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Mesfine BB, Vojisavljevic D, Kapoor R, Watson D, Kandasamy Y, Rudd D. Urinary nephrin-a potential marker of early glomerular injury: a systematic review and meta-analysis. J Nephrol 2024; 37:39-51. [PMID: 36808610 PMCID: PMC10920435 DOI: 10.1007/s40620-023-01585-0] [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: 07/14/2022] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Both early recognition of glomerular injury and diagnosis of renal injury remain important problems in clinical settings, and current diagnostic biomarkers have limitations. The aim of this review was to determine the diagnostic accuracy of urinary nephrin for detecting early glomerular injury. METHODS A search was conducted through electronic databases for all relevant studies published until January 31, 2022. The methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, and other estimates of diagnostic accuracy were determined using a random effect model. The Summary Receiver Operating Characteristics (SROC) was used to pool the data and to estimate the area under the curve (AUC). RESULTS The meta-analysis included 15 studies involving 1587 participants. Overall, the pooled sensitivity of urinary nephrin for detecting glomerular injury was 0.86 (95% CI 0.83-0.89) and specificity was 0.73 (95% CI 0.70-0.76). The AUC-SROC to summarise the diagnostic accuracy was 0.90. As a predictor of preeclampsia, urinary nephrin showed a sensitivity of 0.78 (95% CI 0.71-0.84) and specificity of 0.79 (95% CI 0.75-0.82), and as a predictor of nephropathy the sensitivity was 0.90 (95% CI 0.87-0.93), and specificity was 0.62 (95% CI 0.56-0.67). A subgroup analysis using ELISA as a method of diagnosis showed a sensitivity of 0.89 (95% CI 0.86-0.92), and a specificity of 0.72 (95% CI 0.69-0.75). CONCLUSION Urinary nephrin may be a promising marker for the detection of early glomerular injury. ELISA assays appear to provide reasonable sensitivity and specificity. Once translated into clinical practice, urinary nephrin could provide an important addition to a panel of novel markers to help in the detection of acute and chronic renal injury.
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Affiliation(s)
- Belete Biadgo Mesfine
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia
- College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia
| | - Danica Vojisavljevic
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia
| | - Ranjna Kapoor
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia
| | - David Watson
- Maternal Fetal Medicine Unit and Department of Obstetrics and Gynaecology, Townsville University Hospital, Townsville, Australia
| | - Yogavijayan Kandasamy
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia
- Townsville University Hospital, 100 Angus Smith Dr, Douglas, QLD, 4814, Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia.
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Kostovska I, Trajkovska KT, Topuzovska S, Cekovska S, Labudovic D, Kostovski O, Spasovski G. Nephrinuria and podocytopathies. Adv Clin Chem 2022; 108:1-36. [PMID: 35659057 DOI: 10.1016/bs.acc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The discovery of nephrin in 1998 has launched a new era in glomerular diseases research, emphasizing its crucial role in the structure and function of the glomerular filtration barrier. In the past 20 years, substantial advances have been made in understanding podocyte structure and function as well as the discovery of several podocyte-related proteins including nephrin. The glomerular filtration barrier is comprised of podocytes, the glomerular basement membrane and endothelial cells. Podocytes, with their specialized slit diaphragm, form the essential backbone of the glomerular filtration barrier. Nephrin is a crucial structural and functional feature of the slit diaphragm that prevents plasma protein, blood cell and macromolecule leakage into the urine. Podocyte damage results in nephrin release. Podocytopathies are kidney diseases in which podocyte damage drives proteinuria, i.e., nephrotic syndrome. Many kidney diseases involve podocytopathy including congenital nephrotic syndrome of Finnish type, diffuse mesangial sclerosis, minimal change disease, focal segmental glomerulosclerosis, collapsing glomerulonephropathy, diabetic nephropathy, lupus nephropathy, hypertensive nephropathy and preeclampsia. Recently, urinary nephrin measurement has become important in the early detection of podocytopathies. In this chapter, we elaborate the main structural and functional features of nephrin as a podocyte-specific protein, pathomechanisms of podocytopathies which result in nephrinuria, highlight the most commonly used methods for detecting urinary nephrin and investigate the diagnostic, prognostic and potential therapeutic relevance of urinary nephrin in primary and secondary proteinuric kidney diseases.
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Affiliation(s)
- Irena Kostovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia.
| | - Katerina Tosheska Trajkovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Sonja Topuzovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Svetlana Cekovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Danica Labudovic
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Ognen Kostovski
- University Clinic of Abdominal Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Goce Spasovski
- University Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
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Boutari C, Pappas PD, Theodoridis TD, Vavilis D. Humanin and diabetes mellitus: A review of in vitro and in vivo studies. World J Diabetes 2022; 13:213-223. [PMID: 35432758 PMCID: PMC8984571 DOI: 10.4239/wjd.v13.i3.213] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Humanin (HN) is a 24-amino acid mitochondrial-derived polypeptide with cyto-protective and anti-apoptotic effects that regulates the mitochondrial functions under stress conditions. Accumulating evidence suggests the role of HN against age-related diseases, such as Alzheimer’s disease. The decline in insulin action is a metabolic feature of aging and thus, type 2 diabetes mellitus is considered an age-related disease, as well. It has been suggested that HN increases insulin sensitivity, improves the survival of pancreatic beta cells, and delays the onset of diabetes, actions that could be deployed in the treatment of diabetes. The aim of this review is to present the in vitro and in vivo studies that examined the role of HN in insulin resistance and diabetes and to discuss its newly emerging role as a therapeutic option against those conditions.
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Affiliation(s)
- Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Panagiotis D Pappas
- First Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
| | - Theodoros D Theodoridis
- First Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
| | - Dimitrios Vavilis
- First Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
- Medical School, University of Cyprus, Nicosia, Cyprus 20537 1678, Cyprus
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4
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Peng L, Chen Y, Shi S, Wen H. Stem cell-derived and circulating exosomal microRNAs as new potential tools for diabetic nephropathy management. Stem Cell Res Ther 2022; 13:25. [PMID: 35073973 PMCID: PMC8785577 DOI: 10.1186/s13287-021-02696-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite major advances in the treatment of diabetic nephropathy (DN) in recent years, it remains the most common cause of end-stage renal disease. An early diagnosis and therapy may slow down the DN progression. Numerous potential biomarkers are currently being researched. Circulating levels of the kidney-released exosomes and biological molecules, which reflect the DN pathology including glomerular and tubular dysfunction as well as mesangial expansion and fibrosis, have shown the potential for predicting the occurrence and progression of DN. Moreover, many experimental therapies are currently being investigated, including stem cell therapy and medications targeting inflammatory, oxidant, or pro-fibrotic pathways activated during the DN progression. The therapeutic potential of stem cells is partly depending on their secretory capacity, particularly exosomal microRNAs (Exo-miRs). In recent years, a growing line of research has shown the participation of Exo-miRs in the pathophysiological processes of DN, which may provide effective therapeutic and biomarker tools for DN treatment. METHODS A systematic literature search was performed in MEDLINE, Scopus, and Google Scholar to collect published findings regarding therapeutic stem cell-derived Exo-miRs for DN treatment as well as circulating Exo-miRs as potential DN-associated biomarkers. FINDINGS Glomerular mesangial cells and podocytes are the most important culprits in the pathogenesis of DN and, thus, can be considered valuable therapeutic targets. Preclinical investigations have shown that stem cell-derived exosomes can exert beneficial effects in DN by transferring renoprotective miRs to the injured mesangial cells and podocytes. Of note, renoprotective Exo-miR-125a secreted by adipose-derived mesenchymal stem cells can improve the injured mesangial cells, while renoprotective Exo-miRs secreted by adipose-derived stem cells (Exo-miR-486 and Exo-miR-215-5p), human urine-derived stem cells (Exo-miR-16-5p), and bone marrow-derived mesenchymal stem cells (Exo-miR-let-7a) can improve the injured podocytes. On the other hand, clinical investigations have indicated that circulating Exo-miRs isolated from urine or serum hold great potential as promising biomarkers in DN.
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Affiliation(s)
- Lei Peng
- Department of Nephrology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yu Chen
- Department of Cardiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Shaoqing Shi
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
| | - Heling Wen
- Department of Cardiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
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5
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Urinary podocyte markers in kidney diseases. Clin Chim Acta 2021; 523:315-324. [PMID: 34666027 DOI: 10.1016/j.cca.2021.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Podocytes play an important role in the maintenance of kidney function, and they are the primary focus of many kidney diseases. Podocyte injury results in the shedding of podocyte-derived cellular fragments and podocyte-specific molecular targets into the urine, which may serve as biomarkers of kidney diseases. Intact podocytes, either viable or dead, and podocyte-derived microvesicles could be quantified in the urine by various centrifugation, visualization and culture methods. Podocyte-specific protein targets from the nucleus, cytoplasm, slit-diaphragm, glomerular capillary basement membrane, and cytoskeleton, as well as their corresponding messenger RNA (mRNA), in the urine could be quantified by western blotting, ELISA, or quantitative polymerase chain reaction. Although some of these techniques may be expensive or labor-intensive at present, they may become widely available in the future because of the improvement in technology and automation. The application of urinary podocyte markers for the diagnosis and monitoring of various kidney diseases have been explored but the published data in this area are not sufficiently systematic and lack external validation. Further research should focus on standardizing, comparing, and automizing laboratory methods, as well as defining their added value to the routine clinical tests.
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Kravets I, Mallipattu SK. The Role of Podocytes and Podocyte-Associated Biomarkers in Diagnosis and Treatment of Diabetic Kidney Disease. J Endocr Soc 2020; 4:bvaa029. [PMID: 32232184 PMCID: PMC7093089 DOI: 10.1210/jendso/bvaa029] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
Diabetic kidney disease (DKD) is an important public health problem. Podocyte injury is a central event in the mechanism of DKD development. Podocytes are terminally differentiated, highly specialized glomerular visceral epithelial cells critical for the maintenance of the glomerular filtration barrier. Although potential mechanisms by which diabetic milieu contributes to irreversible loss of podocytes have been described, identification of markers that prognosticate either the development of DKD or the progression to end-stage kidney disease (ESKD) have only recently made it to the forefront. Currently, the most common marker of early DKD is microalbuminuria; however, this marker has significant limitations: not all diabetic patients with microalbuminuria will progress to ESKD and as many as 30% of patients with DKD have normal urine albumin levels. Several novel biomarkers indicating glomerular or tubular damage precede microalbuminuria, suggesting that the latter develops when significant kidney injury has already occurred. Because podocyte injury plays a key role in DKD pathogenesis, identification of markers of early podocyte injury or loss may play an important role in the early diagnosis of DKD. Such biomarkers in the urine include podocyte-released microparticles as well as expression of podocyte-specific markers. Here, we review the mechanisms by which podocyte injury contributes to DKD as well as key markers that have been recently implicated in the development and/or progression of DKD and might serve to identify individuals that require earlier preventative care and treatment in order to slow the progression to ESKD.
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Affiliation(s)
- Igor Kravets
- Division of Endocrinology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Sandeep K Mallipattu
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
- Renal Section, Northport VA Medical Center, Northport, NY
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7
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Fayed A, Rahman Tohamy IA, Kahla H, Elsayed NM, El Ansary M, Saadi G. Urinary podocyte-associated mRNA profile in Egyptian patients with diabetic nephropathy. Diabetes Metab Syndr 2019; 13:2849-2854. [PMID: 31425946 DOI: 10.1016/j.dsx.2019.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Podocyte injury and subsequent excretion in urine play a crucial role in the pathogenesis and progression of diabetic nephropathy (DN). Quantification of messenger RNA expression in urinary sediment by real-time PCR is emerging as a noninvasive method of screening DN-associated biomarkers. We aimed to study the expression of podocyte-associated genes in urinary sediment and their relation to disease severity in type 2 diabetic Egyptian patients with diabetic nephropathy. METHOD ology: Sixty patients with type 2 diabetes mellitus were recruited in addition to twenty non diabetic healthy volunteers. Relative mRNA abundance of nephrin, podocalyxin, and podocin were quantified, and correlations between target mRNAs and clinical parameters were examined. RESULTS The urinary mRNA levels of all genes studied were significantly higher in diabetics compared with controls (p < 0.001), and mRNA levels increased with DN progression. Urinary mRNA levels of all target genes positively correlated with both UAE and HbA1c. The expression of nephrin, podocalyxin, and podocin mRNA correlated with serum creatinine {(r = 0.397, p value = 0.002), (r = 0.431, p value = 0.001), (r = 0.433, p value = 0.001) respectively}. CONCLUSION The urinary mRNA profiles of nephrin, podocalyxin, and podocin were found to increase with the progression of DN, which suggested that quantification of podocyte-associated molecules will be useful biomarkers of DN.
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Affiliation(s)
- Ahmed Fayed
- Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt.
| | | | - Hala Kahla
- Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Naglaa M Elsayed
- Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Mervat El Ansary
- Clinical Pathology Department, School of Medicine, Cairo University, Egypt
| | - Gamal Saadi
- Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
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8
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Yin H, Zhang X, Li K, Li Z, Yang Z. Effects of miR-200b-3p inhibition on the TRPC6 and BK Ca channels of podocytes. Arch Biochem Biophys 2018; 653:80-89. [PMID: 29958896 DOI: 10.1016/j.abb.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
Abstract
Transient receptor potential canonical 6 (TRPC6) and large-conductance Ca2+-activated K+ channels (BKCa), two of the key ion channels for blood filtration function of podocytes, have been implicated in the pathogenesis of kidney diseases. Moreover, it has been reported that miR-200 b plays an important role in regulating the biological processes of podocytes. In this study, we aimed to examine whether there was a relationship between miR-200 b-3p and the two ion channels. It was suggested that miR-200 b-3p down-regulation inhibited the currents of TRPC6 and BKCa channels. It also showed that miR-200 b-3p inhibition reduced the levels of protein expression and mRNA transcription of TRPC6 and BKCa channels. Moreover, the down-regulation of miR-200 b-3p resulted in the decrease of the intracellular Ca2+ concentration. It was also suggested that the decrease of BKCa currents resulting from miR-200 b-3p inhibition could be regulated by TRPC6 channels. TRPC6 blockage also inhibited BKCa currents and reduced the level of BKCa expression. These results together suggested that miR-200 b-3p inhibition reduced the currents of TRPC6, which led to the decrease of intracellular Ca2+ concentration. The decrease of Ca2+ source required for BKCa activation may result in the inhibition of BKCa currents.
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Affiliation(s)
- Hongqiang Yin
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, Tianjin, 300071, China
| | - Xiaochen Zhang
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, Tianjin, 300071, China
| | - Kai Li
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, Tianjin, 300071, China
| | - Zhigui Li
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, Tianjin, 300071, China; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Zhuo Yang
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, Tianjin, 300071, China.
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Abstract
Diabetic kidney disease (DKD) remains one of the leading causes of reduced lifespan in diabetes. The quest for both prognostic and surrogate endpoint biomarkers for advanced DKD and end-stage renal disease has received major investment and interest in recent years. However, at present no novel biomarkers are in routine use in the clinic or in trials. This review focuses on the current status of prognostic biomarkers. First, we emphasise that albuminuria and eGFR, with other routine clinical data, show at least modest prediction of future renal status if properly used. Indeed, a major limitation of many current biomarker studies is that they do not properly evaluate the marginal increase in prediction on top of these routinely available clinical data. Second, we emphasise that many of the candidate biomarkers for which there are numerous sporadic reports in the literature are tightly correlated with each other. Despite this, few studies have attempted to evaluate a wide range of biomarkers simultaneously to define the most useful among these correlated biomarkers. We also review the potential of high-dimensional panels of lipids, metabolites and proteins to advance the field, and point to some of the analytical and post-analytical challenges of taking initial studies using these and candidate approaches through to actual clinical biomarker use.
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Affiliation(s)
- Helen M Colhoun
- MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
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10
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Cao S, Liu YG. [Research advances in the association between transient receptor potential cation channel 6 and kidney disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:72-76. [PMID: 29335087 PMCID: PMC7390320 DOI: 10.7499/j.issn.1008-8830.2018.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
Transient receptor potential cation channel 6 (TRPC6) is a member of the transient receptor superfamily encoded by the TRPC6 gene and is widely expressed in tissues and organs of the human body, especially in the glomerular podocytes. TRPC6 interacts with various slit diaphragm (SD) proteins including podocin, nephrin, ACTN4, and CD2AP to maintain the normal structure and function of glomerular podocytes. Foot process fusion caused by podocyte damage due to various factors is the most important morphological change in kidney disease. This article reviews the biological function of TRPC6 and its effect on kidney disease.
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Affiliation(s)
- Shan Cao
- Graduate School of Youjiang University for Nationalities, Baise, Gangxi 533000, China.
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11
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Campion CG, Sanchez-Ferras O, Batchu SN. Potential Role of Serum and Urinary Biomarkers in Diagnosis and Prognosis of Diabetic Nephropathy. Can J Kidney Health Dis 2017; 4:2054358117705371. [PMID: 28616250 PMCID: PMC5461910 DOI: 10.1177/2054358117705371] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/17/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE OF REVIEW Diabetic nephropathy (DN) is a progressive kidney disease caused by alterations in kidney architecture and function, and constitutes one of the leading causes of end-stage renal disease (ESRD). The purpose of this review is to summarize the state of the art of the DN-biomarker field with a focus on the new strategies that enhance the sensitivity of biomarkers to predict patients who will develop DN or are at risk of progressing to ESRD. OBJECTIVE In this review, we provide a description of the pathophysiology of DN and propose a panel of novel putative biomarkers associated with DN pathophysiology that have been increasingly investigated for diagnosis, to predict disease progression or to provide efficient personal treatment. METHODS We performed a review of the literature with PubMed and Google Scholar to collect baseline data about the pathophysiology of DN and biomarkers associated. We focused our research on new and emerging biomarkers of DN. KEY FINDINGS In this review, we summarized the critical signaling pathways and biological processes involved in DN and highlighted the pathogenic mediators of this disease. We next proposed a large review of the major advances that have been made in identifying new biomarkers which are more sensitive and reliable compared with currently used biomarkers. This includes information about emergent biomarkers such as functional noncoding RNAs, microRNAs, long noncoding RNAs, exosomes, and microparticles. LIMITATIONS Despite intensive strategies and constant investigation, no current single treatment has been able to reverse or at least mitigate the progression of DN, or reduce the morbidity and mortality associated with this disease. Major difficulties probably come from the renal disease being heterogeneous among the patients. IMPLICATIONS Expanding the proteomics screening, including oxidative stress and inflammatory markers, along with metabolomics approaches may further improve the prognostic value and help in identifying the patients with diabetes who are at high risk of developing kidney diseases.
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Affiliation(s)
- Carole G. Campion
- Centre de recherche, Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Oraly Sanchez-Ferras
- Department of Biochemistry, Goodman Cancer Research Centre, McGill University, Montreal, Québec, Canada
| | - Sri N. Batchu
- St. Michael’s Hospital, University of Toronto, Ontario, Canada
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Zhai L, Gu J, Yang D, Hu W, Wang W, Ye S. Metformin ameliorates podocyte damage by restoring renal tissue nephrin expression in type 2 diabetic rats. J Diabetes 2017; 9:510-517. [PMID: 27248136 DOI: 10.1111/1753-0407.12437] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 05/14/2016] [Accepted: 05/26/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies found that metformin provided some renoprotection for diabetic renal damage. In the present study, we evaluated the effects of different doses of metformin on the expression of renal tissue nephrin in type 2 diabetes mellitus (T2DM) model rats and the possible mechanism underlying its protective effect in kidney podocytes. METHODS A high-fat diet combined with a low dose of streptozotocin was used to induce T2DM model rats. Diabetic rats were treated with 150, 300, or 500 mg/kg metformin for 8 weeks. At the end of the study, urine and blood samples were collected for measurement of different indices. Light microscopy and transmission electron microscopy were used to identify morphological changes. Renal expression of nephrin protein was assayed by immunohistochemical staining, whereas real-time polymerase chain reaction was used to detect renal nephrin (Nphs1) mRNA expression. RESULTS Metformin treatment of T2DM rats produced dose-dependent significant reductions in urinary albumin and nephrin concentrations, glomerular basement membrane thickness (GBMT), and the foot process fusion rate (FPFR) compared with control T2DM model rats, whereas renal expression of nephrin protein and Nphs1 mRNA was dose-dependently increased by metformin treatment. CONCLUSION Metformin protects kidney podocytes in T2DM model rats by dose-dependently adjusting renal nephrin expression.
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MESH Headings
- Albuminuria/urine
- Animals
- Blood Glucose/analysis
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/etiology
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/genetics
- Diet, High-Fat/adverse effects
- Dose-Response Relationship, Drug
- Gene Expression/drug effects
- Glycated Hemoglobin/analysis
- Hypoglycemic Agents/pharmacology
- Immunohistochemistry
- Insulin/blood
- Kidney/drug effects
- Kidney/metabolism
- Kidney/ultrastructure
- Male
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Membrane Proteins/urine
- Metformin/pharmacology
- Microscopy, Electron, Transmission
- Podocytes/drug effects
- Podocytes/metabolism
- Podocytes/pathology
- Rats, Sprague-Dawley
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- Limin Zhai
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Junfei Gu
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Di Yang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Wen Hu
- Department of Pathology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Wei Wang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Shandong Ye
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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Ilyas Z, Chaiban JT, Krikorian A. Novel insights into the pathophysiology and clinical aspects of diabetic nephropathy. Rev Endocr Metab Disord 2017; 18:21-28. [PMID: 28289965 DOI: 10.1007/s11154-017-9422-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Diabetic nephropathy (DN) is a well-described complication of diabetes mellitus and the leading cause of end stage renal disease (ESRD). Although increased albuminuria has been the gold standard for screening, data suggests that renal damage starts long before the onset of clinically apparent increases in macro and even micro-albuminuria. Clinical practice guidelines for the prevention of DN have been traditionally focused on the control of serum glucose, blood pressure and dyslipidemia, with some focus on the renin-angiotensin-aldosterone system (RAAS) as a main target for successful therapy. Recent evidence has led to a better understanding of the underlying mechanisms of the pathophysiology of this disease and suggests that various novels pathways can be targeted to delay and even prevent the progression of DN. Hence a more comprehensive therapeutic approach to therapy is on the horizon, carrying the promise for a more successful and impactful management. This review will highlight new insights into the pathophysiology, clinical aspects and future diagnostic and therapeutic modalities for DN.
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Affiliation(s)
- Zubair Ilyas
- Department of Internal Medicine, University of Illinois at Chicago, Advocate Christ Medical Center, Chicago, IL, USA
| | - Joumana T Chaiban
- Department of Internal Medicine, University of Illinois at Chicago, Advocate Christ Medical Center, Chicago, IL, USA
- Division of Endocrinology, Advocate Christ Medical Center, Chicago, IL, USA
| | - Armand Krikorian
- Department of Internal Medicine, University of Illinois at Chicago, Advocate Christ Medical Center, Chicago, IL, USA.
- Division of Endocrinology, Advocate Christ Medical Center, Chicago, IL, USA.
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Fakhruddin S, Alanazi W, Jackson KE. Diabetes-Induced Reactive Oxygen Species: Mechanism of Their Generation and Role in Renal Injury. J Diabetes Res 2017; 2017:8379327. [PMID: 28164134 PMCID: PMC5253173 DOI: 10.1155/2017/8379327] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023] Open
Abstract
Diabetes induces the onset and progression of renal injury through causing hemodynamic dysregulation along with abnormal morphological and functional nephron changes. The most important event that precedes renal injury is an increase in permeability of plasma proteins such as albumin through a damaged glomerular filtration barrier resulting in excessive urinary albumin excretion (UAE). Moreover, once enhanced UAE begins, it may advance renal injury from progression of abnormal renal hemodynamics, increased glomerular basement membrane (GBM) thickness, mesangial expansion, extracellular matrix accumulation, and glomerulosclerosis to eventual end-stage renal damage. Interestingly, all these pathological changes are predominantly driven by diabetes-induced reactive oxygen species (ROS) and abnormal downstream signaling molecules. In diabetic kidney, NADPH oxidase (enzymatic) and mitochondrial electron transport chain (nonenzymatic) are the prominent sources of ROS, which are believed to cause the onset of albuminuria followed by progression to renal damage through podocyte depletion. Chronic hyperglycemia and consequent ROS production can trigger abnormal signaling pathways involving diverse signaling mediators such as transcription factors, inflammatory cytokines, chemokines, and vasoactive substances. Persistently, increased expression and activation of these signaling molecules contribute to the irreversible functional and structural changes in the kidney resulting in critically decreased glomerular filtration rate leading to eventual renal failure.
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Affiliation(s)
- Selim Fakhruddin
- Department of Basic Pharmaceutical Sciences, School of Pharmacy, University of Louisiana at Monroe (ULM), Pharmacy Building, 1800 Bienville Dr., Monroe, LA 71201, USA
| | - Wael Alanazi
- Department of Basic Pharmaceutical Sciences, School of Pharmacy, University of Louisiana at Monroe (ULM), Pharmacy Building, 1800 Bienville Dr., Monroe, LA 71201, USA
| | - Keith E. Jackson
- Department of Basic Pharmaceutical Sciences, School of Pharmacy, University of Louisiana at Monroe (ULM), Pharmacy Building, 1800 Bienville Dr., Monroe, LA 71201, USA
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Petrica L, Ursoniu S, Gadalean F, Vlad A, Gluhovschi G, Dumitrascu V, Vlad D, Gluhovschi C, Velciov S, Bob F, Matusz P, Milas O, Secara A, Simulescu A, Popescu R. Urinary podocyte-associated mRNA levels correlate with proximal tubule dysfunction in early diabetic nephropathy of type 2 diabetes mellitus. Diabetol Metab Syndr 2017; 9:31. [PMID: 28484521 PMCID: PMC5420400 DOI: 10.1186/s13098-017-0228-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
Abstract
AIM The study assessed mRNA expression of podocyte-associated molecules in urinary sediments of patients with type 2 diabetes mellitus (DM) in relation to urinary podocytes, biomarkers of podocyte injury and of proximal tubule (PT) dysfunction. METHODS A total of 76 patients with type 2 DM and 20 healthy subjects were enrolled in a cross-sectional study, and assessed concerning urinary podocytes, urinary mRNA of podocyte-associated genes, urinary biomarkers of podocyte damage and of PT dysfunction. RESULTS We found significant differences between urinary mRNA of podocyte-associated molecules in relation with albuminuria stage. In multivariable regression analysis, urinary mRNA of nephrin, podocin, alpha-actinin-4, CD2-associated protein, glomerular epithelial protein 1 (GLEPP1), ADAM 10, and NFκB correlated directly with urinary podocytes, albuminuria, urinary alpha1-microglobulin, urinary kidney-injury molecule-1, nephrinuria, urinary vascular endothelial growth factor, urinary advanced glycation end-products (AGE), and indirectly with eGFR (p < 0.0001, R2 = 0.808; p < 0.0001, R2 = 0.825; p < 0.0001, R2 = 0.805; p < 0.0001, R2 = 0.663; p < 0.0001, R2 = 0.726; p < 0.0001, R2 = 0.720; p < 0.0001, R2 = 0.724). CONCLUSIONS In patients with type 2 DM there is an association between urinary mRNA of podocyte-associated molecules, biomarkers of podocyte damage, and of PT dysfunction. GLEPP1, ADAM10, and NFκB may be considered additional candidate molecules indicative of early diabetic nephropathy. AGE could be involved in this association.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- Centre for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Public Health Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Adrian Vlad
- Department of Diabetes and Metabolic Diseases, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Petru Matusz
- Department of Anatomy and Embryology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Oana Milas
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Roxana Popescu
- Department of Cellular and Molecular Biology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
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Mariana CP, Ramona PA, Ioana BC, Diana M, Claudia RC, Stefan VD, Maria KI. Urinary angiotensin converting enzyme 2 is strongly related to urinary nephrin in type 2 diabetes patients. Int Urol Nephrol 2016; 48:1491-7. [PMID: 27312782 DOI: 10.1007/s11255-016-1334-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/23/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE Podocyte lesion is recently recognized as an early event in diabetic kidney disease (DKD) and is reflected by urinary (u) nephrin (Neph) shedding. Angiotensin II plays an important role in podocyte dysfunction of diabetes. Angiotensin converting enzyme 2 (ACE2) is the main ACE variant in podocytes and counteracts deleterious angiotensin II effects. We assessed for the first time the relation of uACE2 and uNeph in type 2 diabetes subjects. MATERIAL AND METHOD Seventy-five type 2 diabetes patients were included in a transversal study. History, clinical and laboratory data, urinary albumin-to-creatinine ratio (uACR), and ELISA determination of uNeph and uACE2 were obtained. RESULTS uNeph was 349.00 ± 133.42 pg/ml, and uACE2 was 45.50 (36.35-62.60) pg/ml. uNeph correlated to uACE2 (r = 0.44, p < 0.001) and to uACR (r = 0.25, p = 0.032). In multivariate regression, introducing parameters that are known to be related to DKD, uACE2 (p < 0.0001), LDL cholesterol (p = 0.02) and glycated hemoglobin (p = 0.03) remained significant predictors of uNeph. Normoalbuminuric patients had lower uNeph than patients with uACR > 30 mg/g (325.50 ± 135.45 vs 391.03 ± 121.40 pg/ml, p = 0.04); they also had a tendency versus lower uACE2 [41.40 (34.30-60.65) vs 52.57 (37.95-69.85) pg/ml, p = 0.06]. A cutoff for uNeph of 451.6 pg/ml was derived from the ROC curve analysis; uACE2 was the main determinant for uNeph being above or below this cutoff-OR = 1.09; 95 %CI (1.04-1.15), p = 0.001. Patients taking blockers of the renin angiotensin system had similar uNeph and uACE2. uNeph and uACE2 were not influenced by renal function. CONCLUSION uNeph is significantly correlated to uACE2 and uACR in type 2 diabetes patients.
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Affiliation(s)
- Ciorba Pop Mariana
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Potra Alina Ramona
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania.
| | - Bondor Cosmina Ioana
- Department of Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 6 Pasteur Street, 400349, Cluj-Napoca, Romania
| | - Moldovan Diana
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Rusu Crina Claudia
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Vladutiu Dan Stefan
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Kacso Ina Maria
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
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Voigt A, Jelinek HF. Humanin: a mitochondrial signaling peptide as a biomarker for impaired fasting glucose-related oxidative stress. Physiol Rep 2016; 4:e12796. [PMID: 27173674 PMCID: PMC4873641 DOI: 10.14814/phy2.12796] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 01/13/2023] Open
Abstract
Mitochondrial RNR-2 (mt-RNR2, humanin) has been shown to play a role in protecting several types of cells and tissues from the effects of oxidative stress. Humanin (HN) functions through extracellular and intracellular pathways adjusting mitochondrial oxidative phosphorylation and ATP production. Addition of HN improved insulin sensitivity in animal models of diabetes mellitus but no clinical studies have been carried out to measure HN levels in humans associated with hyperglycemia. The plasma levels of HN in participants attending a diabetes complications screening clinic were measured. Clinical history and anthropometric data were obtained from all participants. Plasma levels of HN were measured by a commercial ELISA kit. All data were analyzed applying nonparametric statistics and general linear modeling to correct for age and gender. A significant decrease (P = 0.0001) in HN was observed in the impaired fasting glucose (IFG) group (n = 23; 204.84 ± 92.87 pg mL(-1)) compared to control (n = 58; 124.3 ± 83.91 pg mL(-1)) consistent with an adaptive cellular response by HN to a slight increase in BGL.
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Affiliation(s)
- Annet Voigt
- Department of Biochemistry, Freie Universität Berlin, Berlin, Germany School of Community Health and Centre for Research in Complex Systems, Charles Sturt University, Bathurst, Australia
| | - Herbert F Jelinek
- School of Community Health and Centre for Research in Complex Systems, Charles Sturt University, Bathurst, Australia Division of Cardiology, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies. Curr Diab Rep 2016; 16:11. [PMID: 26803647 PMCID: PMC5841446 DOI: 10.1007/s11892-015-0708-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
- Department of Medicine, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
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Pereira SV, Dos Santos M, Rodrigues PG, do Nascimento JF, Timm JRT, Zancan R, Friedman R, Veronese FV. Increased urine podocyte-associated messenger RNAs in severe obesity are evidence of podocyte injury. Obesity (Silver Spring) 2015; 23:1643-9. [PMID: 26147062 DOI: 10.1002/oby.21156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/15/2015] [Accepted: 04/20/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to correlate different degrees of excess weight with the expression of podocyte-associated messenger RNAs (mRNAs) in urine. METHODS The sample comprised 83 patients with overweight or obesity class I, II, or III and 18 healthy controls. The expression of nephrin, podocin, podocalyxin, α-actinin-4, α3β1integrin, vascular endothelial growth factor, and transforming growth factor-beta (TGF-β1 ) mRNA in urine was quantified with the real-time polymerase chain reaction. mRNA expression was correlated with body mass index, the metabolic syndrome, albuminuria, and inflammation. RESULTS Adults with obesity class III had higher levels of serum lipids, glucose, HbA1C, insulin resistance, and C-reactive protein (P < 0.05), with 85% of the subjects meeting criteria for the metabolic syndrome (P < 0.001 vs. other groups). Urinary podocyte-associated mRNAs were higher in adults with obesity class III than in other groups (P < 0.05). Patients with overweight or obesity class I or II also had higher levels of podocyte mRNAs than controls: nephrin (P = 0.021), α-actinin-4 (P = 0.014), α3β1integrin (P = 0.036), and TGF-β1 (P = 0.005). Metabolic syndrome, hyperinsulinemia, and C-reactive protein were correlated with podocyturia, but only higher insulin levels were related regardless of obesity. CONCLUSIONS Severe obesity and hyperinsulinemia were associated with higher urinary expression of podocyte-associated mRNAs, even at normal urinary albumin excretion rates.
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Affiliation(s)
- Sane Vianna Pereira
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mariane Dos Santos
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia Garcia Rodrigues
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jonathan Fraportti do Nascimento
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - João Rodolfo Teló Timm
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Zancan
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Friedman
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Francisco Veríssimo Veronese
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Fiseha T. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients. Biomark Res 2015; 3:16. [PMID: 26146561 PMCID: PMC4491239 DOI: 10.1186/s40364-015-0042-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid–binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Xing Y, Ye S, Chen Y, Hu W, Chen Y. Hydrochloride pioglitazone protects diabetic rats against podocyte injury through preserving glomerular podocalyxin expression. ACTA ACUST UNITED AC 2015; 58:630-9. [PMID: 25211446 DOI: 10.1590/0004-2730000003141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/04/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We sought to test the effect of different dosages of pioglitazone (PIO) on the glomerular expression of podocalyxin and urinary sediment podocalyxin excretion and to explore the potential renoprotective mechanism. MATERIALS AND METHODS Type 1 diabetes induced with streptozotocin (65 mg/kg) in 36 male Sprague-Dawley rats were randomly allocated to be treated with vehicle or 10, 20, 30 mg/kg/d PIO respectively for 8 weeks. Eight rats were enrolled in the normal control group. RESULTS At 8th week, rats were sacrificed for the observation of kidney injury through electron microscope. Glomerular podocalyxin production including mRNA and protein were determined by RT-PCR and immunohistochemistry respectively. Levels of urinary albumin excretion and urinary sediment podocalyxin, kidney injury index were all significantly increased, whereas expression of glomerular podocalyxin protein and mRNA were decreased significantly in diabetic rats compared to normal control. Dosages-dependent analysis revealed that protective effect of PIO ameliorated the physiopathological changes and reached a peak at dosage of 20 mg/kg/d. CONCLUSION PIO could alleviate diabetic kidney injury in a dose-dependent pattern and the role may be associated with restraining urinary sediment podocalyxin excretion and preserving the glomerular podocalyxin expression.
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Affiliation(s)
- Yan Xing
- Department of Endocrinology, Anhui Provincial Hospital, Hefei, China
| | - Shandong Ye
- Department of Endocrinology, Anhui Provincial Hospital, Hefei, China
| | - Yumi Chen
- Department of Nephrology, Anhui Provincial Hospital, Hefei, China
| | - Wen Hu
- Department of Pathology, Anhui Provincial Hospital, Hefei, China
| | - Yan Chen
- Endocrinological Laboratory, Anhui Provincial Hospital, Hefei, China
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22
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Zhai L, Gu J, Yang D, Wang W, Ye S. Metformin Ameliorates Podocyte Damage by Restoring Renal Tissue Podocalyxin Expression in Type 2 Diabetic Rats. J Diabetes Res 2015; 2015:231825. [PMID: 26075281 PMCID: PMC4444588 DOI: 10.1155/2015/231825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/18/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022] Open
Abstract
Podocalyxin (PCX) is a signature molecule of the glomerular podocyte and of maintaining integrity of filtration function of glomerulus. The aim of this study was to observe the effect of different doses of metformin on renal tissue PCX expression in type 2 diabetic rats and clarify its protection on glomerular podocytes. Type 2 diabetic Sprague-Dawley (SD) rats in which diabetes was induced by high-fat diet/streptozotocin (HFD-STZ) were treated with different doses of metformin (150, 300, and 500 mg/kg per day, resp.) for 8 weeks. Various biochemical parameters, kidney histopathology, and renal tissue PCX expression levels were examined. In type 2 diabetic rats, severe hyperglycemia and hyperlipidemia were developed. Urinary albumin and PCX were markedly increased. Diabetes induced significant alterations in renal glomerular structure. In addition, protein and mRNA expression of renal tissue PCX were highly decreased. However, treatment of rats with different doses of metformin restored all these changes to a varying degree. These results suggested that metformin can ameliorate glomerular podocyte damage in type 2 diabetic rats, which may be partly associated with its role in restoring PCX expression and inhibiting urinary excretion of PCX with dose dependence.
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Affiliation(s)
- Limin Zhai
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Junfei Gu
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Di Yang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Wei Wang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Shandong Ye
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
- *Shandong Ye:
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Canales CP, Krall P, Kairath P, Perez IC, Fragoso MA, Carmona-Mora P, Ruiz P, Reiser J, Young JI, Walz K. Characterization of a Trpc6 Transgenic Mouse Associated with Early Onset FSGS. ACTA ACUST UNITED AC 2015; 5:1198-2012. [PMID: 34012910 PMCID: PMC8130885 DOI: 10.9734/bjmmr/2015/12493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rationale: Mutations in Transient Receptor Potential Channel 6 (TRPC6) gene are associated with autosomal dominant focal and segmental glomerulosclerosis (FSGS). The majority of the identified mutations affect the ion channel function. Since calcium channels are promising candidate drug targets, there is an an urgent need for a mouse model to assess new therapeutic drugs and to help delineate the pathogenic process leading to FSGS. We have previously reported the generation of three independent transgenic mouse lines carrying different Trpc6 mutations that display a glomerular disease comparable to the phenotype presented by individuals with FSGS. However, the utility of these models for drug testing is dampened by the late-onset of the presentation and the mild phenotypic manifestations. Methodology: In order to obtain a time-effective mouse model for Trpc6-associated FSGS we generated a new transgenic mutant Trpc6 mouse model emulating the amino acid change carried by the first pediatric patient of FSGS associated with a TRPC6 mutation: M132T. Results: Mice carrying the orthologous Trpc6 M131T transgene showed early onset proteinuria and early signs of FSGS. When exploring molecular consequences of the overexpression of this mutated form of Trpc6 in podocytes, differences in expression levels of Axin2 and β-catenin were found in glomeruli from transgenic Trpc6 M131T mice. These data supports the proposed molecular mechanisms related to the activation of calcineurin-NFAT/Wnt signaling, as outcome of the increased calcium influx caused by the mutated form of Trpc6. Conclusion: Given that the Trpc6 M131T mouse develops an early onset of FSGS-like phenotypes it represents a promising model for studying the pathogenesis of FSGS caused by TRpC6, facilitating the assessment of new drugs as treatments and allowing further studies to understand underlying molecular pathways involved in the development of the TRPC6 mediated disease.
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Affiliation(s)
- Cesar P Canales
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW, Sydney, Australia
| | - Paola Krall
- Nephrology Unit, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Pamela Kairath
- School of Biochemistry, Faculty of Sciences, Universidad Austral de Chile, Valdivia, Chile
| | - Irene C Perez
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Miryam A Fragoso
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Paulina Carmona-Mora
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW, Sydney, Australia
| | - Phillip Ruiz
- Department of Surgery and Pathology, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Division of Nephrology and Hypertension, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Jochen Reiser
- Department of Internal Medicine, Rush University, Chicago, USA
| | - Juan I Young
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Department of Human Genetics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Katherina Walz
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Division of Nephrology and Hypertension, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Department of Human Genetics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
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24
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Kandasamy Y, Smith R, Lumbers ER, Rudd D. Nephrin - a biomarker of early glomerular injury. Biomark Res 2014; 2:21. [PMID: 25789166 PMCID: PMC4363192 DOI: 10.1186/2050-7771-2-21] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/07/2014] [Indexed: 01/04/2023] Open
Abstract
Nephrin is a 180 KD trans-membrane protein expressed in glomerular podocytes. It was first identified in children with congenital nephrotic syndrome of the Finnish type (NPHS1). Nephrin forms an integral part of podocytes, which-together with endothelial cells and the basement-form the glomerular filtration barrier. Podocytopathies result in the detection of nephrin in the urine. We reviewed the literature to determine if urine nephrin measurements could become useful as a biomarker to detect early podocyte injury. Our search identified a total of 19 studies that have been published to date. The most common clinical conditions for which urine nephrin analyses were carried out included diabetic nephropathy, glomerulonephritis and pre-eclampsia. Nephrin measurement was carried out using commercially available ELISA kits, the messenger ribonucleic acid real-time polymerase chain Reaction, or electrophoresis. Nephrinuria showed positive correlation with proteinuria and severity of podocyte injury. In two studies, the level of nephrinuria declined in conjunction with clinical improvement in the patient following immunosuppressive treatment. Currently, there is no published data on the value of measuring urinary nephrin in pediatric patients.
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Affiliation(s)
- Yogavijayan Kandasamy
- />Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive, Douglas, QLD 4814 Australia
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
- />College of Public Health, Medical and Veterinary Sciences, The James Cook University, Townsville, QLD 4814 Australia
| | - Roger Smith
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
| | - Eugenie R Lumbers
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
| | - Donna Rudd
- />College of Public Health, Medical and Veterinary Sciences, The James Cook University, Townsville, QLD 4814 Australia
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25
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Rodrigues PG, Bringhenti RN, do Nascimento JF, Joelsons G, dos Santos M, Pereira S, Veronese FV. Expression patterns of podocyte-associated mRNAs in patients with proliferative or non-proliferative glomerulopathies. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2185-2198. [PMID: 24966927 PMCID: PMC4069963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/03/2014] [Indexed: 06/03/2023]
Abstract
AIM It is not clear how the podocyte damage manifests in different glomerulopathies. This study evaluated the podocyte-associated mRNA profiles in renal tissue and urine of patients with proliferative (PGs) or non-proliferative (NPGs) glomerulopathies. METHODS Messenger RNA levels of nephrin, podocin, podocalyxin, synaptopodin, and alpha-actinin-4 were measured in the kidney tissue and urinary cells by real-time polymerase chain reaction. Podocyte-associated mRNAs were correlated with proteinuria and renal function, and the effect of immunosuppressive treatment of PGs and NPGs on urine mRNAs was assessed up to one year of follow up. RESULTS Podocyte-associated mRNAs were expressed consistently less in kidney tissue from patients with NPGs, and urinary podocyte mRNA levels were significantly higher in the PG group. After six months of immunosuppressive therapy, patients with PGs showed a significant reduction in the expression of podocin, podocalyxin, and alpha-actinin-4 compared with baseline (p<0.001). In the NPG group, alpha-actinin-4 levels decreased (p=0.008), and there was also a trend toward reduced podocalyxin mRNA (p=0.08). Urine podocyte-associated mRNAs correlated with the level of proteinuria at baseline and at six months, and there was a trend toward an inverse correlation between urinary mRNAs and kidney function at one year of follow up. CONCLUSIONS Podocyte-associated mRNAs were inhibited in kidney tissue concomitantly with their increase in urine in these patients with glomerulopathies. Different profiles of mRNA expression were seen, pointing to a higher degree of intra-renal podocytopenia in the NPGs and of podocyturia in the PGs. The immunosuppressive therapy effectively reduced the urinary levels of podocyte-associated mRNAs.
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Affiliation(s)
- Patrícia Garcia Rodrigues
- Post-Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do SulPorto Alegre, RS, Brazil
| | | | | | - Gabriel Joelsons
- Post-Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do SulPorto Alegre, RS, Brazil
| | - Mariane dos Santos
- Post-Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do SulPorto Alegre, RS, Brazil
| | - Sane Pereira
- Post-Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do SulPorto Alegre, RS, Brazil
| | - Francisco Veríssimo Veronese
- Post-Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do SulPorto Alegre, RS, Brazil
- Division of Nephrology, Hospital de Clínicas de Porto AlegrePorto Alegre, RS, Brazil
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