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Pérez-Villalobos MC, Barba-González A, García-Carrillo N, Muñoz-Ortega MH, Sánchez-Alemán E, Ávila-Blanco ME, Morones-Gamboa JC, Ventura-Juárez J, Martínez-Hernández SL. Nephroprotective effect of pioglitazone in a Wistar rat model of adenine‑induced chronic kidney disease. Exp Ther Med 2024; 28:392. [PMID: 39161617 PMCID: PMC11332140 DOI: 10.3892/etm.2024.12681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/27/2024] [Indexed: 08/21/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive disease with a high mortality rate and a worldwide prevalence of 13.4%, triggered by various diseases with high incidence. The aim of the present study was to investigate the anti-inflammatory and antifibrotic effect of pioglitazone on kidney in an adenine-induced Wistar rats and the mechanisms possibly involved. CKD was induced in 40 rats. Rats were divided into two groups, which were split into the following sub-groups: i) Therapeutic (pioglitazone administered after renal damage) divided into intact (healthy), adenine (CKD) and adenine/pioglitazone (treatment) and ii) prophylactic (adenine and pioglitazone administered at the same time) split into intact (healthy), adenine (CKD), endogenous reversion (recovery without treatment), adenine/pioglitazone (treatment) and pioglitazone sub-groups. Reverse transcription-quantitative PCR (collagen I, α-SMA and TGF-β), and hematoxylin-eosin, Masson's trichrome and Sirius red staining were performed to measure histological markers of kidney damage, also the serum markers (urea, creatinine and uric acid) were performed, for analyze the effects of pioglitazone. In the adenine/pioglitazone rats of the therapeutic group, renal function parameters such as eGFR increased and serum creatinine decreased from those of untreated rats (CKD), however the renal index, serum urea, abnormalities in renal morphology, inflammatory cells and relative gene expression of collagen I, α-SMA and TGF-β did not change relative to the CKD rats. In adenine/pioglitazone rats, extracellular matrix collagen accumulation was significantly lower than the CKD rats. On the other hand, in adenine/pioglitazone rats of the prophylactic group, the renal index, creatinine, urea, uric acid serum and relative gene expression of collagen I, α-SMA, and TGF-β were significantly lower, as well as the presence of 2,8-dihydroxyadenine crystals, and extracellular matrix collagen compared with CKD rats. In addition, the eGFR in the treatment group was similar to healthy rats, renal morphology was restored, and inflammatory cells were significantly lower. In conclusion, pioglitazone has a nephroprotective effect when administered in the early stages of kidney damage, reducing inflammatory and fibrotic processes and improving glomerular filtration rate. Furthermore, in the late phase of treatment, a tendency to decrease creatinine and increase eGFR was observed.
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Affiliation(s)
| | - Andrea Barba-González
- Department of Morphology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
| | - Nicté García-Carrillo
- Department of Morphology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
| | - Martín Humberto Muñoz-Ortega
- Department of Chemistry, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
| | - Esperanza Sánchez-Alemán
- Department of Morphology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
- Family Medicine Unit 8, Mexican Social Security Institute, 20180 Aguascalientes, Mexico
| | - Manuel Enrique Ávila-Blanco
- Department of Morphology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
| | | | - Javier Ventura-Juárez
- Department of Morphology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
| | - Sandra Luz Martínez-Hernández
- Department of Microbiology, Center of Basic Sciences, Autonomous University of Aguascalientes, 20100 Aguascalientes, Mexico
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Zhong X, Fan J. Effect of Atorvastatin combined with Irbesartan in the treatment of early diabetic nephropathy. Pak J Med Sci 2024; 40:1410-1414. [PMID: 39092054 PMCID: PMC11255805 DOI: 10.12669/pjms.40.7.9214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/03/2023] [Accepted: 04/26/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To explore the effect of Atorvastatin combined with Irbesartan in the treatment of early diabetic nephropathy (DN). Methods Clinical data from 153 patients with early DN, admitted to Huzhou Central Hospital from January 2020 to December 2022, was retrospectively selected. Patients were divided into two groups based on the treatment they received: patients received Irbesartan treatment alone were assigned to Irbesartan group (n=74); patients received Irbesartan combined with Atorvastatin were assigned to combined group (n=79). Levels of renal function indicators, renal fibrosis indicators, micro inflammatory status indicators, and incidence of adverse reactions were compared between the two groups before and after the treatment. Results After the treatment, indicators of renal function, renal fibrosis and micro-inflammation in both groups significantly decreased compared to pretreatment levels (P<0.05), and were significantly lower in the combined group compared to Irbesartan group (P<0.05). There was no significant difference in the incidence of adverse reactions between the groups (P>0.05). Conclusions Compared with Irbesartan alone, Atorvastatin combined with Irbesartan is more effective in the treatment of early DN. Combined treatment regimen is able to effectively reduces the micro-inflammatory state, improve renal function and fibrosis, and is not associated with the increased risk of adverse reactions.
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Affiliation(s)
- Xiaojing Zhong
- Xiaojing Zhong, Department of Endocrinology, Huzhou Central Hospital, 1558 Sanhuan North Road, Huzhou, Zhejiang Province 313003, P.R. China
| | - Jiajia Fan
- Jiajia Fan, Department of General Medicine, Huzhou Central Hospital, 1558 Sanhuan North Road, Huzhou, Zhejiang Province 313003, P.R. China
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Li Y, Wu T, Li H, Liu M, Xu H. Tanshinone IIA Promoted Autophagy and Inhibited Inflammation to Alleviate Podocyte Injury in Diabetic Nephropathy. Diabetes Metab Syndr Obes 2024; 17:2709-2724. [PMID: 39072344 PMCID: PMC11277913 DOI: 10.2147/dmso.s464015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose Tanshinone IIA (Tan-IIA) is widely used in patients with diabetic nephropathy (DN), but its protective effect on podocytes in DN has not been well studied. In this study, the effects of Tan-IIA on autophagy and inflammation of glomerular podocytes in DN were observed in vivo and in vitro, and the underlying mechanisms were investigated. Irbesartan, an angiotensin II receptor blocker, is a representative medication for the clinical treatment of DN. So irbesartan was chosen as a positive control drug. Methods Eight-week-old male db/db mice were randomly divided into a DN group, an irbesartan group, and three groups receiving different doses of Tan-IIA. The control group consisted of the db/m littermate mice. Blood, urine, and kidney samples were taken from the mice after 12 weeks of continuous administration. Renal protection of Tan-IIA was evaluated using enzyme-linked immunosorbent assay kits, haematoxylin and eosin staining, transmission electron microscopy, Western blotting, and immunohistochemistry. In vitro, the protective effect of Tan-IIA on podocytes was explored using MPC5 cells cultured with high glucose. Results Tan-IIA significantly improved renal pathological injury and relieved the renal dysfunction in DN. Compared with the DN group, Tan-IIA could up-regulate the expression of Synaptopodin, Podocin, LC3II/I and Beclin-1 (p < 0.05), and down-regulate the expression of p62, F4/80, NF-κB p65, IL-1β, TNF-α and IL-6 (p < 0.05) both in vivo and in vitro, suggesting that Tan-IIA treatment alleviated podocyte injury by promoting autophagy and inhibiting inflammation during DN. The levels of p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR in Tan-IIA group were lower than those in DN group (p < 0.05), indicating that Tan-IIA inhibited the PI3K/Akt/mTOR signalling pathway in podocytes, which was a key pathway in regulating both autophagy and inflammation. Conclusion Tan-IIA prevented podocyte injury in DN by fostering autophagy and inhibiting inflammation, at least in part via inhibition of the PI3K/Akt/mTOR signalling pathway.
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Affiliation(s)
- Yuan Li
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Tong Wu
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Hongye Li
- Lianyungang Clinical School of Xuzhou Medical University, Lianyungang, 222006, People’s Republic of China
| | - Mingming Liu
- Lianyungang Clinical School of Xuzhou Medical University, Lianyungang, 222006, People’s Republic of China
| | - Haiyan Xu
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
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Zhao J, Wang S, Li X, Zhang G, Xu Y, Zheng X, Guo J, Zhang Z. A Prospective, Multicentered, Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Keluoxin Capsules in the Treatment of Microalbuminuria in Patients with Type 2 Early Diabetic Kidney Disease. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:185-195. [PMID: 37733303 PMCID: PMC10884549 DOI: 10.1089/jicm.2022.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background: To evaluate the efficacy and safety of Keluoxin (KLX) capsules and provide validated evidence for the application of KLX in the treatment of diabetic kidney disease (DKD). Methods: A multicenter, randomized, double-blind, placebo-controlled trial design was used to screen 129 patients with DKD (urinary albumin-to-creatinine ratio [UACR]: male, 2.5-30 mg/mmol; female, 3.5-30 mg/mmol) and with Qi and Yin deficiency and blood stasis symptoms. Written informed consent was obtained from all patients. The patients were randomly divided into KLX and control groups. The KLX group was orally administered KLX (6 g/day) and irbesartan tablets (150 mg/day), whereas the control group was administered KLX placebo (6 g/day) and irbesartan tablets (150 mg/day). Patients were observed for 24 weeks to evaluate the natural logarithm of the UACR (log-UACR), the odds ratio (OR) for a sustained increase in the UACR of at least 30% and 40%, estimated glomerular filtration rate (eGFR), changes in symptoms and quality-of-life scores, and adverse events. Results: The changes of the natural log-UACR during the 24 weeks compared with baseline in the KLX group were better than those in the control group (LS mean ± standard error, -0.26 ± 0.10 vs. 0.01 ± 0.09, p = 0.0292). The incidence of a sustained increase in the UACR of at least 30% and 40% was found to be significantly lower in the KLX group (OR, 0.26; 95% confidence interval [CI], 0.09-0.75; OR, 0.29; 95% CI, 0.10-0.82). Changes in symptoms and quality-of-life scores in the KLX group were better than those in the control group. There was no statistically significant difference in eGFR or the incidence of adverse events between the groups. Conclusions: Overall, these results suggest that KLX capsules combined with irbesartan can reduce microalbuminuria, relieve the symptoms, and improve the quality of life for patients with type 2 early DKD compared with the use of irbesartan alone. Trial registration: Chinese Clinical Trial Registry, registration number: ChiCTR2100052764.
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Affiliation(s)
- Jinxi Zhao
- Department of Nephropathy and Endocrinology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shidong Wang
- Department of Nephropathy and Endocrinology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoran Li
- Department of Nephropathy and Endocrinology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Guangde Zhang
- Department of Endocrinology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Xu
- Department of TCM Diabetes, China-Japan Friendship Hospital, Beijing, China
| | - Xianling Zheng
- Department of Endocrinology, Handan Central Hospital, Handan, China
| | - Jian Guo
- Department of Endocrine and Metabolic Diseases, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Zhenxian Zhang
- Diabetes Clinic, Luohe Hospital of Traditional Chinese Medicine, Luohe, China
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Liu Z. Efficacy of metformin combined with liraglutide on the glucose and lipid metabolism, vascular endothelial function, and oxidative stress of patients with T2DM and metabolic syndrome. Pak J Med Sci 2024; 40:26-30. [PMID: 38196473 PMCID: PMC10772425 DOI: 10.12669/pjms.40.1.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 03/30/2023] [Accepted: 07/23/2023] [Indexed: 01/11/2024] Open
Abstract
Objective This study evaluates the impact of metformin combined with liraglutide on the glucose and lipid metabolism, oxidative stress, and vascular endothelium of patients with type-2 diabetes mellitus (T2DM) and metabolic syndrome. Methods Medical records of 78 patients with T2DM and metabolic syndrome, admitted to Caoxian People's Hospital from July 2021 to July 2022, were retrospectively analysed. Thirty five patients were treated with metformin (control group), and 43 patients were treated with metformin combined with liraglutide (observation group). Indexes of glucose and lipid metabolism, function of vascular endothelium and the oxidative stress of both groups were compared before and after the treatment. Results There was a significant decrease in the levels of fasting plasma glucose (FPG), Glycosylated Hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP) and waist circumference in both groups three months after the treatment, These indexes were significantly lower in the observation group compared to the control group (P<0.05). High-density lipoprotein cholesterol (HDL-C) levels were higher in the observation group (P<0.05). There was a significant improvement in the levels of nitric oxide (NO), endothelin-1 (ET-1), superoxide dismutase (SOD), and malondialdehyde (MDA) after the treatment, and these indexes were markedly better in the observation group compared to the control group (P<0.05). Conclusions Metformin combined with liraglutide treatment is associated with better outcomes than metformin alone in patients with T2DM and metabolic syndrome. Combined treatment results in improved glucose and lipid metabolism, vascular endothelial function, and oxidative stress index values.
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Affiliation(s)
- Zaisheng Liu
- Zaisheng Liu Department of Endocrinology Caoxian People’s Hospital Cao Country, Heze City, Shandong Province 274400, P.R. China
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