Estimation of Fluoride and Sirtuin1 in Patients with Diabetic Nephropathy in Kolar District of Karnataka, India

Sirtuins in kidney homeostasis and disease: where are we now?

Sirtuins, identified as (NAD+)- dependent class III histone deacetylases, engage in a spectrum of biological functions, encompassing DNA damage repair, oxidative stress, immune modulation, mitochondrial homeostasis, apoptosis and autophagy. Sirtuins play an apoptosis role in regulating cellular operations and overall organism health. Mounting data indicate that dysregulated sirtuin expression is linked to the onset of renal diseases. Effective modulation of sirtuins expression and activity has been shown to improve renal function and attenuate the advancement of kidney diseases. In this review, we present a comprehensive overview of the biological impacts of sirtuins and their molecular targets in regulating renal diseases. Additionally, we detail advancements in elucidating sirtuin roles in the pathophysiology of both chronic and acute renal disorders. We review compounds that modulate sirtuin activity through activation or inhibition, potentially improving outcomes in renal disease. In summary, strategic manipulation of sirtuin activity represents a prospective therapeutic approach for renal diseases.

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.

Serum albumin adjusted calcium and fluoride among type 2 diabetes mellitus patients

The regulation of glucose-dependent insulin secretion in pancreatic β-cells relies on calcium concentration, making it a calcium-dependent process. Disruptions in calcium homeostasis may contribute to insulin dysfunction and disturbances in glucose homeostasis, potentially playing a role in the development of type 2 diabetes mellitus (T2DM). In T2DM patients, there may be changes in fluoride metabolism due to impaired renal function. Measurement of serum albumin-adjusted calcium and is crucial since changes in albumin levels can impact the accurate estimation of true calcium.

Role of sirtuins in metabolic disease-related renal injury

Poor control of metabolic diseases induces kidney injury, resulting in microalbuminuria, renal insufficiency and, ultimately, chronic kidney disease. The potential pathogenetic mechanisms of renal injury caused by metabolic diseases remain unclear. Tubular cells and podocytes of the kidney show high expression of histone deacetylases known as sirtuins (SIRT1-7). Available evidence has shown that SIRTs participate in pathogenic processes of renal disorders caused by metabolic diseases. The present review addresses the regulatory roles of SIRTs and their implications for the initiation and development of kidney damage due to metabolic diseases. SIRTs are commonly dysregulated in renal disorders induced by metabolic diseases such as hypertensive nephropathy and diabetic nephropathy. This dysregulation is associated with disease progression. Previous literature has also suggested that abnormal expression of SIRTs affects cellular biology, such as oxidative stress, metabolism, inflammation, and apoptosis of renal cells, resulting in the promotion of invasive diseases. This literature reviews the research progress made in understanding the roles of dysregulated SIRTs in the pathogenesis of metabolic disease-related kidney disorders and describes the potential of SIRTs serve as biomarkers for early screening and diagnosis of these diseases and as therapeutic targets for their treatment.

Changes in diabetic and renal profile of people exposed to fluoride in south India

Type 2 Diabetes Mellitus is leading cause of Diabetic microvascular complications. India stands second across the globe in prevalence of diabetes mellitus. Due to deficit rain fall, the water table is exposed to more of salts and minerals from the rocks underground. One of the minerals is the Fluoride. Fluoride in negligible amount is good for dental health, chronic exposure to higher range of fluoride causes various metabolic disturbances. Aim: To study the effect of chronic fluoride exposure on diabetes mellitus. A total of 288 study subjects were recruited. The blood samples and urine samples were collected from all the study subjects. Study groups; Group1: Healthy Controls, Group2: Type 2 Diabetes Mellitus and Group3: Diabetic Nephropathy. The serum (0.313± 0.154) and urine (0.3±0.6) fluoride values of diabetic nephropathy group were significantly decreased in comparison between groups. The primary objective of the fluoride with insulin (-0.06) levels are inversely correlating and fluoride with microalbumin (0.083) levels are directly correlating. Results of the study gave a clear picture of effect of fluoride on insulin action and renal damage. In conclusion, though there is no significant effect of fluoride on FBS, PPBS and HbA1c, insulin is the determining factor for glucose homeostasis which is decreased. Microalbumin is yet another marker for renal clearance which is increased. Therefore, fluoride shall be considered as a parameter in prognosis of metabolic disorder especially Diabetes mellitus in fluoride endemic areas.