life 2023; 75:624-642. [PMID: 36856001 DOI: 10.1002/iub.2711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/23/2023] [Indexed: 03/02/2023]
Abstract
AIMS Diabetic kidney disease (DKD) is a severe microvascular complication frequently associated with type 1 and type 2 diabetes mellitus. The objective of this work was to evaluate the relevance of PI3K/Akt pathway polymorphisms and DKD susceptibility by a meta-analysis. METHODS Case-control studies related to the relationship between PI3K/Akt pathway polymorphisms and DKD risk were searched from Pubmed, Embase, Cochrane Library, SINOMED, CNKI, and Wanfang databases. Statistical analysis and heterogeneity test were conducted by Review Manager 5.4. RESULTS Totally, 52 eligible studies were enrolled, including seven single nucleotide polymorphisms (SNPs) for four genes in the PI3K/AKT pathway (GNB3: rs5443; eNOS: rs1799983, rs869109213, rs2070744; IL-6: rs1800795, rs1800796; TNFα: rs1800629). The "M" allele of eNOS rs1799983 was related to the increased risk of DKD under random effects model, especially in Asian population (Overall:M vs. W: I2 = 75%, OR = 1.29, 95%CI 1.07-1.56; MM + WM vs. WW: I2 = 75%, OR = 1.50, 95%CI 1.21-1.86). The "M" allele of eNOS rs869109213 was implicated with higher prevalence of DKD under random effects model, especially in Asian population (Overall:M vs. W: I2 = 63%, OR = 1.43, 95%CI 1.22-1.68; MM + WM vs. WW: I2 = 50%, OR = 1.36, 95%CI 1.16-1.58; MM vs. WM + WW: I2 = 59%, OR = 2.20, 95%CI 1.41-3.43). The "M" allele of eNOS rs2070744 was implicated with higher prevalence of DKD under random effects model, especially in Indian population (Overall: M vs. W: I2 = 47%, OR = 1.35, 95%CI 1.15-1.59; MM + WM vs. WW: I2 = 45%, OR = 1.32, 95%CI 1.07-1.62; MM vs. WM + WW: I2 = 65%, OR = 2.29, 95%CI 1.39-3.77). The "M" allele of IL-6 rs1800796 was predominately associated with higher DKD risks under random effects model, especially in Asian population (Overall: M versus W: I2 = 23%, OR = 1.49, 95%CI 1.21-1.84; MM + WM vs. WW: I2 = 1%, OR = 1.43, 95%CI 1.15-1.77; MM + WM vs. WW: I2 = 71%, OR = 2.77, 95%CI 1.09-7.06). CONCLUSIONS This meta-analysis indicated that polymorphisms in the PI3K/Akt pathway in eNOS rs1799983, rs869109213, rs2070744, and IL-6 rs1800796 were related to the increased risk of DKD.
Collapse
Affiliation(s)
- Hang Fu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Endocrinology and Metabology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Congcong Guo
- Department of Endocrinology and Metabology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jing Zhang
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lusi Xu
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shan Jiang
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Siyi Guo
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiqi Sheng
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Junyu Zhao
- Department of Endocrinology and Metabology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lin Liao
- Department of Endocrinology and Metabology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| |
Collapse
|
3
|
The genetic side of diabetic kidney disease: a review. Int Urol Nephrol 2023; 55:335-343. [PMID: 35974289 DOI: 10.1007/s11255-022-03319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Diabetic kidney disease (DKD) is one of the most common complications of diabetes, with approximately 30-40% of patients with type 1 diabetes mellitus and 20% of patients with type 2 diabetes mellitus eventually developing DKD. If DKD is not controlled in the early clinical stage and proteinuria develops, the disease will progress to end-stage renal disease. The pathogenesis of DKD remains largely unknown and is multifactorial, likely due to interactions between genetic and environmental factors. Familial clustering also supports a critical role of hereditary factors in DKD. The development of gene detection technology has promoted the exploration of DKD susceptibility genes in different cohorts of patients with diabetes. Identifying susceptibility genes can provide insights into the pathogenesis of DKD, as well as a basis for its clinical diagnosis and therapy. RESULTS Numerous candidate gene loci have been found to be associated with DKD, many of which play critical regulatory roles in the pathogenesis of this disease, including genes involved in glycol-metabolism, lipid metabolism, the renin-angiotensin-aldosterone system, inflammation and oxidative stress. In this review, we summarize the functions of several susceptibility genes involved in the development of DKD. CONCLUSION Based on our findings, we recommend that studying susceptibility gene polymorphisms can lead to a better understanding of the pathogenesis of DKD and could help prevent this disease or improve its outcomes.
Collapse
|
4
|
Abu Seman N, Othman SH. Recent Progress in Genetics and Epigenetics Research on Diabetic Nephropathy in Malaysia. J Diabetes Res 2023; 2023:9053580. [PMID: 37187702 PMCID: PMC10181909 DOI: 10.1155/2023/9053580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/15/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Diabetic nephropathy is a multifactorial disease. Gene susceptibility, as well as environmental exposure, plays an important role in disease progression. Malaysia is reported to be among the world's second-fastest-growing rates of kidney failure. Diabetic nephropathy has become the main cause of end-stage renal disease in Malaysia. This article is aimed at reviewing genetic studies conducted among diabetic nephropathy patients in the Malaysian population. This review was conducted by searching PubMed, MEDLINE, and Google Scholar databases to identify all relevant papers published in English from March 2022 to April 2022, using the following keywords: diabetes, type 2 diabetes, diabetic nephropathy, diabetic kidney disease, and Malaysia. The case-control study among diabetic patients with and without diabetic nephropathy showed a significant association with diabetic nephropathy in CNDP1, NOS3, and MnSOD genes. In the ethnic subgroup analysis, significant differences for diabetic nephropathy in terms of diabetes duration (≥10 years) were observed for CCL2 rs3917887, CCR5 rs1799987, ELMO1 rs74130, and IL8 rs4073. The IL8 rs4073 was associated only with the Indians, while the CCR5 rs1799987 was associated with the Chinese. In Malays, SLC12A3 Arg913Gln polymorphism and ICAM1 K469E (A/G) polymorphism were found to be associated with diabetic nephropathy. Studies on gene-environment interactions have suggested significant genetic and environmental factors such as smoking, waist circumference, and sex for eNOS rs2070744, PPARGC1A rs8192678, KCNQ1 rs2237895, and KCNQ1 rs2283228 with kidney disease. The genetic variants' contributions differed across ethnic groups. Therefore, a study to validate the genetic variants that are found to be associated with different ethnicities in Malaysia may be important in future studies.
Collapse
Affiliation(s)
- Norhashimah Abu Seman
- Endocrine and Metabolic Unit, Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Siti Haslina Othman
- Endocrine and Metabolic Unit, Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
5
|
Li H, Shu G, Gao H. Epithelial nitric oxide synthases (eNOS) 894 G < T polymorphism and diabetic nephropathy susceptibility: A meta-analysis. Pteridines 2022. [DOI: 10.1515/pteridines-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
To investigate the epithelial nitric oxide synthases (eNOS) 894 G < T polymorphism and diabetic nephropathy (DN) susceptibility by pooling the open published data.
Methods
Studies relevant to eNOS 894 G < T polymorphism and DN susceptibility published in PubMed, EMBASE, Medline, CNKI, and Wanfang databases were systematically screened by using the text words of endothelial nitric oxide synthase, eNOS, NOS-3, G894T, rs179983, polymorphism, diabetic nephropathy, and DN. The correlation between eNOS 894 G < T polymorphism and DN susceptibility was demonstrated by odds ratio (OR) and corresponding 95% confidence interval (95% CI). The data were combined through fixed or random effect model according to statistical heterogeneity. The publication bias was assessed by Begg’s funnel plot and Egger’s line regression test.
Results
Twenty-six case-control studies relevant to eNOS 894 G < T polymorphism and DN susceptibility were identified by electronic searching of the related databases. Type 2 diabetes mellitus (T2MD) patients with T allele had increased susceptibility to DN compared with G allele under homologous gene model (TT vs GG) (OR = 1.40, 95% CI: 1.16–1.69, p = 0.001), dominant gene model (TT + GT) vs GG (OR = 1.61, 95% CI: 1.30–2.00, p = 0.000) and recessive gene model TT vs (GT + GG) (OR = 1.39, 95% CI: 1.16–1.66, p = 0.000). Publication bias was not statistically significant for homologous and recessive gene model.
Conclusion
Based on the present evidence, DN risk was increased in T2MD cases with T allele compared to G allele.
Collapse
Affiliation(s)
- Hui Li
- Department of Nephrology , The No. 1 People’s Hospital of Pinghu , Pinghu City , Zhejiang Province 314200 , PR China
| | - Guiqin Shu
- Department of General Practice Medicine , The No. 1 People’s Hospital of Pinghu , Pinghu City , Zhejiang Province 314200 , PR China
| | - Huihui Gao
- Department of General Practice Medicine , The No. 1 People’s Hospital of Pinghu , Pinghu City , Zhejiang Province 314200 , PR China
| |
Collapse
|
6
|
Wang D, Liu L, Zhang C, Lu W, Wu F, He X. Evaluation of Association Studies and Meta-Analyses of eNOS Polymorphisms in Type 2 Diabetes Mellitus Risk. Front Genet 2022; 13:887415. [PMID: 35832187 PMCID: PMC9271911 DOI: 10.3389/fgene.2022.887415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Numerous studies reported the associations between endothelial nitric oxide synthase (eNOS) polymorphisms (4b/a VNTR (rs869109213), G894T (rs1799983) and T786C (rs2070744)) and type 2 diabetes mellitus (T2DM) risk. However, the conclusions were incongruent. Moreover, since no published meta-analyses were performed, a key issue regarding false-positive results needs to be addressed. Furthermore, four new articles have been published on these issues. Therefore, an updated meta-analysis was conducted to further explore these associations. Objectives: To investigate the association between eNOS 4b/a, G894T and T786C polymorphisms and T2DM risk. Methods: Studies were searched by using the PubMed, China National Knowledge Infrastructure (CNKI), Medline, Embase, International Statistical Institute (ISI) and the China Wanfang databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the associations using five genetic models. Furthermore, the false-positive report probability (FPRP), Bayesian false discovery probability (BFDP), and the Venice criteria were employed to assess the credibility of statistically significant associations. Results: Overall, the eNOS 4b/a polymorphism was associated with a significantly decreased T2DM risk in Asians (bb vs. aa: OR = 0.44, 95% CI = 0.23–0.84; ab + bb vs. aa: OR = 0.45, 95% CI = 0.24–0.86; bb vs. aa + ab: OR = 0.73, 95% CI = 0.59–0.91; b vs. a: OR = 0.71, 95% CI = 0.57–0.88); the eNOS G894T polymorphism was associated with a significantly increased T2DM risk in Asians (GT vs. GG: OR = 1.52, 95% CI = 1.15–2.01; GT + TT vs. GG: OR = 1.52, 95% CI = 1.15–2.01; T vs. G: OR = 1.39, 95% CI = 1.09–1.76); the eNOS T786C polymorphism was associated with a significantly increased T2DM risk in Indian (TC vs. TT: OR = 1.93, 95% CI = 1.27–2.94; TC + CC vs. TT: OR = 2.06, 95%CI = 1.26–3.36; C vs. T: OR = 1.90, 95%CI = 1.17–3.08). However, when a sensitivity analysis was performed after excluding low quality and Hardy–Weinberg Disequilibrium (HWD) studies, no significant association was found for the eNOS G894T polymorphism. After credibility assessment, we identified “less-credible positive results” for the statistically significant associations in the current meta-analysis. Conclusion: In conclusion, this article suggests that all substantial relationships between eNOS 4b/a, G894T, and T786C polymorphisms and T2DM risk are most likely due to false positive results rather than real connections or biological variables.
Collapse
Affiliation(s)
- Di Wang
- Changzhi Medical College, Changzhi, China
| | | | | | - Wensheng Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- *Correspondence: Wensheng Lu, ; Feifei Wu, ; Xiaofeng He,
| | - Feifei Wu
- Department of Endocrinology and Metabolism, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
- *Correspondence: Wensheng Lu, ; Feifei Wu, ; Xiaofeng He,
| | - Xiaofeng He
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
- *Correspondence: Wensheng Lu, ; Feifei Wu, ; Xiaofeng He,
| |
Collapse
|
7
|
Role of eNOS and TGFβ1 gene polymorphisms in the development of diabetic nephropathy in type 2 diabetic patients in South Indian population. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diabetic nephropathy is known to be a leading complication of diabetes mellitus, characterized by diverse aspects such as high urinary albumin level, elevated blood pressure, and genetic susceptibility leading to end-stage renal disease. The current study was carried out to investigate the association of eNOS and TGFβ1 gene polymorphisms in the progression of diabetic nephropathy among type 2 diabetic patients in the South Indian population. The eNOS and TGFβ1 genetic variants were genotyped in 280 T2DM patients, 140 with DN, 140 without DN, and 140 controls. Genotyping was performed using ARMS PCR and the genomic variants were confirmed by the Sanger sequencing method.
Results
A significant (p < 0.05) association was observed in the genotypic frequencies of eNOS (G > T) polymorphism in the T2DM patients with diabetic nephropathy when compared to controls. The frequency of TT (heterozygous) genotype was observed to increase in patients with type 2 diabetes and DN when compared to the diabetic patients without DN and controls. This indicates that diabetic patients with TT genotype are at an increased risk to develop DN. However, TGFβ1 (G > C) polymorphism did not show any association in the allele and genotypic frequencies with DN when compared with T2DM and controls.
Conclusion
The results of the study propose a strong influence of TT genotype of eNOS gene be significantly linked with diabetic nephropathy in T2DM patients. Whereas no association was examined concerning TGFβ1 gene polymorphism and DN. Nevertheless, large sample size studies are required to confirm the part of these genetic variants in the development of DN.
Collapse
|
8
|
Raina P, Sikka R, Gupta H, Matharoo K, Bali SK, Singh V, Bhanwer A. Association of eNOS and MCP-1 Genetic Variants with Type 2 Diabetes and Diabetic Nephropathy Susceptibility: A Case-Control and Meta-Analysis Study. Biochem Genet 2021; 59:966-996. [PMID: 33609191 PMCID: PMC7896546 DOI: 10.1007/s10528-021-10041-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/24/2020] [Indexed: 10/26/2022]
Abstract
Type 2 diabetes (T2D) and its secondary complications result from the complex interplay of genetic and environmental factors. To understand the role of these factors on disease susceptibility, the present study was conducted to assess the association of eNOS and MCP-1 variants with T2D and diabetic nephropathy (DN) in two ethnically and geographically different cohorts from North India. A total of 1313 subjects from two cohorts were genotyped for eNOS (rs2070744, rs869109213 and rs1799983) and MCP-1 (rs1024611 and rs3917887) variants. Cohort-I (Punjab) comprised 461 T2D cases (204 T2D with DN and 257 T2D without DN) and 315 healthy controls. Cohort-II (Jammu and Kashmir) included 337 T2D (150 T2D with DN and 187 T2D without DN) and 200 controls. Allele, genotype and haplotype frequencies were compared among the studied participants, and phenotype-genotype interactions were determined. Meta-analysis was performed to investigate the association between the selected variants and disease susceptibility. All three eNOS variants were associated with 1.5-4.0-fold risk of DN in both cohorts. MCP-1 rs1024611 conferred twofold risk towards DN progression in cohort-II, while rs3917887 provided twofold risk for both T2D and DN in both cohorts. eNOS and MCP-1 haplotypes conferred risk for T2D and DN susceptibility. Phenotype-genotype interactions showed significant associations between the studied variants and anthropometric and biochemical parameters. In meta-analysis, all eNOS variants conferred risk towards DN progression, whereas no significant association was observed for MCP-1 rs1024611. We show evidences for an association of eNOS and MCP-1 variants with T2D and DN susceptibility.
Collapse
Affiliation(s)
- Priyanka Raina
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Ruhi Sikka
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Himanshu Gupta
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kawaljit Matharoo
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | | | - Virinder Singh
- Dr Virinder Singh Kidney Clinic and Dialysis Centre, Amritsar, Punjab, India
| | - Ajs Bhanwer
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, 143005, India.
| |
Collapse
|
9
|
Genetic and epigenetic polymorphisms of eNOS and CYP2D6 in mainland Chinese Tibetan, Mongolian, Uygur, and Han populations. THE PHARMACOGENOMICS JOURNAL 2019; 20:114-125. [PMID: 31616043 DOI: 10.1038/s41397-019-0104-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 09/09/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022]
Abstract
Cytochrome P450 2D6 (CYP2D6) and endothelial nitric oxide synthase (eNOS) are important in the cardiovascular disease susceptibility and drug response. The methylation of cytosine in the promoter of genes could influence expression. The interindividual differences of drug response could only be explained partly by the polymorphisms of drug disposition genes. This study was aimed to investigate the genetic and epigenetic polymorphisms of CYP2D6 and eNOS in Chinese Tibetan, Mongolian, Uygur, and Han volunteers. Blood samples were collected from 842 unrelated Chinese healthy subjects (323 Tibetan, 134 Mongolian, 162 Uygur, and 223 Han) for genotyping and part of the DNA samples were subjected to cytosine methylation analysis. Significant genetic and epigenetic interethnic polymorphisms of eNOS and CYP2D6 were found in the four Chinese groups. The 4b-G-T wild-type haplotype of eNOS was the most common in Chinese Tibetan (87.1%), Mongolian (79.9%), Uygur (76.4%), and Han (79.5%), respectively. eNOS T-786C creates a new CpG site and a significantly higher methylation level was found in -786CC than that in -786TC in Chinese Han (P = 0.0485) and total Chinese (P = 0.0104). CYP2D6 A-678 (rs28633410) makes the symmetrical CpG site changed to be an asymmetrical CpA site, and the methylation level of cytosine in the CpG context of G-678A was significantly higher than that in the CpA. The results of the present study could be useful for understanding the interindividual disparity of cardiovascular disease susceptibility and drug response among different Chinese ethnic groups and would provide more evidences for the precise medication of Chinese.
Collapse
|
10
|
Varghese S, Kumar SG. Association between genetic variants of NOS3, TGF-β and susceptibility of diabetic nephropathy: A meta-analysis. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
11
|
Rizvi S, Raza ST, Rahman Q, Eba A, Zaidi ZH, Mahdi F. Association of endothelial nitric oxide synthase (eNOS) and norepinephrine transporter (NET) genes polymorphism with type 2 diabetes mellitus. Mol Biol Rep 2019; 46:5433-5441. [PMID: 31377977 DOI: 10.1007/s11033-019-04998-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
Genetic factors in combination with environmental factors play a critical role in the development type 2 diabetes mellitus (T2DM) which is growing as an epidemic globally. In present study we aim to assess the association of eNOS (G894T, rs1799983) and NET (G1287A, rs5569) genes polymorphism with T2DM. A case-control study including a total of 400 North Indian subjects (200 T2DM cases and 200 controls) was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach to analyze genetic polymorphism. Alleles/genotype frequencies between cases and controls were compared using χ2 and Student's t-tests. Odds ratios and 95% confidence intervals were calculated by logistic regression to assess the relative association between disease and genotypes. In case of NET gene, GG (P = 0.002 in T2DM males, 0.053 in overall T2DM cases) genotype and G allele (P = 0.003 in T2DM males, 0.027 in overall T2DM cases) were found to be a positive risk factors and AG genotype (P = 0.012 in T2DM males) and A allele (P = 0.003 in T2DM males, P = 0.027 in overall T2DM cases) as negative risk factor for T2DM. No association of eNOS gene polymorphism was found with T2DM (P values of all genotypes and alleles were greater than 0.05). NET gene polymorphism might be associated with the risk of T2DM whereas; eNOS gene polymorphism do not confer any risk of T2DM in North Indian Ethnic group. It is hoped that understanding genetic causes of T2DM will lead to earlier diagnosis, preventive measures and more effective and specific treatment.
Collapse
Affiliation(s)
- Saliha Rizvi
- Molecular Biology Lab, Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, 226003, India
| | - Syed Tasleem Raza
- Molecular Biology Lab, Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, 226003, India.
| | - Qamar Rahman
- Amity University, Lucknow Campus, Lucknow, India
| | - Ale Eba
- Molecular Biology Lab, Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, 226003, India
| | - Zeashan H Zaidi
- Department of Statistics, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Farzana Mahdi
- Molecular Biology Lab, Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, 226003, India
| |
Collapse
|
12
|
Mirfeizi M, Hasanzad M, Sattari M, Afshari M, Abbasi D, Ajoodani Z, Sheykheslam AB. Association of eNOS and ACE gene polymorphisms as a genetic risk factor in gestational diabetes in Iranian women. J Diabetes Metab Disord 2018; 17:123-127. [PMID: 30918845 DOI: 10.1007/s40200-018-0348-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/30/2018] [Indexed: 01/31/2023]
Abstract
Background Gestational diabetes mellitus (GDM) is the most popular metabolic disease during pregnancy. The aim of the present study was to investigate any possible association between eNOS Glu298Asp and ACE I/D gene polymorphisms and the risk of GDM in a group of Iranian pregnant women. Methods In this case-control study 204 pregnant women were recruited (94 cases and 110 controls). Genomic DNA was isolated from whole blood and genotyping was performed by the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR- RFLP) and only PCR for eNOS and ACE polymorphisms respectively. Results Frequencies of GT and TT genotype of eNOS polymorphism among women with and without GDM were 67.90% vs. 74.47 and 7.41% vs. 8.51% respectively (P = 0.4). Corresponding figures for DD genotype of ACE polymorphism among GDM patients was more than that in healthy women (51.65% vs. 63.81% respectively). Conversely, ACE heterozygote genotype was more common in diabetic women (35.16% vs. 26.67% respectively). Although these differences were not statistically significant (P = 0.2). Conclusions Our study showed that there is no association between the presence of eNOS and ACE gene polymorphisms and developing gestational diabetes mellitus among pregnant women in our population. Further longitudinal and multicenter studies should be carried out to assess the exact metabolic effects of these polymorphisms.
Collapse
Affiliation(s)
- Mani Mirfeizi
- Department of Midwifery, College of Nursing & Midwifery, Islamic Azad University, Karaj Branch, Moazen Blvd and Esteglal Blvd Rajaeishahr, Karaj, Alborz, 1916893813 Iran
| | - Mandana Hasanzad
- 2Medical Genomics Research Center, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.,3Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Sattari
- 2Medical Genomics Research Center, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Mahdi Afshari
- 4Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Davood Abbasi
- Iranian Diabetes Society, Eslamshahr Branch, Eslamshahr, Iran
| | - Zarin Ajoodani
- Department of Midwifery, College of Nursing & Midwifery, Islamic Azad University, Karaj Branch, Moazen Blvd and Esteglal Blvd Rajaeishahr, Karaj, Alborz, 1916893813 Iran.,Alborz Hospital, Alborz, Iran
| | | |
Collapse
|
13
|
Medina AM, Zubero EE, Jiménez MAA, Barragan SAA, García CAL, Ramos JJG, Gutierrez JFS, Castillo ZG. NOS3 Polymorphisms and Chronic Kidney Disease. ACTA ACUST UNITED AC 2018; 40:273-277. [PMID: 29927456 PMCID: PMC6533959 DOI: 10.1590/2175-8239-jbn-3824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Chronic kidney disease (CKD) is a multifactorial pathophysiologic irreversible
process that often leads to a terminal state in which the patient requires renal
replacement therapy. Most cases of CKD are due to chronic-degenerative diseases
and endothelial dysfunction is one of the factors that contribute to its
pathophysiology. One of the most important mechanisms for proper functioning of
the endothelium is the regulation of the synthesis of nitric oxide. This
compound is synthesized by the enzyme nitric oxide synthase, which has 3
isoforms. Polymorphisms in the NOS3 gene have been implicated as factors that
alter the homeostasis of this mechanism. The Glu298Asp polymorphisms 4 b/a and
-786T>C of the NOS3 gene have been associated with a more rapid deterioration
of kidney function in patients with CKD. These polymorphisms have been evaluated
in patients with CKD of determined and undetermined etiology and related to a
more rapid deterioration of kidney function.
Collapse
Affiliation(s)
- Alejandro Marín Medina
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Departamento de Genética, Guadalajara, México
| | | | - Moisés Alejandro Alatorre Jiménez
- Asociación Mexicana de Atrofia Muscular Espinal, Guadalajara, México.,Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Departamento de Neurociencias, Guadalajara, México.,Centro de Investigación Biomédica de Occidente, Guadalajara, México
| | - Sara Anabel Alonso Barragan
- Asociación Mexicana de Atrofia Muscular Espinal, Guadalajara, México.,Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Departamento de Neurociencias, Guadalajara, México.,Centro de Investigación Biomédica de Occidente, Guadalajara, México
| | - Carlos Arturo López García
- University of Texas Health Science Center at San Antonio, Department of Cellular and Structural Biology, San Antonio, United States
| | - José Juan Gómez Ramos
- Instituto Mexicano del Seguro Social (IMSS), Hospital General Regional No. 89, Guadalajara, México
| | | | | |
Collapse
|
14
|
İlhan N, Ateş K, İlhan N, Kaman D, Çeliker H. eNOS Glu298Asp Polymorphism and Endothelial Dysfunction in Patients with and without End-stage Renal Disease. Balkan Med J 2016; 33:128-37. [PMID: 27403380 DOI: 10.5152/balkanmedj.2016.16566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/20/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic kidney diseases are known to influence nitric oxide metabolites (NOx) and asymmetric dimethylarginine (ADMA), though the exact mechanism is still poorly understood. AIMS The purpose of the present study was to examine eNOS Glu298Asp gene polymorphism, plasma NOx and ADMA concentration in subjects with and without End-stage Renal Disease. STUDY DESIGN Case-control study. METHODS In this study, genotype distributions of Glu-298Asp in exon 7 of the eNOS gene polymorphisms in 130 hemodialysis and 64 peritoneal dialysis patients were compared with 92 controls. NOx was measured by using the Griess reaction while arginine, ADMA and SDMA measurements were performed by HPLC. Genotyping for eNOS Glu298Asp polymorphism was detected with the polymerase chain reaction and/or polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. RESULTS When the genotype frequencies of TT and GT genes were compared between both groups, there was no detected statistically important difference, even-though a TT genotype frequency was 27 (20.8%) versus 17 (26.6%), GT heterozygote genotype frequency was 52 (40%) versus 22 (34.4%), and GG homozygote genotype frequency was 51 (39.2%) versus 25 (39.1%), respectively (p>0.05). NOx, SDMA and ADMA concentrations were significantly elevated in subjects with hemodialysis patients as compared to their corresponding controls. Whereas nitrite was found to be significantly decreased in the patient with peritoneal dialysis. CONCLUSION Not observed any connection between the Glu298Asp polymorphism in the eNOS gene and end-stage Renal Diseases in our study population under different dialysis treatments. However, higher ADMA and SDMA concentrations in subjects with ESRD support the existing hypothesis that NOx overproduction affects endothelial dysfunction. Thus, the reduction of ADMA and SDMA concentrations might play a protective role in ESRD patients.
Collapse
Affiliation(s)
- Nevin İlhan
- Department of Medical Biochemistry, Fırat University School of Medicine, Elazığ, Turkey
| | - Kadir Ateş
- Department of Medical Biochemistry, Fırat University School of Medicine, Elazığ, Turkey
| | - Necip İlhan
- Department of Medical Biochemistry, Fırat University School of Medicine, Elazığ, Turkey
| | - Dilara Kaman
- Department of Medical Biochemistry, Fırat University School of Medicine, Elazığ, Turkey
| | - Hüseyin Çeliker
- Department of Nephrology, Fırat University Hospital, Elazığ, Turkey
| |
Collapse
|
15
|
Zhang Y, Xiao HQ, Zeng XT, Zuo HX, Xu YC. Associations between endothelial nitric oxide synthase polymorphisms and risk of diabetic nephropathy: an updated meta-analysis. Ren Fail 2015; 37:312-26. [DOI: 10.3109/0886022x.2015.1062339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Zeng R, Duan L, Sun L, Kong Y, Wu X, Wang Y, Xin G, Yang K. A meta-analysis on the relationship of eNOS 4b/a polymorphism and diabetic nephropathy susceptibility. Ren Fail 2014; 36:1520-35. [DOI: 10.3109/0886022x.2014.958955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Dellamea BS, Pinto LCF, Leitão CB, Santos KG, Canani LHS. Endothelial nitric oxide synthase gene polymorphisms and risk of diabetic nephropathy: a systematic review and meta-analysis. BMC MEDICAL GENETICS 2014; 15:9. [PMID: 24433471 PMCID: PMC3900462 DOI: 10.1186/1471-2350-15-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/06/2014] [Indexed: 02/06/2023]
Abstract
Background Nitric oxide (NO) has numerous functions in the kidney, including control of renal and glomerular hemodynamics, by interfering at multiple pathological and physiologically critical steps of nephron function. Endothelial NOS (eNOS) gene has been considered a potential candidate gene to diabetic nephropathy (DN) susceptibility. Endothelial nitric oxide synthase gene (eNOS-3) polymorphisms have been associated with DN, however some studies do not confirm this association. The analyzed polymorphisms were 4b/4a, T-786C, and G986T. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this report. Case–control studies that had diabetic patients with DN as cases and diabetic patients without nephropathy as controls, as well as that evaluated at least one of the three polymorphisms of interest were considered eligible. All studies published up until December 31st, 2012 were identified by searching electronic databases. Hardy-Weinberg equilibrium assessment was performed. Gene-disease association was measured using odds ratio estimation based on the following genetic contrast/models: (1) allele contrast; (2) additive model; (3) recessive model; (4) dominant model and (4) co-dominant model. Results Twenty-two studies were eligible for meta-analysis (4b/a: 15 studies, T-786C: 5 studies, and G984T: 12 studies). Considering 4b/a polymorphism, an association with DN was observed for all genetic models: allele contrast (OR = 1.14, CI: 1.04-1.25); additive (OR = 1.77, CI: 1.37-2.28); recessive (OR = 1.77, CI: 1.38-2,27); dominant (OR = 1.12, CI: 1.01-1.24), with the exception for co-dominance model. As well, T-786C polymorphism showed association with all models, with exception for co-dominance model: allele contrast (OR = 1.22, CI: 1.07-1.39), additive (OR = 1.52, CI: 1.18-1.97), recessive (OR = 1.50, CI: 1.16-1.93), and dominant (OR = 1.11, CI: 1.01-1.23). For the G894T polymorphism, an association with DN was observed in allelic contrast (OR = 1.12, CI: 1.03-1.25) and co-dominance models (OR = 1.13, CI: 1.04-1.37). Conclusions In the present study, there was association of DN with eNOS 4b/a and T-786C polymorphism, which held in all genetic models tested, except for co-dominance model. G894T polymorphism was associated with DN only in allele contrast and in co-dominance model. This data suggested that the eNOS gene could play a role in the development of DN.
Collapse
Affiliation(s)
- Bruno Schmidt Dellamea
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, CEP 90035-903 Porto Alegre, RS, Brazil.
| | | | | | | | | |
Collapse
|
18
|
Bressler J, Pankow JS, Coresh J, Boerwinkle E. Interaction between the NOS3 gene and obesity as a determinant of risk of type 2 diabetes: the Atherosclerosis Risk in Communities study. PLoS One 2013; 8:e79466. [PMID: 24278136 PMCID: PMC3835793 DOI: 10.1371/journal.pone.0079466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/21/2013] [Indexed: 02/07/2023] Open
Abstract
Endothelial nitric oxide synthase 3 (NOS3) catalyzes the production of nitric oxide from L-arginine in endothelial cells. Obesity is a modifiable risk factor for diabetes, and obese individuals have been reported to have reduced nitric oxide availability compared to controls whose weight is in the normal range. Since homozygous carriers of the NOS3 G894T variant are predicted to have decreased enzyme activity, the association between NOS3 genotype and type 2 diabetes, and possible effect modification by body mass index (BMI) were evaluated. The prevalence of diabetes and BMI was determined at baseline in 14,374 participants 45-66 years of age from the prospective biracial population-based Atherosclerosis Risk in Communities (ARIC) Study of the development of atherosclerosis in four communities in the United States. Individuals with a BMI ≥30 kg/m(2) were considered obese. Those subjects not meeting the case definition were the comparison groups for the 728 African American and 980 white participants with diabetes. Multivariable logistic regression models adjusted for age, sex, and field center were used to test for main genetic effects and interaction with obesity. Although the NOS3 G894T variant was not independently associated with diabetes in either African Americans or whites, significant interaction between BMI and the NOS3 polymorphism indicated that obesity was an effect modifier of diabetes risk for white individuals with the TT genotype (odds ratio (OR) for interaction = 1.65, p = 0.04). In stratified analyses, homozygosity for the NOS3 T allele in obese white participants but not in those whose BMI <30 kg/m(2) was associated with an elevated risk of diabetes (OR = 1.47, p = 0.02) when compared to the common GG genotype. These results suggest that interaction between obesity and NOS3 genotype may be a determinant of diabetes case status in whites in the ARIC cohort. Replication in other populations will be required to confirm these observations.
Collapse
Affiliation(s)
- Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| |
Collapse
|
19
|
Zhou TB, Xu HL, Yin SS. Association between Endothelial Nitric Oxide Synthase Glu298Asp Gene Polymorphism and Diabetic Nephropathy Susceptibility. Ren Fail 2012; 35:173-8. [PMID: 23113598 DOI: 10.3109/0886022x.2012.734939] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
20
|
Santos KG, Crispim D, Canani LH, Ferrugem PT, Gross JL, Roisenberg I. Relationship of endothelial nitric oxide synthase (eNOS) gene polymorphisms with diabetic retinopathy in Caucasians with type 2 diabetes. Ophthalmic Genet 2011; 33:23-7. [PMID: 22017289 DOI: 10.3109/13816810.2011.620057] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nitric oxide synthesized by endothelial nitric oxide synthase (eNOS) plays a key role in the regulation of endothelial function, and controversial results regarding the association of eNOS gene polymorphisms with diabetic complications have been reported. MATERIALS AND METHODS In this case-control study, the relationship of the -786T/C, the VNTR intron 4 a/b and the 894G/T (Glu298Asp) polymorphisms in the eNOS gene with the presence or severity of diabetic retinopathy was analyzed in 630 Caucasian-Brazilians with type 2 diabetes (434 with and 196 without diabetic retinopathy). Genotyping of eNOS polymorphisms was carried out using the PCR or PCR-RFLP method, and haplotype frequencies were estimated using a Bayesian method. RESULTS Genotype and allele frequencies in patients with any degree of diabetic retinopathy or proliferative diabetic retinopathy were not significantly different from those of patients without this complication for all eNOS polymorphisms. Likewise, there were no differences in haplotype frequencies among diabetic patients with or without diabetic retinopathy (p values > 0.05 for all comparisons). CONCLUSION Our findings do not support the hypothesis that the -786T/C, the VNTR intron 4 a/b and the 894G/T (Glu298Asp) polymorphisms in the eNOS gene play a role in the pathogenesis of diabetic retinopathy in type 2 diabetes.
Collapse
Affiliation(s)
- Kátia G Santos
- Research Center in Medical Sciences, Universidade Luterana do Brasil, Canoas, Brazil.
| | | | | | | | | | | |
Collapse
|