Association between nitric oxide synthase (NOS3) gene polymorphisms and diabetic nephropathy: An updated meta-analysis

Polymorphisms located within NOS3 gene have been investigated as susceptibility variants for diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) in a large number of studies. However, these previous articles yielded inconsistent results and we aimed at elucidating the impact of NOS3 variants on DN risk in T2DM by conducting an updated systematic data synthesis. A total of 36 studies (12,807 participants) were selected for qualitative data synthesis, while 33 records with 11,649 subjects were included in the meta-analysis. The pooled analysis demonstrated the association of minor alleles of rs2070744 and rs1799983 with an increased susceptibility to DN (P < 0.001 and P = 0.015 for allelic model, respectively). For both of these variants, a significant effect of subgrouping according to ethnicity was found. Rs869109213 displayed an association with DN susceptibility, with pooled effect measures indicating a predisposing effect of the minor allele a (Prec = 0.002, ORrec = 1.960, 95%CI 1.288-2.983; Paavs. bb = 0.001, ORaavs. bb = 2.014, 95%CI 1.316-3.083). These findings support the effects of NOS3 variants on the risk of developing DN in T2DM.

Altered expression of WFS1 and NOTCH2 genes associated with diabetic nephropathy in T2DM patients

AIM

The increased incidence of type 2 diabetes mellitus (T2DM) and the importance of early identification and management of its complications, especially diabetic nephropathy (DN), have spotted the light on genetic factors that increase risk of T2DM and its related nephropathy. The present study aimed at investigating expression of (KCNJ11, ABCC8, JAZF1, WFS1, PPARG, NOTCH2 and EXOSC4) genes in peripheral blood of T2DM patients.

METHOD

The study included 30 non-complicated T2DM patients, 30 patients with DN and 40 healthy controls. Quantitative Real Time PCR Array was used to study gene expression.

RESULTS

NOTCH2 showed higher expression while KCNJ11, JAZF1, WFS1 and PPARG genes showed lower expression in DN patients compared to non-complicated patients. KCNJ11, JAZF1, WFS1, PPARG, and EXOSC4 expression showed significant negative correlation with microalbumin, while NOTCH2 expression was significantly positively correlated with microalbumin. AS regard HbA1c and studied genes expression, there was significant negative correlation between WFS1 expression and HbA1c, while NOTCH2, KCNJ11, JAZF1, PPARG, EXOSC4 expression didn't show significant correlation with HbA1c. Risk ratio of studied genes expression showed that WFS1 and NOTCH2 had highest risk ratio (30) and highest sensitivity and specificity, in relation to DN and they were the best predictors in the group of studied genes at cut off value of ≤0.861 for WFS1 and ≥0.678 for NOTCH2.

CONCLUSION

Altered expression of WFS1 and NOTCH2 genes may play a role in pathogenesis and development of DN in patients with T2DM. These results may contribute in early identification and management of DN.

Modern methods of diagnosing chronic kidney disease in patients with diabetes mellitus

Chronic kidney disease (CKD) is a general concept that involves renal tissue regardless of the aetiology of the leading disease. CKD occurs in one out of every two patients with diabetes mellitus (DM) and appreciably limits the duration and quality of life. CKD can be diagnosed by glomerular filtration rate (GFR), which is recognised as the most representative indicator of the quantity and total workload of nephrons. However, the decrease in GFR occurs at an advanced stage of nephropathy and causes irreversible renal damage, which ultimately requires substitutive renal therapy and, thereby, increases the expense. In this regard, clinical trials have been conducted to identify the biomarkers of CKD reflecting renal damage at earlier stages of the disease. This article presents an overview of modern methods for the diagnosis of CKD and preclinical markers of kidney injury in patients with DM.

[Diabetes mellitus and chronic kidney disease: Possibilities of prediction, early diagnosis, and nephroprotection in the 21st century]

The. review gives data on the prognostic value of genetic markers when analyzing the risk of chronic kidney disease in diabetes mellitus, those on new possibilities of early diagnosis of diabetic nephropathy using urinary biomarkers (nephrinuria, podocinuria) and proteomic urinalysis at the stage of normoalbuminuria. The interpretation of the index mrcroalbuminuria in type 2 diabetesis critically analyzed. The nephroprotective properties of novel classes of glucose-lowering drugs, such as incretins and gliflozins, are considered.