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Soh V, Tan SJX, Sehgal R, Shirke MM, Ashry A, Harky A. The Relationship Between Vitamin D Status and Cardiovascular Diseases. Curr Probl Cardiol 2021; 46:100836. [PMID: 33848960 DOI: 10.1016/j.cpcardiol.2021.100836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
With cardiovascular conditions being a leading cause of mortality and morbidity globally, several studies have identified that there is an important correlation between the level of Vitamin D and cardiovascular diseases, including an increased risk of hypertension, heart failure, and coronary artery diseases. Current published studies are in the form of both in vivo and in vitro studies and they primarily showed the evidence of how Vitamin D can downregulate Renin-Angiotensin-Aldosterone system activity and therefore providing a cardioprotective role. Nevertheless, most of these studies are observational, and there yet to be large-scale randomized controlled trials which would increase the evidence of the findings.This review aims to capture the current evidence of Vitamin D as a metabolite which is critical in reducing cardiovascular conditions and the possible physiological pathways that it works via.
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Affiliation(s)
- Vernie Soh
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Shawn Jia Xiang Tan
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Rijuvani Sehgal
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Amr Ashry
- Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK; Department of Cardiothoracic Surgery, Assiut University Hospital, Assiut, Egypt
| | - Amer Harky
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Vitamin D and Glomerulonephritis. ACTA ACUST UNITED AC 2021; 57:medicina57020186. [PMID: 33671780 PMCID: PMC7926883 DOI: 10.3390/medicina57020186] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
Vitamin D presents a plethora of different functions that go beyond its role in skeletal homeostasis. It is an efficient endocrine regulator of the Renin–Angiotensin–Aldosterone System (RAAS) and erythropoiesis, exerts immunomodulatory effects, reduces the cardiovascular events and all-cause mortality. In Chronic Kidney Disease (CKD) patients, Vitamin D function is impaired; the renal hydrolyzation of its inactive form by the action of 1α-hydroxylase declines at the same pace of reduced nephron mass. Moreover, Vitamin D major carrier, the D-binding protein (DBP), is less represented due to Nephrotic Syndrome (NS), proteinuria, and the alteration of the cubilin–megalin–amnionless receptor complex in the renal proximal tubule. In Glomerulonephritis (GN), Vitamin D supplementation demonstrated to significantly reduce proteinuria and to slow kidney disease progression. It also has potent antiproliferative and immunomodulating functions, contributing to the inhibitions of kidney inflammation. Vitamin D preserves the structural integrity of the slit diaphragm guaranteeing protective effects on podocytes. Activated Vitamin D has been demonstrated to potentiate the antiproteinuric effect of RAAS inhibitors in IgA nephropathy and Lupus Nephritis, enforcing its role in the treatment of glomerulonephritis: calcitriol treatment, through Vitamin D receptor (VDR) action, can regulate the heparanase promoter activity and modulate the urokinase receptor (uPAR), guaranteeing podocyte preservation. It also controls the podocyte distribution by modulating mRNA synthesis and protein expression of nephrin and podocin. Maxalcalcitol is another promising alternative: it has about 1/600 affinity to vitamin D binding protein (DBP), compared to Calcitriol, overcoming the risk of hypercalcemia, hyperphosphatemia and calcifications, and it circulates principally in unbound form with easier availability for target tissues. Doxercalciferol, as well as paricalcitol, showed a lower incidence of hypercalcemia and hypercalciuria than Calcitriol. Paricalcitol demonstrated a significant role in suppressing RAAS genes expression: it significantly decreases angiotensinogen, renin, renin receptors, and vascular endothelial growth factor (VEGF) mRNA levels, thus reducing proteinuria and renal damage. The purpose of this article is to establish the Vitamin D role on immunomodulation, inflammatory and autoimmune processes in GN.
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Hornik ES, Altman-Merino AE, Koefoed AW, Meyer KM, Stone IB, Green JA, Williams GH, Adler GK, Williams JS. A clinical trial to evaluate the effect of statin use on lowering aldosterone levels. BMC Endocr Disord 2020; 20:105. [PMID: 32664962 PMCID: PMC7362429 DOI: 10.1186/s12902-020-00587-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Statins are the first-line pharmaceutical agent in the management of hypercholesterolemia and cardiovascular (CV) risk reduction, and the most commonly prescribed class of drugs worldwide. Studies describing CV risk reduction independent of LDL-cholesterol lowering have evoked an interest in the pleiotropic mechanisms of statins' benefits. We recently demonstrated that administration of statins in animal models lowers aldosterone levels and observed an association between statin use and reduced aldosterone levels in two human cohorts, with lipophilic statins displaying a greater effect than hydrophilic statins. Therefore, we designed a randomized, placebo-controlled, double-blinded intervention study to assess whether statin treatment lowers aldosterone in a type-dependent manner in humans, with simvastatin (lipophilic) showing a greater effect than pravastatin (hydrophilic). METHODS/DESIGN One hundred five healthy participants will be recruited from the general population to enroll in a 12-week, randomized, placebo-controlled, double-blinded, 3-arm clinical trial. Ninety participants are anticipated to complete the protocol. After baseline assessment of aldosterone levels, participants will be randomized to daily simvastatin, pravastatin, or placebo. Aldosterone levels will be assessed after 2 days on study drug and again after 6 weeks and 12 weeks on study drug. Prior to each aldosterone assessment, participants will consume an isocaloric sodium and potassium-controlled run-in diet for 5 days. Assessments will occur on an inpatient research unit to control for diurnal, fasting, and posture conditions. The primary outcome will compare 12-week angiotensin II-stimulated serum aldosterone by study drug. Secondary outcomes will compare baseline and 12-week 24-h urine aldosterone by study drug. DISCUSSION Results from this rigorous study design should provide strong support that statins lower aldosterone levels in humans. These results may explain some of the beneficial effects of statins that are not attributed to the LDL-lowering effect of this important class of medications. Results would demonstrate that statin lipophilicity is an important attribute in lowering aldosterone levels. The outcomes of this program will have implications for the design of studies involving statin medications, as well as for the differential use of classes of statins. TRIAL REGISTRATION ClinicalTrials.gov; NCT02871687 ; First Posted August 18, 2016.
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Affiliation(s)
- Ezra S Hornik
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Anne E Altman-Merino
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Andrew W Koefoed
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Kayla M Meyer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Isabella B Stone
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Jessica A Green
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Gordon H Williams
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
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Liu M, Wang J, He Y. Serum 25-Hydroxyvitamin D were associated with higher risk of both albuminuria and impaired GFR incidence: a cohort study based on CLHLS study. BMC Nephrol 2019; 20:20. [PMID: 30646860 PMCID: PMC6332878 DOI: 10.1186/s12882-019-1202-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to examine the relationship between 25-hyfromxyvitamin D (25OHD) and chronic kidney disease (CKD) incidence. METHODS All the elderly who had participated both in the 2011-2012 survey and 2014 survey in the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and have biomarker data were included in the analysis. We studied those without CKD with complete data at 2011-2012 waves. Serum 25-Hydroxyvitamin D was assessed at baseline. Cox proportional risk model was used to evaluate associations between serum 25-Hydroxyvitamin D and CKD (including both albuminuria and impaired eGFR) incidence after adjusted for potential confounding.. RESULTS During the follow-up years, 255 incident cases of CKD were diagnosed. Those who developed CKD had relatively lower serum 25(OH)D (mean 37.63 vs.51.36 nmol/L, p < 0.001) compared with those who remained free of CKD. Each 1 nmol/L increase in 25(OH)D was associated with 3.4% reduced risk of CKD (HR = 0.966, 95%CI: 0.959-0.973) after adjusted for related covariates. The HRs of each 1 nmol/L increase in 25(OH)D for albuminuria and impaired eGFR were 0.952(95%CI: 0.941-0.963) and 0.975(95%CI: 0.966-0.983) respectively. When use the classifications (sufficiency, insufficiency, deficiency) or quintiles of baseline 25(OH)D levels in the Cox model, the corresponding HRs showed an increasing trend along with the decrease of baseline 25(OH)D levels (p for trend < 0.001). CONCLUSIONS Higher 25(OH)D levels were inversely and independently associated with CKD incidence among Chinese elderly. The trend for the observed linear relationship b was most pronounced among the lowest quintile.
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Affiliation(s)
- Miao Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National clinical research center for geriatrics diseases, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Jianhua Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National clinical research center for geriatrics diseases, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National clinical research center for geriatrics diseases, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
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Zaheer S, Taquechel K, Brown JM, Adler GK, Williams JS, Vaidya A. A randomized intervention study to evaluate the effect of calcitriol therapy on the renin-angiotensin system in diabetes. J Renin Angiotensin Aldosterone Syst 2018; 19:1470320317754178. [PMID: 29562806 PMCID: PMC5896865 DOI: 10.1177/1470320317754178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Prior studies suggest that vitamin D therapy may decrease cardiovascular disease risk in type 2 diabetes (T2DM) by lowering renin-angiotensin system (RAS) activity. However, randomized human intervention studies to evaluate the effect of vitamin D receptor (VDR) agonists on RAS activity are lacking. Objective: The objective of this article is to investigate the effect of direct VDR activation with calcitriol on circulating RAS activity and vascular hemodynamics in T2DM. Methods: A randomized, double-blinded, and placebo-controlled study wherein 18 participants with well-controlled T2DM without chronic kidney disease (CKD) were administered calcitriol or placebo for three weeks was conducted. Outcome measures included plasma renin activity (PRA), serum and urinary aldosterone, mean arterial pressure (MAP) before and after an infusion of angiotensin II, and renal plasma flow (RPF) via para-aminohippurate clearance. Results: Despite an increase in 1,25(OH)2D with calcitriol administration (45.4 to 61.8 pg/ml, p = 0.03) and no change with placebo, there were no significant differences in PRA, serum or urinary aldosterone, baseline and angiotensin II-stimulated MAP, or basal and angiotensin II-stimulated RPF between interventions. Conclusion: In this randomized and placebo-controlled study in participants with T2DM without CKD, calcitriol therapy to raise 1,25(OH)2D levels, when compared with placebo, did not significantly change circulating RAS activity or vascular hemodynamics.
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Affiliation(s)
- Sarah Zaheer
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | - Jenifer M Brown
- 3 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Gail K Adler
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Jonathan S Williams
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Anand Vaidya
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
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Yin F, Liu J, Fan MX, Zhou XL, Zhang XL. Association between the vitamin D receptor gene polymorphisms and diabetic nephropathy risk: A meta-analysis. Nephrology (Carlton) 2018; 23:107-116. [PMID: 28703918 DOI: 10.1111/nep.13111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Fang Yin
- Department of Nephrology; Weifang People’s Hospital; Weifang China
| | - Jing Liu
- Department of Nephrology; Weifang People’s Hospital; Weifang China
| | - Ming-Xiu Fan
- Department of Nephrology; Weifang People’s Hospital; Weifang China
| | - Xiao-Li Zhou
- Department of Nephrology; Weifang People’s Hospital; Weifang China
| | - Xiao-Ling Zhang
- Department of Nephrology; Weifang People’s Hospital; Weifang China
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Yang S, Li A, Wang J, Liu J, Han Y, Zhang W, Li YC, Zhang H. Vitamin D Receptor: A Novel Therapeutic Target for Kidney Diseases. Curr Med Chem 2018; 25:3256-3271. [PMID: 29446731 PMCID: PMC6142412 DOI: 10.2174/0929867325666180214122352] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/25/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Kidney disease is a serious problem that adversely affects human health, but critical knowledge is lacking on how to effectively treat established chronic kidney disease. Mounting evidence from animal and clinical studies has suggested that Vitamin D Receptor (VDR) activation has beneficial effects on various renal diseases. METHODS A structured search of published research literature regarding VDR structure and function, VDR in various renal diseases (e.g., IgA nephropathy, idiopathic nephrotic syndrome, renal cell carcinoma, diabetic nephropathy, lupus nephritis) and therapies targeting VDR was performed for several databases. RESULT Included in this study are the results from 177 published research articles. Evidence from these papers indicates that VDR activation is involved in the protection against renal injury in kidney diseases by a variety of mechanisms, including suppression of RAS activation, anti-inflammation, inhibiting renal fibrogenesis, restoring mitochondrial function, suppression of autoimmunity and renal cell apoptosis. CONCLUSION VDR offers an attractive druggable target for renal diseases. Increasing our understanding of VDR in the kidney is a fertile area of research and may provide effective weapons in the fight against kidney diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Hao Zhang
- Address correspondence to this author is at the Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China; Tel: 86-731-88638238; E-mail:
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Yan MKW, Khalil H. Vitamin supplements in type 2 diabetes mellitus management: A review. Diabetes Metab Syndr 2017; 11 Suppl 2:S589-S595. [PMID: 28420574 DOI: 10.1016/j.dsx.2017.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a major public health challenge that affects countries across the world. The use of pharmacological therapy is often limited in some patients due to a loss of effect over time or development of adverse effects such as weight gain or hypoglycaemia. This has prompted searches into the role of non-pharmacological therapies in T2DM. The availability and use of vitamin supplements in developed countries have increased significantly and there is evidence that certain vitamins may have roles in the management of T2DM. This review examines the literature assessing the use of vitamins A, C, E, D, K and the B group vitamins (B1, B3, B7, B6, B9, B12) in the management of T2DM. No clear evidence supporting the beneficial role of any specific vitamin in the treatment of T2DM was found. Thus, it is recommended that until further studies are conducted to clarify the role of such vitamins in T2DM management, they should not be routinely recommended in clinical practice.
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Affiliation(s)
| | - Hanan Khalil
- School of Rural Health, Monash University, Victoria, Australia.
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Kim SS, Kim JH, Kim IJ. Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes. Endocrinol Metab (Seoul) 2016; 31:245-53. [PMID: 27246284 PMCID: PMC4923408 DOI: 10.3803/enm.2016.31.2.245] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 12/29/2022] Open
Abstract
Diabetes is often associated with chronic kidney disease (CKD) and is the primary cause of kidney failure in half of patients who receive dialysis therapy. Given the increasing prevalence of diabetes and its high morbidity and mortality, diabetic nephropathy is a serious drawback in individual patients and a tremendous socioeconomic burden on society. Despite growing concern for the management of diabetic nephropathy, the prevalence of CKD with diabetes is the same today as it was 20 years ago. The current strategy to manage diabetic nephropathy, including the control of hyperglycemia, dyslipidemia, and blood pressure and the wide-spread use of renin-angiotensin-aldosterone system inhibitors, is well established to be beneficial in the early stages of diabetic nephropathy. However, the effects are uncertain in patients with relatively progressed CKD. Therefore, early diagnosis or risk verification is extremely important in order to reduce the individual and socioeconomic burdens associated with diabetic nephropathy by providing appropriate management to prevent the development and progression of this condition. This review focuses on recent research and guidelines regarding risk assessment, advances in medical treatment, and challenges of and future treatments for diabetic nephropathy.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
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Lin M, Gao P, Zhao T, He L, Li M, Li Y, Shui H, Wu X. Calcitriol regulates angiotensin-converting enzyme and angiotensin converting-enzyme 2 in diabetic kidney disease. Mol Biol Rep 2016; 43:397-406. [PMID: 26968558 DOI: 10.1007/s11033-016-3971-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
To investigate the effects of calcitriol on angiotensin-converting enzyme (ACE) and ACE2 in diabetic nephropathy. Streptozotocin (STZ) induced diabetic rats were treated with calcitriol for 16 weeks. ACE/ACE2 and mitogen activated protein kinase (MAPK) enzymes were measured in the kidneys of diabetic rats and rat renal tubular epithelial cells exposed to high glucose. Calcitriol reduced proteinuria in diabetic rats without affecting calcium-phosphorus metabolism. ACE and ACE2 levels were significantly elevated in diabetic rats compared to those in control rats. The increase in ACE levels was greater than that of ACE2, leading to an elevated ACE/ACE2 ratio. Calcitriol reduced ACE levels and ACE/ACE2 ratio and increased ACE2 levels in diabetic rats. Similarly, high glucose up-regulated ACE expression in NRK-52E cells, which was blocked by the p38 MAPK inhibitor SB203580, but not the extracellular signal-regulated kinase (ERK) inhibitor FR180204 or the c-Jun N-terminal kinase (JNK) inhibitor SP600125. High glucose down-regulated ACE2 expression, which was blocked by FR180204, but not SB203580 or SP600125. Incubation of cells with calcitriol significantly inhibited p38 MAPK and ERK phosphorylation, but not JNK phosphorylation, and effectively attenuated ACE up-regulation and ACE2 down-regulation in high glucose conditions. The renoprotective effects of calcitriol in diabetic nephropathy were related to the regulation of tubular levels of ACE and ACE2, possibly by p38 MAPK or ERK, but not JNK pathways.
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Affiliation(s)
- Mei Lin
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Ping Gao
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Tianya Zhao
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Lei He
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Mengshi Li
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yaoyao Li
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Hua Shui
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
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Abstract
Diabetic nephropathy is a significant cause of chronic kidney disease and end-stage renal failure globally. Much research has been conducted in both basic science and clinical therapeutics, which has enhanced understanding of the pathophysiology of diabetic nephropathy and expanded the potential therapies available. This review will examine the current concepts of diabetic nephropathy management in the context of some of the basic science and pathophysiology aspects relevant to the approaches taken in novel, investigative treatment strategies.
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Affiliation(s)
- Andy Kh Lim
- Department of Nephrology, Monash Medical Center, Monash Health, Clayton, VIC, Australia ; Department of General Medicine, Dandenong Hospital, Monash Health, Clayton, VIC, Australia ; Department of Medicine, Monash University, Clayton, VIC, Australia
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12
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Kent ST, Cushman M, Howard G, Judd SE, Crosson WL, Al-Hamdan MZ, McClure LA. Sunlight exposure and cardiovascular risk factors in the REGARDS study: a cross-sectional split-sample analysis. BMC Neurol 2014; 14:133. [PMID: 24946776 PMCID: PMC4075775 DOI: 10.1186/1471-2377-14-133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/13/2014] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has suggested that vitamin D and sunlight are related to cardiovascular outcomes, but associations between sunlight and risk factors have not been investigated. We examined whether increased sunlight exposure was related to improved cardiovascular risk factor status. Methods Residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine previous-year sunlight radiation exposure for 17,773 black and white participants aged 45+ from the US. Exploratory and confirmatory analyses were performed by randomly dividing the sample into halves. Logistic regression models were used to examine relationships with cardiovascular risk factors. Results The lowest, compared to the highest quartile of insolation exposure was associated with lower high-density lipoprotein levels in adjusted exploratory (−2.7 mg/dL [95% confidence interval: −4.2, −1.2]) and confirmatory (−1.5 mg/dL [95% confidence interval: −3.0, −0.1]) models. The lowest, compared to the highest quartile of insolation exposure was associated with higher systolic blood pressure levels in unadjusted exploratory and confirmatory, as well as the adjusted exploratory model (2.3 mmHg [95% confidence interval: 0.8, 3.8]), but not the adjusted confirmatory model (1.6 mg/dL [95% confidence interval: −0.5, 3.7]). Conclusions The results of this study suggest that lower long-term sunlight exposure has an association with lower high-density lipoprotein levels. However, all associations were weak, thus it is not known if insolation may affect cardiovascular outcomes through these risk factors.
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Affiliation(s)
| | | | | | | | | | | | - Leslie A McClure
- Department of Biostatistics, 1665 University Blvd, University of Alabama at Birmingham, Birmingham 35294, Alabama.
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Brown JM, Vaidya A. Interactions between adrenal-regulatory and calcium-regulatory hormones in human health. Curr Opin Endocrinol Diabetes Obes 2014; 21:193-201. [PMID: 24694551 PMCID: PMC4123208 DOI: 10.1097/med.0000000000000062] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To summarize the evidence characterizing the interactions between adrenal-regulating and calcium-regulating hormones, and the relevance of these interactions to human cardiovascular and skeletal health. RECENT FINDINGS Human studies support the regulation of parathyroid hormone (PTH) by the renin-angiotensin-aldosterone system (RAAS): angiotensin II may stimulate PTH secretion via an acute and direct mechanism, whereas aldosterone may exert a chronic stimulation of PTH secretion. Studies in primary aldosteronism, congestive heart failure, and chronic kidney disease have identified associations between hyperaldosteronism, hyperparathyroidism, and bone loss, which appear to improve when inhibiting the RAAS. Conversely, elevated PTH and insufficient vitamin D status have been associated with adverse cardiovascular outcomes, which may be mediated by the RAAS. Studies of primary hyperparathyroidism implicate PTH-mediated stimulation of the RAAS, and recent evidence shows that the vitamin D-vitamin D receptor complex may negatively regulate renin expression and RAAS activity. Ongoing human interventional studies are evaluating the influence of RAAS inhibition on PTH and the influence of vitamin D receptor agonists on RAAS activity. SUMMARY Although previously considered independent endocrine systems, emerging evidence supports a complex web of interactions between adrenal-regulating and calcium-regulating hormones, with implications for human cardiovascular and skeletal health.
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Affiliation(s)
- Jenifer M Brown
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kowalski A, Krikorian A, Lerma EV. Diabetic nephropathy for the primary care provider: new understandings on early detection and treatment. Ochsner J 2014; 14:369-79. [PMID: 25249803 PMCID: PMC4171795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Diabetic nephropathy is the leading cause of renal disease in the United States, occurring in 20%-40% of patients with diabetes. This condition is a distinct manifestation of diabetic renal disease seen in patients with type 1 and type 2 diabetes. Despite clear screening and management recommendations, diabetic nephropathy remains substantially underdiagnosed. METHODS This review presents recent guidelines and recommendations from varied work groups to identify, monitor, and halt the progression of diabetic nephropathy. Our search of the recent literature focused on diagnostic criteria, the latest screening recommendations, novel screening methods, current research, new treatment recommendations, and goals for early intervention. RESULTS Current recommendations for early detection and treatment of diabetic nephropathy include yearly albumin to creatinine ratio checks and more frequent tests if indicated based on glomerular filtration rate and albuminuria; optimizing glucose control with a target hemoglobin A1c goal of <7%; initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) as the first line in disease management with dual therapy of ACE inhibitors and ARBs no longer recommended; managing blood pressure with a goal of <140/90 mmHg as the target for all patients with diabetes; and initiating statin therapy for patients <50 years old and with concomitant chronic kidney disease and diabetes and in all patients with chronic kidney disease >50 years of age regardless of the coexistence of diabetes. CONCLUSION With early detection, proper screening, and management, the impact of diabetic nephropathy may be better mitigated to lessen its impact on society and healthcare.
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Affiliation(s)
- Andrew Kowalski
- Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL
| | - Armand Krikorian
- Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL
| | - Edgar V. Lerma
- Section of Nephrology, Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL
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