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Heyns IM, Davis G, Ganugula R, Ravi Kumar MNV, Arora M. Glucose-Responsive Microgel Comprising Conventional Insulin and Curcumin-Laden Nanoparticles: a Potential Combination for Diabetes Management. AAPS J 2023; 25:72. [PMID: 37442863 DOI: 10.1208/s12248-023-00839-w] [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: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Successful management of type 2 diabetes mellitus (T2DM), a complex and chronic disease, requires a combination of anti-hyperglycemic and anti-inflammatory agents. Here, we have conceptualized and tested an integrated "closed-loop mimic" in the form of a glucose-responsive microgel (GRM) based on chitosan, comprising conventional insulin (INS) and curcumin-laden nanoparticles (nCUR) as a potential strategy for effective management of the disease. In addition to mimicking the normal, on-demand INS secretion, such delivery systems display an uninterrupted release of nCUR to combat the inflammation, oxidative stress, lipid metabolic abnormality, and endothelial dysfunction components of T2DM. Additives such as gum arabic (GA) led to a fivefold increased INS loading capacity compared to GRM without GA. The GRMs showed excellent in vitro on-demand INS release, while a constant nCUR release is observed irrespective of glucose concentrations. Thus, this study demonstrates a promising drug delivery technology that can simultaneously, and at physiological/pathophysiological relevance, deliver two drugs of distinct physicochemical attributes in the same formulation.
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Affiliation(s)
- Ingrid M Heyns
- The Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama, USA
- Bioscience and Medicine Initiative, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Garrett Davis
- The Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama, USA
- Bioscience and Medicine Initiative, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Biological Sciences, The University of Alabama, SEC 1325, Box 870344, Tuscaloosa, Alabama, USA
| | - Raghu Ganugula
- The Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama, USA
- Bioscience and Medicine Initiative, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Biological Sciences, The University of Alabama, SEC 1325, Box 870344, Tuscaloosa, Alabama, USA
| | - M N V Ravi Kumar
- The Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama, USA
- Bioscience and Medicine Initiative, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Biological Sciences, The University of Alabama, SEC 1325, Box 870344, Tuscaloosa, Alabama, USA
- Chemical and Biological Engineering, University of Alabama, SEC 3448, Box 870203, Tuscaloosa, Alabama, USA
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Nephrology Research and Training Center, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meenakshi Arora
- The Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama, USA.
- Bioscience and Medicine Initiative, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA.
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA.
- Department of Biological Sciences, The University of Alabama, SEC 1325, Box 870344, Tuscaloosa, Alabama, USA.
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Gui Y, Palanza Z, Fu H, Zhou D. Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts. FASEB J 2023; 37:e22884. [PMID: 36943403 PMCID: PMC10602403 DOI: 10.1096/fj.202201340rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Acute kidney injury (AKI) and diabetes mellitus (DM) are public health problems that cause a high socioeconomic burden worldwide. In recent years, the landscape of AKI etiology has shifted: Emerging evidence has demonstrated that DM is an independent risk factor for the onset of AKI, while an alternative perspective considers AKI as a bona fide complication of DM. Therefore, it is necessary to systematically characterize the features of AKI in DM. In this review, we summarized the epidemiology of AKI in DM. While focusing on circulation- and tissue-specific microenvironment changes after DM, we described the active cellular and molecular mechanisms of increased kidney susceptibility to AKI under DM stress. We also reviewed the current diagnostic and therapeutic strategies for AKI in DM recommended in the clinic. Updated recognition of the epidemiology, pathophysiology, diagnosis, and medications of AKI in DM is believed to reveal a path to mitigate the frequency of AKI and DM comorbidity that will ultimately improve the quality of life in DM patients.
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Affiliation(s)
- Yuan Gui
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Zachary Palanza
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Dong Zhou
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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Maisons V, Halimi JM, Fauchier G, de Fréminville JB, Goin N, Gueguen J, Gatault P, Sautenet B, Angoulvant D, Herbert J, Bisson A, Ducluzeau PH, Fauchier L. Type 2 diabetes and cardiorenal syndromes. A nationwide French hospital cohort study. DIABETES & METABOLISM 2023; 49:101441. [PMID: 36931430 DOI: 10.1016/j.diabet.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for cardiac and renal complications; its effect on cardiorenal syndromes is unknown. METHODS In a French nationwide cohort of 5,123,193 patients hospitalized in 2012 with ≥5 years of follow-up, we assessed the effect of T2DM on cardiorenal syndrome (CRS) (using cardiorenal, renocardiac, and simultaneous subtypes) incidence and outcomes using 1:1 propensity matching. RESULTS Among 4,605,236 adults without cardiorenal syndrome, 380,581 (8.5%) with T2DM were matched to 380,581 adults without T2DM. During follow-up, CRS occurred in 104,788 patients: simultaneous n = 25,225 (24.0%); cardiorenal n = 51,745 (49.4%); renocardiac n = 27,818 (26.5%). T2DM doubled the risk of incident CRS (1.30% versus 0.65%/year; adjusted hazard ratio (HR) for any cardiorenal syndrome: 2.14 [95% confidence interval 2.10;2.19]; renocardiac: 2.43 [2.34;2.53]; cardiorenal: 2.09 [2.03;2.15]; simultaneous: 1.94 [1.86;2.03]. Among the 26,396 adults with CRS in 2012, 11,355 (43.0%) had T2DM and were younger than non-diabetic adults (77.4 ± 9.5 versus 82.3 ± 10.0); 8,314 patients with T2DM were matched to 8,314 patients without. T2DM increased risk of: end-stage kidney disease, adjusted HR 1.50 [1.39;1.62]; myocardial infarction 1.35 [1.19;1.53]; cardiovascular death 1.20 [1.13;1.27]; heart failure 1.17 [1.12;1.21]; and all-cause death 1.09 [1.06;1.13], but not ischemic stroke. CONCLUSION Patients with T2DM represent almost half of patients with CRS and are younger than their non-diabetic counterparts. T2DM doubles the risk of CRS and increases the risk of death, cardiovascular outcome, and end-stage kidney disease but not ischemic stroke after CRS.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Michel Halimi
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; EA4245, T2I, Université de Tours, Tours, France; INI-CRCT, France.
| | - Grégoire Fauchier
- Service de Service d'endocrinologie, diabétologie et métabolisme, Hôpital Bretonneau, CHU Tours, Tours, France
| | | | - Nicolas Goin
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Juliette Gueguen
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Philippe Gatault
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; EA4245, T2I, Université de Tours, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; INI-CRCT, France; INSERM U1246 SPHERE, Université de Tours-Université de Nantes, Tours, France
| | - Denis Angoulvant
- EA4245, T2I, Université de Tours, Tours, France; Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Julien Herbert
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Pierre-Henri Ducluzeau
- Service de Service d'endocrinologie, diabétologie et métabolisme, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
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Valensi P, Prévost G, Pinto S, Halimi JM, Donal E. The impact of diabetes on heart failure development: The cardio-renal-metabolic connection. Diabetes Res Clin Pract 2021; 175:108831. [PMID: 33895192 DOI: 10.1016/j.diabres.2021.108831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) and chronic kidney disease (CKD) are often associated in type 2 diabetes (T2D), aggravate each other and exert synergistic effects to increase the risk of cardiac and renal events. The risks of renal worsening in HF patients and HF in CKD patients need to be evaluated to tailor preventive therapy. The recent CV and renal trials enriched our knowledge about the natural history of HF and CKD in T2D and provided evidence for the benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in HF and renal decline prevention. SGLT-2is are the best choice in patients with HFrEF to improve CV prognosis and HF-related outcomes and also to prevent kidney-related outcomes, and in CKD patients to slow down renal failure and also reduce hospitalization for HF and CV death. In both situations the number of patients to treat in order to prevent such events in one patient is lower than in the general T2D population at high CV risk. GLP1-receptor agonists could be an alternative in a patient who is intolerant or has a contraindication to SGLT-2is. A tight collaboration between diabetologists, nephrologists and cardiologists should be encouraged for a holistic and effective strategy to reduce the burden of cardio-renal-metabolic interaction.
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Affiliation(s)
- Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France.
| | - Gaétan Prévost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, 76000 Rouen, France
| | - Sara Pinto
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
| | - Jean-Michel Halimi
- Department of Nephrology, CHU Tours, France and EA4245, Tours University, Tours, France
| | - Erwan Donal
- Department of Cardiology, University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
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Halimi JM. [SGLT2 inhibitors: A new era for our patients]. Nephrol Ther 2021; 17:143-148. [PMID: 33773943 DOI: 10.1016/j.nephro.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
Since 2015, 10 randomized clinical trials assessed the cardiovascular safety of SGLT2 inhibitors, and then assessed the potential renal and cardiovascular benefits of these drugs (EMPAREG Outcome, CANVAS, DECLARE, DAPA-HF, CREDENCE, EMPEROR-reduced, VERTIS, DAPA-CKD, SCORED, SOLOIST-WHF) in over 88,000 patients. The results of EMPAREG Outcome showed major renal and cardiovascular protection but they were unexpected. The other trials regarding the effects of dapagliflozin, canagliflozin, empagliflozin and more recently sotagliflozin have confirmed most of these results and extended them to other populations. There is no scientific doubt that these drugs confer a marked renal protection in patients already treated with renin angiotensin system blockers (reduction of the risk of end-stage renal disease: -35 to 40%) et reduce the risk of hospitalization for heart failure (-30 to 35%), especially in patients with heart failure with reduced ejection fraction. The benefit/risk profile is highly favorable but minor (genital candidosis, urinary tract infections, euglycemic acido-ketosis) and serious (Fournier gangrene) side effects must not be forgotten. Renal protection is twice the effect of renin angiotensin system blockers, and is maintained in patients already treated with them, in patients with GFR 25mL/min/1.73m2 and over, regardless of whether they have type 2 diabetes mellitus or not (of note, patients with type 1 diabetes mellitus, polycystic kidney disease, lupus and vasculitis were excluded in these studies). Reduction of the incidence of heart failure is similar to that observed with sacubitril/valsartan, and is maintained in patients already treated with sacubitril/valsartan. SGLT2 inhibitors have now defined a new standard of care, and it will be necessary to explore the proper use of the new mineralocorticoid receptor antagonist finerenone that demonstrated significant renal and cardiovascular protection in mostly SGLT2 inhibitors-untreated diabetic patients with chronic kidney disease (or even some GLP-1 agonists). A new era for our patients.
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Affiliation(s)
- Jean-Michel Halimi
- Service de néphrologie-HTA, dialyses et transplantation rénale, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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