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Hartman RE, Rao PSS, Churchwell MD, Lewis SJ. Novel therapeutic agents for the treatment of diabetic kidney disease. Expert Opin Investig Drugs 2020; 29:1277-1293. [PMID: 32799584 DOI: 10.1080/13543784.2020.1811231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Diabetic kidney disease (DKD) involves multifaceted pathophysiology which increases the risk of cardiorenal events and mortality. Conventional therapy is limited to renin-angiotensin aldosterone system inhibition and management of hyperglycemia and hypertension. Recent clinical trials have demonstrated promising nephroprotective effects of antihyperglycemic agents thus modifying guideline treatment recommendations for type 2 diabetic patients with chronic kidney disease. AREAS OF COVERED Relevant studies and clinical trials were searched via PubMed and clinicaltrials.gov through August 2020. Authors offer an update on clinical evidence regarding nephroprotective effects and side effects of sodium-glucose-cotransporter-2 (SGLT2) inhibitors, glucagon-like-peptide-1 (GLP1) agonists and dipeptidylpeptidase-4 (DPP4) inhibitors. They discuss the potential benefits of novel therapy targeting DKD pathogenic processes including inflammation, oxidative stress, fibrosis, and vasoconstriction shown in early phases of clinical trials and offer an opinion on key challenges and directions for future progress. EXPERT OPINION SGLT2 inhibitors are the most promising agents for DKD and improving cardiorenal outcomes. Mineralocorticoid-receptor antagonists and janus kinase inhibitors are also promising investigational therapies that target oxidative stress, nitric oxide synthesis, and inflammation. Novel therapeutic targets and the identification of clinically useful biomarkers may provide future therapies that detect early stages of DKD enabling a slower kidney function decline.
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Affiliation(s)
| | - P S S Rao
- Department of Pharmaceutical Science, University of Findlay , Findlay, OH, USA
| | | | - Susan J Lewis
- Department of Pharmacy Practice, University of Findlay , Findlay, OH, USA
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Zusi C, Trombetta M, Bonetti S, Dauriz M, Boselli ML, Trabetti E, Malerba G, Penno G, Zoppini G, Bonora E, Solini A, Bonadonna RC. A renal genetic risk score (GRS) is associated with kidney dysfunction in people with type 2 diabetes. Diabetes Res Clin Pract 2018; 144:137-143. [PMID: 30153470 DOI: 10.1016/j.diabres.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/12/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
This study aims to investigate whether renal and cardiovascular phenotypes in Italian patients with type 2 diabetes (T2D) could be influenced by a number of disease risk SNPs recently found in genome-wide association studies (GWAS). In 1591 Italian subjects with T2D: (1) 47 SNPs associated to kidney function and/or chronic kidney disease (CKD) and 49 SNPs associated to cardiovascular disease (CVD) risk were genotyped; (2) urinary albumin/creatinine (A/C) ratio, glomerular filtration rate (eGFR) and lipid profile were assessed; (3) a standard electrocardiogram was performed; (4) two genotype risk scores (GRS) were computed (a renal GRS calculated selecting 39 SNPs associated with intermediate traits of kidney damage and a cardiovascular GRS determined selecting 42 SNPs associated to CVD risk phenotypes). After correction for multiple comparisons, the renal GRS was not associated to A/C ratio (p = 0.33), but it was significantly related to decreased eGFR (p = 0.005). No association between the cardiovascular GRS and electrocardiogram was detected. Thus, in Italian patients with T2D a renal GRS might predict the decline in glomerular function, suggesting that the clock of diabetes associated CKD starts ticking long before hyperglycemia. Our data support the feasibility of gene-based prediction of complications in people with T2D.
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Affiliation(s)
- Chiara Zusi
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Hospital Trust of Verona, Verona, Italy.
| | - Sara Bonetti
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Marco Dauriz
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maria L Boselli
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Elisabetta Trabetti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Biology and Genetics, University of Verona, Verona, Italy
| | - Giovanni Malerba
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Biology and Genetics, University of Verona, Verona, Italy
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giacomo Zoppini
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Enzo Bonora
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Hospital Trust of Verona, Verona, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
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Lindenmeyer MT, Kretzler M. Renal biopsy-driven molecular target identification in glomerular disease. Pflugers Arch 2017; 469:1021-1028. [PMID: 28664406 DOI: 10.1007/s00424-017-2006-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022]
Abstract
Chronic kidney disease has severe impacts on the patient and represents a major burden to the health care systems worldwide. Despite an increased knowledge of pathophysiological processes involved in kidney diseases, the progress in defining novel treatment strategies has been limited. One reason is the descriptive disease categorization used in nephrology based on clinical findings or histopathological categories irrespective of potential different molecular disease mechanisms. To accelerate progress toward a targeted treatment, a definition of human disease extending from phenotypic disease classification to mechanism-based disease definitions is needed. In recent years, we have witnessed a major transition in biomedical research from a single gene research to an information rich and collaborative science. Tissue-based analysis in renal disease allows to link structure to molecular function. In our review, we introduce the concept of precision medicine in nephrology, describe several large cohort studies established for molecular analysis of kidney diseases, and highlight examples of renal biopsy-driven target identification by integrative systems biology approaches. Furthermore, we give an outlook on how the new disease definitions can be used for patient stratification in clinical trial design. Finally, we introduce the concept of an informational commons of renal precision medicine for joint analyses of large-scale data sets in renal failure.
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Affiliation(s)
- Maja T Lindenmeyer
- Nephrological Center, Medical Clinic and Policlinic IV, University of Munich, Munich, Germany
| | - Matthias Kretzler
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Internal Medicine - Nephrology, University of Michigan, 1150 W. Medical Center Dr. 1560 MSRB II, Ann Arbor, MI, 48109-5676, USA.
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Albrecht T, Zhang S, Braun JD, Xia L, Rodriquez A, Qiu J, Peters V, Schmitt CP, van den Born J, Bakker SJL, Lammert A, Köppel H, Schnuelle P, Krämer BK, Yard BA, Hauske SJ. The CNDP1 (CTG) 5 Polymorphism Is Associated with Biopsy-Proven Diabetic Nephropathy, Time on Hemodialysis, and Diabetes Duration. J Diabetes Res 2017; 2017:9506730. [PMID: 28553654 PMCID: PMC5434468 DOI: 10.1155/2017/9506730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/18/2022] Open
Abstract
Considering that the homozygous CNDP1 (CTG)5 genotype affords protection against diabetic nephropathy (DN) in female patients with type 2 diabetes, this study assessed if this association remains gender-specific when applying clinical inclusion criteria (CIC-DN) or biopsy proof (BP-DN). Additionally, it assessed if the prevalence of the protective genotype changes with diabetes duration and time on hemodialysis and if this occurs in association with serum carnosinase (CN-1) activity. Whereas the distribution of the (CTG)5 homozygous genotype in the no-DN and CIC-DN patients was comparable, a lower frequency was found in the BP-DN patients, particularly in females. We observed a significant trend towards high frequencies of the (CTG)5 homozygous genotype with increased time on dialysis. This was also observed for diabetes duration but only reached significance when both (CTG)5 homo- and heterozygous patients were included. CN-1 activity negatively correlated with time on hemodialysis and was lower in (CTG)5 homozygous patients. The latter remained significant in female subjects after gender stratification. We confirm the association between the CNDP1 genotype and DN to be likely gender-specific. Although our data also suggest that (CTG)5 homozygous patients may have a survival advantage on dialysis and in diabetes, this hypothesis needs to be confirmed in a prospective cohort study.
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Affiliation(s)
- Thomas Albrecht
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- *Thomas Albrecht:
| | - Shiqi Zhang
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jana D. Braun
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Li Xia
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Angelica Rodriquez
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jiedong Qiu
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Verena Peters
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Claus P. Schmitt
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jacob van den Born
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexander Lammert
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hannes Köppel
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Schnuelle
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard K. Krämer
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benito A. Yard
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sibylle J. Hauske
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Yadav AK, Kumar V, Dutta P, Bhansali A, Jha V. Variations in CCR5, but not HFE, ELMO1, or SLC12A3, are associated with susceptibility to kidney disease in north Indian individuals with type 2 diabetes. J Diabetes 2014; 6:547-55. [PMID: 24433479 DOI: 10.1111/1753-0407.12128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/10/2013] [Accepted: 01/11/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN), the leading cause of end-stage renal disease worldwide, may have a genetic component. In the present study, we investigated variations in a set of genes with susceptibility to DN in a north Indian population. METHODS Four genes (HFE, ELMO1, SLC12A3, and CCR5) were selected on the basis of reported association with type 2 diabetes and nephropathy. In all, 417 diabetic subjects (215 without kidney disease [DM] and 202 with DN) and 197 healthy controls (HC) were evaluated for variations in HFE (845 G>A and 187G>C), SLC12A3 (g.34372G>A), CCR5 (59029A>G), and ELMO1 (+9170 G>A). Polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism and Taqman allele discrimination assays. RESULTS Significant differences were found in genotype and allelic frequency in SLC12A3 (g.34372G>A) between diabetic subjects and HC (P < 0.03). There were no differences in the SLC12A3 g.34372G>A (AA+GA) genotype between diabetic subjects with and without nephropathy. However, the CCR5 59029AA genotype and A allele were significantly more frequent in diabetics compared with the HC (P = 0.01 and 0.03, respectively) and subjects with DN versus DM (P = 0.002 and 0.01, respectively). For ELMO1 (+9170 G>A), the GG genotype frequency was higher in the diabetic versus HC group. There were no differences in the frequency of HFE-845 G>A and HFE-187G>C among the groups. CONCLUSION This study shows that the CCR5 AA genotype is over-represented in subjects with kidney disease due to type 2 diabetes. The CCR5 59029G>A and ELMO1 (+9170 G>A) loci are more frequent, and the SLC12A3 34372 AA genotype is associated with a reduced risk of diabetes.
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Affiliation(s)
- Ashok K Yadav
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Stefanidis I, Kreuer K, Dardiotis E, Arampatzis S, Eleftheriadis T, Hadjigeorgiou GM, Zintzaras E, Mertens PR. Association Between the Interleukin-1β Gene (IL1B) C−511T Polymorphism and the Risk of Diabetic Nephropathy in Type 2 Diabetes: A Candidate–Gene Association Study. DNA Cell Biol 2014; 33:463-8. [DOI: 10.1089/dna.2013.2204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ioannis Stefanidis
- Department of Nephrology, School of Medicine, University of Thessaly, Larissa, Greece
- Department of Nephrology and Hypertension, Endocrinology and Metabolic Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Karsten Kreuer
- Department of Nephrology and Hypertension, Endocrinology and Metabolic Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Efthimios Dardiotis
- Department of Neurology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Spyridon Arampatzis
- Universitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie, Inselspital, Bern, Schweiz
| | | | - Georgios M. Hadjigeorgiou
- Department of Neurology, School of Medicine, University of Thessaly, Larissa, Greece
- Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
| | - Elias Zintzaras
- Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
- Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, Massachusetts
| | - Peter-Rene Mertens
- Department of Nephrology and Hypertension, Endocrinology and Metabolic Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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7
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Sallée M, Fontès M, Louis L, Cérini C, Brunet P, Burtey S. Alternative splicing events is not a key event for gene expression regulation in uremia. PLoS One 2013; 8:e82702. [PMID: 24358217 PMCID: PMC3865105 DOI: 10.1371/journal.pone.0082702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/26/2013] [Indexed: 11/29/2022] Open
Abstract
Background The control of gene expression in the course of chronic kidney disease (CKD) is not well addressed. Alternative splicing is a common way to increase complexity of proteins. More than 90% of human transcripts are alternatively spliced. We hypothesised that CKD can induce modification of the alternative splicing machinery. Methods During mutation screening in autosomal dominant polycystic kidney disease, we identified in mononuclear cells (PBMC), an alternative splicing event on the exon 30 of PKD1 gene, the gene implicated in this disease. This alternative splice variant was not correlated with the cystic disease but with CKD. To confirm the association between this variant and CKD, a monocentric clinical study was performed with 3 different groups according to their kidney function (CKD5D, CKD3-5 and normal kidney function). An exon microarray approach was used to highlight splicing events in whole human genome in a normal cell model (fibroblasts) incubated with uremic serum. Alternative splicing variants identified were confirmed by RT-PCR. Results The splicing variant of the exon 30 of PKD1 was more frequent in PBMCs from patients with CKD compared to control. With the microarray approach, despite the analysis of more than 230 000 probes, we identified 36 genes with an abnormal splicing index evocating splicing event in fibroblasts exposed to uremic serum. Only one abnormal splicing event in one gene, ADH1B, was confirmed by RT-PCR. Conclusion We observed two alternative spliced genes in two different cell types associated with CKD. Alternative splicing could play a role in the control of gene expression during CKD but it does not seem to be a major mechanism.
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Affiliation(s)
- Marion Sallée
- Aix-Marseille Université, INSERM UMR_S 1076, UFR Pharmacie, Marseille, France ; Centre de Néphrologie et Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Conception, Marseille, France
| | - Michel Fontès
- Aix-Marseille Université, INSERM UMR_S 1062 UFR Médecine, Marseille, France
| | - Laurence Louis
- Aix-Marseille Université, Plate-forme génomique et transcriptomique, UMR_S 910, UFR médecine, Marseille, France
| | - Claire Cérini
- Aix-Marseille Université, INSERM UMR_S 1076, UFR Pharmacie, Marseille, France
| | - Philippe Brunet
- Aix-Marseille Université, INSERM UMR_S 1076, UFR Pharmacie, Marseille, France ; Centre de Néphrologie et Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Conception, Marseille, France
| | - Stéphane Burtey
- Aix-Marseille Université, INSERM UMR_S 1076, UFR Pharmacie, Marseille, France ; Centre de Néphrologie et Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Conception, Marseille, France
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Chen K, Jin X, Li Q, Wang W, Wang Y, Zhang J. Association of TRPC1 gene polymorphisms with type 2 diabetes and diabetic nephropathy in Han Chinese population. Endocr Res 2013; 38:59-68. [PMID: 23544998 PMCID: PMC3619450 DOI: 10.3109/07435800.2012.681824] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The recent genome-wide association studies reveal that chromosome 3q resides within the linkage region for diabetic nephropathy (DN) in type 1 and type 2 diabetes mellitus (T1D and T2D). The TRPC1 gene is on chromosome 3q22-24, and it has been demonstrated that TRPC1 expression is reduced in the kidney of diabetic animal models. Genetic association of TRPC1 polymorphism with T1D and DN has been reported in European Americans. However, there are no studies reporting the association of TRPC1 genetic polymorphism with T2D with and without DN in Chinese population. This study aimed to demonstrate the genetic role of TRPC1 in the development of T2D with and without DN in Chinese Han population. A genetic association study of TRPC1 was performed in T2D cases and in nondiabetic controls from Han population located in Northern Chinese areas. Six tag single nucleotide polymorphism (SNP) markers derived from HapMap data were genotyped. Among the six SNPs, only rs7638459 was suspected as risk factor of T2D without DN, fitting the log-additive model. The adjusted odds ratio (OR) for the CC genotyping was 2.39 (95% confidence interval (CI) = 1.00-5.68), compared with the TT genotyping. In addition, rs953239 was found to be a protective factor of getting DN in T2D, also fitting the log-additive model. When compared with the AA genotyping for SNP rs953239, the adjusted OR for CC genotyping was 0.63 (95% CI = 0.44-0.99). To summarize, this study shows that TRPC1 genetic polymorphisms are associated with T2D and DN in T2D in the Han Chinese population.
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Affiliation(s)
- Kelin Chen
- Departmentof Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuehua Jin
- Department of Endocrinology and Metabolism, Daqing Oil Field General Hospital, Daqing, China
| | - Qiang Li
- Departmentof Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Wang
- Departmentof Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Wang
- Department of Endocrinology and Metabolism, Daqing Oil Field General Hospital, Daqing, China
| | - Jinchao Zhang
- Departmentof Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Gu T, Horová E, Möllsten A, Seman NA, Falhammar H, Prázný M, Brismar K, Gu HF. IGF2BP2 and IGF2 genetic effects in diabetes and diabetic nephropathy. J Diabetes Complications 2012; 26:393-8. [PMID: 22770937 DOI: 10.1016/j.jdiacomp.2012.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/11/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The IGF2BP2 gene is located on chromosome 3q27.2 within a region linked to type 1 diabetes (T1D), type 2 diabetes (T2D) and diabetic nephropathy (DN). Its protein functionally binds to 5'-UTR of the imprinting IGF2 gene. The present study aims to evaluate the IGF2BP2-IGF2 genetic effects in diabetes and DN. MATERIALS AND METHODS Three cohorts including T1D with and without DN (n=1139) of European descents from the GoKinD study, Swedish T1D with and without DN (n=303) and Czech control subjects without diabetes, T1D, T2D with and without DN (n=1418) were enrolled in TaqMan genotyping experiments for IGF2BP2 rs4402960 and IGF2 rs10770125. Igf2bp2 gene expression in kidney tissues of db/db and control mice at the ages of 5 and 26 weeks was examined with real time RT-PCR and Western blot. RESULTS An association of IGF2BP2 rs4402960 with T2D in the Czech population was replicated. This IGF2BP2 polymorphism (P=0.037, OR=0.69 95% CI 0.49-0.98) was found to be associated with DN in male not in female patients with T1D selected from the GoKinD study. In the analyses of combined the GoKinD, Czech and Swedish populations, the association between IGF2BP2 polymorphism and DN in male patients with T1D was still significant (P=0.030, OR=0.73, 95% CI 0.54-0.97). IGF2 rs10770125 was also associated with DN in male T1D patients of the GoKinD population (P=0.038, OR=0.67 95% CI 0.46-0.98). There might be a genetic interaction between IGF2BP2 and IGF2 (P=0.05). The Igf2bp2 gene expression levels were increased in the kidneys of db/db mice compared to controls at the age of 5weeks but not at 26 weeks. CONCLUSIONS The present study has replicated the association of IGF2BP2 rs4402960 with T2D in the Czech population and provided data suggesting that IGF2BP2 may have genetic interaction with IGF2 with a protective effect against DN in male patients with T1D.
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Affiliation(s)
- Tianwei Gu
- Department of Molecular Medicine and Surgery, Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Graham S, Yuan JP, Ma R. Canonical transient receptor potential channels in diabetes. Exp Biol Med (Maywood) 2012; 237:111-8. [PMID: 22282397 DOI: 10.1258/ebm.2011.011208] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Canonical transient receptor potential (TRPC) channel proteins have been identified as downstream molecules in a G protein-coupled receptor signaling pathway and are involved in a variety of cell functions due to their ability to regulate intracellular calcium signaling. TRPC channel physiology has been an increasingly interesting and relevant topic over the last decade, and the outcomes from various studies have advanced our understanding of TRPC function in the normal state. Recently, attention has turned to whether or not TRPC proteins are implicated in diseases. Emerging evidence suggests a significant contribution of several isoforms of TRPC proteins to cardiovascular as well as renal diseases. This review focuses on the implication of TRPC proteins as they pertain to diabetes. We summarize the recent findings by other investigators as well as ourselves and additionally discuss the important role of TRPC proteins in the development of various diabetic complications, such as diabetic nephropathy and diabetic vasculopathy. The underlying mechanisms which contribute to these complications are also outlined. Lastly, we elaborate on the role of TRPC proteins as a potential therapeutic target for treating diabetes-associated diseases.
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Affiliation(s)
- Sarabeth Graham
- Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Riedl E, Pfister F, Braunagel M, Brinkkötter P, Sternik P, Deinzer M, Bakker SJL, Henning RH, van den Born J, Krämer BK, Navis G, Hammes HP, Yard B, Koeppel H. Carnosine prevents apoptosis of glomerular cells and podocyte loss in STZ diabetic rats. Cell Physiol Biochem 2011; 28:279-88. [PMID: 21865735 DOI: 10.1159/000331740] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS We identified carnosinase-1 (CN-1) as risk-factor for diabetic nephropathy (DN). Carnosine, the substrate for CN-1, supposedly is a protective factor regarding diabetic complications. In this study, we hypothesized that carnosine administration to diabetic rats might protect the kidneys from glomerular apoptosis and podocyte loss. METHODS We examined the effect of oral L-carnosine administration (1g/kg BW per day) on apoptosis, podocyte loss, oxidative stress, AGEs and hexosamine pathway in kidneys of streptozotocin-induced diabetic Wistar rats after 3 months of diabetes and treatment. RESULTS Hyperglycemia significantly reduced endogenous kidney carnosine levels. In parallel, podocyte numbers significantly decreased (-21% compared to non-diabetics, p<0.05), apoptotic glomerular cells numbers increased (32%, compared to non-diabetic, p<0.05) and protein levels of bax and cytochrome c increased (175% and 117%). Carnosine treatment restored carnosine kidney levels, prevented podocytes loss (+23% compared to diabetic, p<0.05), restrained glomerular apoptosis (-34% compared to diabetic; p<0.05) and reduced expression of bax and cytochrome c (-63% and -54% compared to diabetics, both p<0.05). In kidneys of all diabetic animals, levels of ROS, AGEs and GlcNAc-modified proteins were increased. CONCLUSION By inhibition of pro-apoptotic signaling and independent of biochemical abnormalities, carnosine protects diabetic rat kidneys from apoptosis and podocyte loss.
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Affiliation(s)
- Eva Riedl
- 5th Medical Clinic, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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12
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Wu J, Chen YD, Yu JK, Shi XL, Gu W. Analysis of urinary proteomic patterns for type 2 diabetic nephropathy by ProteinChip. Diabetes Res Clin Pract 2011; 91:213-9. [PMID: 21237525 DOI: 10.1016/j.diabres.2010.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/18/2010] [Accepted: 11/29/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To detect urinary proteomic profiling of patients with type 2 diabetes by using ProteinChip array technology, for searching new potential biomarkers in early diagnosis of type 2 diabetic nephropathy (T2DN). METHODS A total of 95 urine samples from type 2 diabetic patients with normoalbuminuria (DM, n=30), microalbuminuria (DNl, n=25) and macroalbuminuria (DN2, n=20), and healthy controls (n=20) were analyzed by SELDI-TOF-MS (the surface-enhanced laser desorption/ionization time-of-flight mass spectrometry) technology combined with bioinformatics tools. RESULTS Over 300 proteins or peptides from 1 to 80 kDa were obtained using ProteinChip. About 40 of them with the m/z values from 2008.78 to 79176.55 Da were significantly differentiated between type 2 diabetic patients and control subjects. Four proteins of mass 2797.03, 4545.77, 4984.03 and 9083.71 Da were selected as the potential biomarkers for T2DN with sensitivity of 88% and specificity of 96.7%. CONCLUSION ProteinChip technology can help to discover new biomarkers and provide a novel non-invasive tool to early diagnosis of T2DN.
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Affiliation(s)
- Jing Wu
- Department of Endocrinology and Metabolism, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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13
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Bowden DW, Cox AJ, Freedman BI, Hugenschimdt CE, Wagenknecht LE, Herrington D, Agarwal S, Register TC, Maldjian JA, Ng MCY, Hsu FC, Langefeld CD, Williamson JD, Carr JJ. Review of the Diabetes Heart Study (DHS) family of studies: a comprehensively examined sample for genetic and epidemiological studies of type 2 diabetes and its complications. Rev Diabet Stud 2010; 7:188-201. [PMID: 21409311 DOI: 10.1900/rds.2010.7.188] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Diabetes Heart Study (DHS) is a genetic and epidemiological study of 1,443 European American and African American participants from 564 families with multiple cases of type 2 diabetes. Initially, participants were comprehensively examined for measures of subclinical cardiovascular disease (CVD) including computed tomography measurement of vascular calcified plaque, ultrasound imaging of carotid artery wall thickness, and electrocardiographic intervals. Subsequent studies have investigated the relationship between bone mineral density and vascular calcification, measures of adiposity, and biomarkers. Ongoing studies are carrying out an extensive evaluation of cerebrovascular disease using magnetic resonance imaging and cognitive assessment. A second, parallel study, the African American DHS, has expanded the sample of African Americans to investigate marked racial differences in subclinical CVD between European Americans and African Americans. Studies in development will evaluate the impact of social stress during the lifecourse on CVD risk, and the prevalence of gastroparesis in this diabetes enriched sample. In addition, the ongoing high mortality rate in DHS participants provides novel insights into the increased risks for type 2 diabetes affected individuals. A comprehensive genetic analysis of the sample is underway using the genome-wide association study (GWAS) approach. Data from this GWAS survey will complement prior family-based linkage data in the analysis of genetic contributors to the wide range of traits in the sample. To our knowledge the DHS family of studies has created the most comprehensively examined sample of individuals with type 2 diabetes yet available, and represents a unique resource for the study people with type 2 diabetes. The aim of this review is to provide a collective overview of the major results from the DHS family of studies, and relate them to the larger body of biomedical investigations of diabetes and its complications.
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Affiliation(s)
- Donald W Bowden
- Center for Diabetes Research, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina, USA.
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Effects of MCF2L2, ADIPOQ and SOX2 genetic polymorphisms on the development of nephropathy in type 1 Diabetes Mellitus. BMC MEDICAL GENETICS 2010; 11:116. [PMID: 20667095 PMCID: PMC2919463 DOI: 10.1186/1471-2350-11-116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/28/2010] [Indexed: 11/10/2022]
Abstract
Background MCF2L2, ADIPOQ and SOX2 genes are located in chromosome 3q26-27, which is linked to diabetic nephropathy (DN). ADIPOQ and SOX2 genetic polymorphisms are found to be associated with DN. In the present study, we first investigated the association between MCF2L2 and DN, and then evaluated effects of these three genes on the development of DN. Methods A total of 1177 type 1 diabetes patients with and without DN from the GoKinD study were genotyped with TaqMan allelic discrimination. All subjects were of European descent. Results Leu359Ile T/G variant in the MCF2L2 gene was found to be associated with DN in female subjects (P = 0.017, OR = 0.701, 95%CI 0.524-0.938) but not in males. The GG genotype carriers among female patients with DN had tendency decreased creatinine and cystatin levels compared to the carriers with either TT or TG genotypes. This polymorphism MCF2L2-rs7639705 together with SNPs of ADIPOQ-rs266729 and SOX2-rs11915160 had combined effects on decreased risk of DN in females (P = 0.001). Conclusion The present study provides evidence that MCF2L2, ADIPOQ and SOX2 genetic polymorphisms have effects on the resistance of DN in female T1D patients, and suggests that the linkage with DN in chromosome 3q may be explained by the cumulated genetic effects.
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Ju W, Eichinger F, Bitzer M, Oh J, McWeeney S, Berthier CC, Shedden K, Cohen CD, Henger A, Krick S, Kopp JB, Stoeckert CJ, Dikman S, Schröppel B, Thomas DB, Schlondorff D, Kretzler M, Böttinger EP. Renal gene and protein expression signatures for prediction of kidney disease progression. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 174:2073-85. [PMID: 19465643 DOI: 10.2353/ajpath.2009.080888] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although chronic kidney disease (CKD) is common, only a fraction of CKD patients progress to end-stage renal disease. Molecular predictors to stratify CKD populations according to their risk of progression remain undiscovered. Here we applied transcriptional profiling of kidneys from transforming growth factor-beta1 transgenic (Tg) mice, characterized by heterogeneity of kidney disease progression, to identify 43 genes that discriminate kidneys by severity of glomerular apoptosis before the onset of tubulointerstitial fibrosis in 2-week-old animals. Among the genes examined, 19 showed significant correlation between mRNA expression in uninephrectomized left kidneys at 2 weeks of age and renal disease severity in right kidneys of Tg mice at 4 weeks of age. Gene expression profiles of human orthologs of the 43 genes in kidney biopsies were highly significantly related (R(2) = 0.53; P < 0.001) to the estimated glomerular filtration rates in patients with CKD stages I to V, and discriminated groups of CKD stages I/II and III/IV/V with positive and negative predictive values of 0.8 and 0.83, respectively. Protein expression patterns for selected genes were successfully validated by immunohistochemistry in kidneys of Tg mice and kidney biopsies of patients with IgA nephropathy and CKD stages I to V, respectively. In conclusion, we developed novel mRNA and protein expression signatures that predict progressive renal fibrosis in mice and may be useful molecular predictors of CKD progression in humans.
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Affiliation(s)
- Wenjun Ju
- Dept. of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Pl., Box 1118, New York, NY 10029, USA
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16
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Zhang D, Freedman BI, Flekac M, Santos E, Hicks PJ, Bowden DW, Efendic S, Brismar K, Gu HF. Evaluation of genetic association and expression reduction of TRPC1 in the development of diabetic nephropathy. Am J Nephrol 2008; 29:244-51. [PMID: 18802326 DOI: 10.1159/000157627] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/29/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The TRPC1 gene on chromosome 3q22-24 resides within the linkage region for diabetic nephropathy (DN) in type 1 (T1D) and type 2 diabetes mellitus (T2D). A recent study has demonstrated that TRPC1 expression is reduced in the kidney of diabetic ZDF- and STZ-treated rats. The present study aimed to evaluate the genetic and functional role of TRPC1 in the development of DN. METHODS Genetic association study was performed with two independent cohorts, including 1,177 T1D European Americans with or without DN from GoKinD population and 850 African-American subjects with T2D-associated end-stage renal disease (ESRD), or with hypertensive (non-diabetic) ESRD, and nondiabetic controls. Seven tag SNP markers derived from HapMap data (phase II) were genotyped. TRPC1 gene expression was examined using real time RT-PCR. RESULTS No significant association of TRPC1 DNA polymorphisms with DN or ERSD was found in GoKinD and African-American populations. TRPC1 gene mRNA expression in kidney was found to be trendily reduced in 12-week and significantly in 26-week-old db/db mice. CONCLUSIONS TRPC1 genetic polymorphism may not fundamentally contribute to the development of DN, while reduction of the gene expression in kidney may be a late phenomenon of DN as seen in diabetic animal models.
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Affiliation(s)
- Dongying Zhang
- Rolf Luft Center for Diabetes Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
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Gu W, Zou LX, Shan PF, Chen YD. Analysis of urinary proteomic patterns for diabetic nephropathy by ProteinChip. Proteomics Clin Appl 2008; 2:744-50. [DOI: 10.1002/prca.200780083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Riedl E, Koeppel H, Brinkkoetter P, Sternik P, Steinbeisser H, Sauerhoefer S, Janssen B, van der Woude FJ, Yard BA. A CTG polymorphism in the CNDP1 gene determines the secretion of serum carnosinase in Cos-7 transfected cells. Diabetes 2007; 56:2410-3. [PMID: 17601991 DOI: 10.2337/db07-0128] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, we demonstrated that a polymorphism in exon 2 of the serum carnosinase (CNDP1) gene is associated with susceptibility to developing diabetic nephropathy. Based on the number of CTG repeats in the signal peptide, five different alleles coding for 4, 5, 6, 7, or 8 leucines (4L-8L) are known. Diabetic patients without nephropathy are homozygous for the 5L allele more frequently than those with nephropathy. Since serum carnosinase activity correlates with CNDP1 genotype, we hypothesized in the present study that secretion of serum carnosinase is determined by the CNDP1 genotype. To test this hypothesis, we transfected Cos-7 cells with different CNDP1 constructs varying in CTG repeats and assessed the expression of CNDP1 protein in cell extracts and supernatants. Our results demonstrate that CNDP1 secretion is significantly higher in cells expressing variants with more than five leucines in the signal peptide. Hence, our data might explain why individuals homozygous for the 5L allele have low serum carnosinase activity. Because carnosine, the natural substrate for carnosinase, exerts antioxidative effects and inhibits ACE activity and advanced glycation end product formation, our results support the finding that diabetic patients homozygous for CNDP1 5L are protected against diabetic nephropathy.
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Affiliation(s)
- Eva Riedl
- Department of Nephrology, Endocrinology, and Rheumatology, Fifth Medical Clinic, Mannheim, Germany
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Nakhoul FM, Miller-Lotan R, Awaad H, Asleh R, Levy AP. Hypothesis--haptoglobin genotype and diabetic nephropathy. ACTA ACUST UNITED AC 2007; 3:339-44. [PMID: 17525716 DOI: 10.1038/ncpneph0467] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 02/09/2007] [Indexed: 12/13/2022]
Abstract
Vascular complications cause serious morbidity in patients with diabetes mellitus. Three such complications are nephropathy, retinopathy and accelerated atherosclerotic cardiovascular disease. There is currently scant evidence of a genetic marker that predicts which patients will have vascular complications. Oxidative stress has an important role in the development of diabetic vascular complications. Haptoglobin (Hp) is a hemoglobin-binding protein that has a major role in protecting against heme-driven oxidative stress. There are two common alleles for Hp (1 and 2) and, therefore, three common Hp genotypes: Hp 1-1, Hp 2-1, and Hp 2-2. The antioxidant protection provided by Hp is genotype-dependent; the protein encoded by Hp 1-1 provides superior antioxidant protection compared with that encoded by Hp 2-2. We have shown that diabetic individuals with Hp 2-2 are more likely to develop nephropathy, retinopathy, and cardiovascular disease than those with the Hp 2-1 or Hp 1-1 genotypes.
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Affiliation(s)
- Farid M Nakhoul
- Department of Nephrology, Rambam Health Care Campus, Haifa, Israel.
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Abstract
The incidence and prevalence rates of most forms of chronic kidney disease (CKD) had steadily been increasing for the past 30 years, although these rates now appear to have reached a plateau. It is clear that an individual's likelihood of developing progressive CKD results from complex interactions between multiple genetic and environmental factors. Familial clustering of CKD and end-stage renal disease (ESRD) is observed among all the common etiologies of nephropathy. This article reviews the epidemiology of the familial clustering of kidney disease, as well as potential environmental and genetic contributors. The related impact of familial clustering of cardiovascular disease (CVD) and the impact of CVD on the current epidemic of ESRD is also discussed. It is imperative that nephrologists and primary care physicians recognize that individuals who have relatives with advanced nephropathy are themselves at high risk for subsequent kidney disease, proteinuria, and atherosclerotic cardiovascular complications. Until kidney failure genes are identified, it is reasonable to use "family history" (FH) as a surrogate marker for risk of future nephropathy. The detection of kidney disease genes holds great promise for detecting novel pathways that initiate renal fibrosis and lead to progressive loss of renal function. These pathways are likely to offer new therapies that may slow or halt development of chronic kidney failure.
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Affiliation(s)
- Scott G Satko
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. 27157-1053
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Abstract
Diabetic nephropathy affects approximately one third of diabetic patients and is the leading cause of end-stage renal disease. Identification of genetic susceptibility factors contributing to the development of diabetic nephropathy could facilitate prediction, development of improved treatments, and prevention of this devastating complication of diabetes. Although investigations to identify the causal genetic variants associated with diabetic nephropathy have been inconclusive, new approaches, including whole genome association scanning, offer hope for the future.
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Affiliation(s)
- David A Savage
- Nephrology Research Laboratory, Queen's University Belfast, Regional Genetics Centre, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland.
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Nishida N, Tanabe T, Takasu M, Suyama A, Tokunaga K. Further development of multiplex single nucleotide polymorphism typing method, the DigiTag2 assay. Anal Biochem 2007; 364:78-85. [PMID: 17359929 DOI: 10.1016/j.ab.2007.02.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/02/2007] [Accepted: 02/02/2007] [Indexed: 12/01/2022]
Abstract
A number of single nucleotide polymorphisms (SNPs) are considered to be candidate susceptibility or resistance genetic factors for multifactorial disease. Genome-wide searches for disease susceptibility regions followed by high-resolution mapping of primary genes require cost-effective and highly reliable technology. To accomplish successful and low-cost typing for candidate SNPs, new technologies must be developed. We previously reported a multiplex SNP typing method, designated the DigiTag assay, that has the potential to analyze nearly any SNP with high accuracy and reproducibility. However, the DigiTag assay requires multiple washing steps in manipulation and uses genotyping probes modified with biotin for each target SNP. Here we describe the next version of the assay, DigiTag2, which works with simple protocols and uses unmodified genotyping probes. We investigated the feasibility of the DigiTag2 assay by genotyping 96 target SNPs spanning a 610-kb region of human chromosome 5. The DigiTag2 assay is suitable for genotyping an intermediate number of SNPs (tens to hundreds of sites) with a high conversion rate (>90%), high accuracy, and low cost.
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Affiliation(s)
- Nao Nishida
- Department of Human Genetics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Response to White-Coat and Masked Hypertension: Selective Elevation of Blood Pressure or an Arbitrarily Partitioned Continuum? Hypertension 2006. [DOI: 10.1161/01.hyp.0000228895.91985.8f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Mancia
- Istituto di Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitα Milano-Bicocca, Ospedale San Gerardo, Milan, Italy, and, Istituto Auxologico Italiano, Milan, Italy, and, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Universitα di Milano, Milan-Bicocca, Italy
| | - Rita Facchetti
- Istituto di Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitα Milano-Bicocca, Ospedale San Gerardo, Milan, Italy
| | - Michele Bombelli
- Istituto di Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitα Milano-Bicocca, Ospedale San Gerardo, Milan, Italy
| | - Guido Grassi
- Istituto di Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitα Milano-Bicocca, Ospedale San Gerardo, Milan, Italy, and, Istituto Auxologico Italiano, Milan, Italy, and, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Universitα di Milano, Milan-Bicocca, Italy
| | - Roberto Sega
- Istituto di Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitα Milano-Bicocca, Ospedale San Gerardo, Milan, Italy
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