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Bhatia D, Srivastava SP. Editorial: Diabetic kidney disease: routes to drug development, pharmacology and underlying molecular mechanisms. Front Pharmacol 2023; 14:1252315. [PMID: 37614315 PMCID: PMC10442945 DOI: 10.3389/fphar.2023.1252315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Divya Bhatia
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, New York, NY, United States
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Swayam Prakash Srivastava
- Division of Regenerative Medicine, Department of Medicine, Hartman Institute of Therapeutic Organ Regeneration, Weill Cornell Medicine, New York, NY, United States
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Zhang YZ, Fan ML, Zhang WZ, Liu W, Li HP, Ren S, Jiang S, Song MJ, Wang Z, Li W. Schisandrin ameliorates diabetic nephropathy via regulating of PI3K/Akt/NF-κB-mediated inflammation and TGF-β1-induced fibrosis in HFD/STZ-induced C57BL/6J mice. J Funct Foods 2023. [DOI: 10.1016/j.jff.2022.105376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Phosphodiesterase 4 inhibitors in diabetic nephropathy. Cell Signal 2021; 90:110185. [PMID: 34785349 DOI: 10.1016/j.cellsig.2021.110185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 12/18/2022]
Abstract
Phosphodiesterase subtype 4 (PDE4) hydrolyzes cyclic AMP, a secondary messenger that mediates intracellular signaling, and plays key roles in inflammatory and fibrotic responses. Based on these significant anti-inflammatory effects, oral administration of PDE4 inhibitor is approved for the treatment of chronic obstructive pulmonary disease, atopic dermatitis, and psoriasis. However, PDE4 inhibition also has adverse effects, such as diarrhea, vomiting, dyspepsia, and headache. Therefore, the application of PDE4 inhibitors for chronic diseases, such as diabetes and its complications, has not yet been approved. Recent studies have reported the clinical benefits of pentoxifylline, a non-selective PDE inhibitor, in patients with kidney disease. The PDE4 inhibitor, roflumilast, also clearly ameliorates the symptoms of diabetes mellitus by improving hyperglycemia and insulin resistance. However, the beneficial effects of PDE4 inhibition on diabetic nephropathy have not yet been evaluated, and its potential mechanisms of action remain unknown. In this review, we discuss the beneficial effects of PDE4 inhibitors and their mechanisms of action using diabetes and DN models.
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Natesan V, Kim SJ. Diabetic Nephropathy - a Review of Risk Factors, Progression, Mechanism, and Dietary Management. Biomol Ther (Seoul) 2021; 29:365-372. [PMID: 33888647 PMCID: PMC8255138 DOI: 10.4062/biomolther.2020.204] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) leads to many health problems like diabetic nephropathy (DN). One of the key factors for chronic kidney disease and end-stage renal disease (ESRD) is T2DM. Extensive work is being done to delineate the pathogenesis of DN and to extend possible remedies. This review is intended to understand the nature of DN risk factors, progression, effects of glycemic levels, and stages of DN. We also explored the novel diagnostic and therapeutic approaches for DN such as gene therapy and stem cell treatments.
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Affiliation(s)
- Vijayakumar Natesan
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608002, Tamilnadu, India
| | - Sung-Jin Kim
- Department of Pharmacology and Toxicology, Metabolic Diseases Research Laboratory, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
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Ookawara M, Nio Y, Yamasaki M, Kuniyeda K, Hanauer G, Tohyama K, Hazama M, Matsuo T. Protective effect of a novel phosphodiesterase 4 selective inhibitor, compound A, in diabetic nephropathy model mice. Eur J Pharmacol 2021; 894:173852. [PMID: 33422506 DOI: 10.1016/j.ejphar.2021.173852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
Phosphodiesterase subtype 4 (PDE4) hydrolyzes cyclic AMP (cAMP), a secondary messenger that mediates intracellular signaling, and plays key roles in inflammatory and profibrotic responses. Clinical benefits of pentoxifylline, a non-selective PDE inhibitor, have been reported in patients with kidney disease. Here, we identified compound A as a potent and selective PDE4 inhibitor and evaluated its potential as a novel therapeutic agent for diabetic nephropathy (DN). To determine its in vivo efficacy on DN, uninephrectomized (UNx-) db/db mice and KKAy mice were used as DN mice models. Eight-week repeated dosing with compound A (1-10 mg/kg, QD, p.o.) showed dose-dependent and significant suppressive effects on glycosylated hemoglobin (GHb) and urinary albumin/creatinine ratio (UACR) in UNx-db/db mice. These effects are more potent than irbesartan, a clinically approved angiotensin II receptor blocker of DN. Moreover, compound A suppressed pro-fibrotic and pro-inflammatory marker mRNAs and increased anti-reactive oxygen species marker mRNAs in the kidneys of UNx-db/db mice. The similar effect of compound A on UACR was also demonstrated by 8-week repeated dose in KKAy mice, another model for DN with intact leptin axis. Taken together, these data suggest that the PDE4-selective inhibitor compound A has potential as a new therapeutic agent for DN with multiple mechanisms of action including anti-diabetic, anti-fibrotic, and anti-reactive oxygen species effects.
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Affiliation(s)
| | - Yasunori Nio
- Extra-Value Generation and General Medicine DDU, Japan.
| | | | | | - Guido Hanauer
- Takeda Pharmaceuticals International GmbH, Switzerland
| | - Kimio Tohyama
- Drug Metabolism & Pharmacokinetics Research Laboratories, Japan
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Nio Y, Ookawara M, Yamasaki M, Hanauer G, Tohyama K, Shibata S, Sano T, Shimizu F, Anayama H, Hazama M, Matsuo T. Ameliorative effect of phosphodiesterase 4 and 5 inhibitors in deoxycorticosterone acetate-salt hypertensive uni-nephrectomized KKA y mice. FASEB J 2020; 34:14997-15014. [PMID: 32939821 DOI: 10.1096/fj.202001084r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022]
Abstract
Diabetic nephropathy (DN) is a leading cause of end-stage renal disease (ESRD). Hypertension increases kidney stress, which deteriorates function, and leads to peripheral renal vascular resistance. Long-term hypoperfusion promotes interstitial fibrosis and glomerular sclerosis, resulting in nephrosclerosis. Although hypertension and DN are frequent ESRD complications, relevant animal models remain unavailable. We generated a deoxycorticosterone acetate (DOCA)-salt hypertensive uni-nephrectomized (UNx) KKAy mouse model demonstrating hypertension, hyperglycemia, cardiac hypertrophy, kidney failure, increased urinary albumin creatinine ratio (UACR), and increased renal PDE4D and cardiac PDE5A mRNA levels. We hypothesized that the novel PDE4 selective inhibitor, compound A, and PDE5 inhibitor, sildenafil, exhibit nephroprotective, and cardioprotective effects in this new model. Compound A, sildenafil, and the angiotensin II receptor blocker, irbesartan, significantly reduced ventricular hypertrophy and pleural effusion volume. Meanwhile, compound A and sildenafil significantly suppressed the UACR, urinary kidney injury molecule-1, and monocyte chemoattractant protein-1 levels, as well as that of renal pro-fibrotic marker mRNAs, including collagen 1A1, fibronectin, and transforming growth factor-beta (TGF-β). Moreover, compound A significantly suppressed TGF-β-induced pro-fibrotic mRNA expression in vitro in all major kidney lesions, including within the glomerular mesangial region, podocytes, and epithelial region. Hence, PDE4 and PDE5 inhibitors may be promising treatments, in combination with irbesartan, for DN with hypertension as they demonstrate complementary mechanisms.
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Affiliation(s)
- Yasunori Nio
- Extra-Value Generation and General Medicine DDU, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Mitsugi Ookawara
- Extra-Value Generation and General Medicine DDU, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Midori Yamasaki
- Extra-Value Generation and General Medicine DDU, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Guido Hanauer
- Takeda Pharmaceuticals International AG, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Kimio Tohyama
- Drug Metabolism & Pharmacokinetics Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Sachio Shibata
- Drug Metabolism & Pharmacokinetics Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Tomoya Sano
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Fumi Shimizu
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Hisashi Anayama
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Masatoshi Hazama
- Extra-Value Generation and General Medicine DDU, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Takanori Matsuo
- Extra-Value Generation and General Medicine DDU, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
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Yuanlin P, Dehai Y. Mechanism underlying treatment of diabetic kidney disease using Traditional Chinese Medicine based on theory of Yin and Yang balance. J TRADIT CHIN MED 2018. [DOI: 10.1016/s0254-6272(18)30921-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Xie Z, Zhong L, Wu Y, Wan X, Yang H, Xu X, Li P. Carnosic acid improves diabetic nephropathy by activating Nrf2/ARE and inhibition of NF-κB pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2018; 47:161-173. [PMID: 30166101 DOI: 10.1016/j.phymed.2018.04.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/22/2018] [Accepted: 04/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Diabetic nephropathy (DN), one of the most serious complications of diabetes, is the leading cause of morbidity and mortality of end-stage renal disease. Our previous research found that carnosic acid (CA) or rosemary extract can effectively improve glucose and lipid metabolism disorder by inhibiting SREBPs. PURPOSE In this study, we aimed to explore the therapeutic effects of CA on the DN. METHODS The mice glomerular mesangial cells (mGMCs) were used to evaluate the anti-oxidative and anti-inflammation effects of CA under high glucose (HG) condition. Furthermore, db/db mice and streptozotocin (STZ)-induced diabetic mice were used to investigate the effects of CA against DN in vivo. RESULTS The results showed that CA activated Nrf2, inhibited NF-κB pathway and regulated related downstream genes in mGMC under HG condition. A 14-week treatment of mice with CA reduced water uptake and urine volume, attenuated diabetes-induced albuminuria, increased urine creatinine, and subsequently improved the glomerular sclerosis and mesangial expansion in db/db mice. Similarly, a 20-week oral administration of CA improved kidney damage in STZ-induced diabetic mice. In addition, CA inhibited the expression of profibrotic factors, such as TGF-β1, fibronectin and E-cadherin. Compared to irbesartan, CA exerted better glucose lowering effect, and in kidney, CA was more potent to reduce fibronectin and E-cadherin expression. In all the animal experiment, CA did not lead to abnormal damages to other tissues. CONCLUSION These findings suggest that CA is a safe compound which exerts the protective effects on diabetes-induced kidney complications.
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Affiliation(s)
- Zhisheng Xie
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Lingjun Zhong
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Yanrao Wu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Xiaomeng Wan
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Hua Yang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Xiaojun Xu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
| | - Ping Li
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
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Trasino SE, Tang XH, Shevchuk MM, Choi ME, Gudas LJ. Amelioration of Diabetic Nephropathy Using a Retinoic Acid Receptor β2 Agonist. J Pharmacol Exp Ther 2018; 367:82-94. [PMID: 30054312 DOI: 10.1124/jpet.118.249375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/20/2018] [Indexed: 12/17/2022] Open
Abstract
Vitamin A (VA) and its derivatives, known as retinoids, play critical roles in renal development through retinoic acid receptor β2 (RARβ2). Disruptions in VA signaling pathways are associated with the onset of diabetic nephropathy (DN). Despite the known role of RARβ2 in renal development, the effects of selective agonists for RARβ2 in a high-fat diet (HFD) model of DN are unknown. Here we examined whether AC261066 (AC261), a highly selective agonist for RARβ2, exhibited therapeutic effects in a HFD model of DN in C57BL/6 mice. Twelve weeks of AC261 administration to HFD-fed mice was well tolerated with no observable side effects. Compared with HFD-fed mice, HFD + AC261-treated mice had improved glycemic control and reductions in proteinuria and urine albumin-to-creatinine ratio. Several cellular hallmarks of DN were mitigated in HFD + AC261-treated mice, including reductions in tubule lipid droplets, podocyte (POD) effacement, endothelial cell collapse, mesangial expansion, and glomerular basement membrane thickening. Mesangial and tubule interstitial expression of the myofibroblast markers α-smooth muscle actin (α-SMA) and type IV collagen (Col-IV) was lower in HFD + AC261-treated mice compared with HFD alone. Ultrastructural and immunohistochemistry analyses showed that, compared with HFD-fed mice, HFD + AC261-treated mice showed preservation of POD foot process and slit-diaphragm morphology, an increase in the levels of slit-diagram protein podocin, and the transcription factor Wilms tumor-suppressor gene 1 in PODs. Given the need for novel DN therapies, our results warrant further studies of the therapeutic properties of AC261 in DN.
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Affiliation(s)
- Steven E Trasino
- Departments of Pharmacology (S.E.T., X.-H.T., L.J.G.) and Pathology (M.M.S.) and Division of Nephrology and Hypertension, Department of Medicine (M.E.C.), Weill Cornell Medical College of Cornell University, School of Urban Public Health, Nutrition Program, Hunter College, City University of New York (S.E.T.), and NewYork-Presbyterian Hospital-Weill Cornell Medical Center (M.E.C.), New York, New York
| | - Xiao-Han Tang
- Departments of Pharmacology (S.E.T., X.-H.T., L.J.G.) and Pathology (M.M.S.) and Division of Nephrology and Hypertension, Department of Medicine (M.E.C.), Weill Cornell Medical College of Cornell University, School of Urban Public Health, Nutrition Program, Hunter College, City University of New York (S.E.T.), and NewYork-Presbyterian Hospital-Weill Cornell Medical Center (M.E.C.), New York, New York
| | - Maria M Shevchuk
- Departments of Pharmacology (S.E.T., X.-H.T., L.J.G.) and Pathology (M.M.S.) and Division of Nephrology and Hypertension, Department of Medicine (M.E.C.), Weill Cornell Medical College of Cornell University, School of Urban Public Health, Nutrition Program, Hunter College, City University of New York (S.E.T.), and NewYork-Presbyterian Hospital-Weill Cornell Medical Center (M.E.C.), New York, New York
| | - Mary E Choi
- Departments of Pharmacology (S.E.T., X.-H.T., L.J.G.) and Pathology (M.M.S.) and Division of Nephrology and Hypertension, Department of Medicine (M.E.C.), Weill Cornell Medical College of Cornell University, School of Urban Public Health, Nutrition Program, Hunter College, City University of New York (S.E.T.), and NewYork-Presbyterian Hospital-Weill Cornell Medical Center (M.E.C.), New York, New York
| | - Lorraine J Gudas
- Departments of Pharmacology (S.E.T., X.-H.T., L.J.G.) and Pathology (M.M.S.) and Division of Nephrology and Hypertension, Department of Medicine (M.E.C.), Weill Cornell Medical College of Cornell University, School of Urban Public Health, Nutrition Program, Hunter College, City University of New York (S.E.T.), and NewYork-Presbyterian Hospital-Weill Cornell Medical Center (M.E.C.), New York, New York
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Zhou X, Zhang J, Haimbach R, Zhu W, Mayer-Ezell R, Garcia-Calvo M, Smith E, Price O, Kan Y, Zycband E, Zhu Y, Hoek M, Cox JM, Ma L, Kelley DE, Pinto S. An integrin antagonist (MK-0429) decreases proteinuria and renal fibrosis in the ZSF1 rat diabetic nephropathy model. Pharmacol Res Perspect 2018; 5. [PMID: 28971604 PMCID: PMC5625158 DOI: 10.1002/prp2.354] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 01/24/2023] Open
Abstract
Multiple integrins have been implicated in modulating renal function. Modulation of integrin function can lead to pathophysiological processes associated with diabetic nephropathy such as alterations in the glomerular filtration barrier and kidney fibrosis. The complexity of these pathophysiological changes implies that multiple integrin subtypes might need to be targeted to ameliorate the progression of renal disease. To address this hypothesis, we investigated the effects of MK‐0429, a compound that was originally developed as an αvβ3 inhibitor for the treatment of osteoporosis, on renal function and fibrosis. We demonstrated that MK‐0429 is an equipotent pan‐inhibitor of multiple av integrins. MK‐0429 dose‐dependently inhibited podocyte motility and also suppressed TGF‐β‐induced fibrosis marker gene expression in kidney fibroblasts. Moreover, in the obese ZSF1 rat model of diabetic nephropathy, chronic treatment with MK‐0429 resulted in significant reduction in proteinuria, kidney fibrosis, and collagen accumulation. In summary, our results suggest that inhibition of multiple integrin subtypes might lead to meaningful impact on proteinuria and renal fibrosis in diabetic nephropathy.
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Affiliation(s)
- Xiaoyan Zhou
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Ji Zhang
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Robin Haimbach
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Wei Zhu
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Rosemary Mayer-Ezell
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Margarita Garcia-Calvo
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Elizabeth Smith
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Olga Price
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Yanqing Kan
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Emanuel Zycband
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Yonghua Zhu
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Maarten Hoek
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Jason M Cox
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Lijun Ma
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - David E Kelley
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Shirly Pinto
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
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Jamali AA, Jamali GM, Tanwani BM, Jamali AA, Tanwani Y, Jamali NM. Association of Hypomagnesemia in Type 2 Diabetic Patients with and without Peripheral Neuropathy. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/jdm.2018.82004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bolignano D, Cernaro V, Gembillo G, Baggetta R, Buemi M, D’Arrigo G. Antioxidant agents for delaying diabetic kidney disease progression: A systematic review and meta-analysis. PLoS One 2017; 12:e0178699. [PMID: 28570649 PMCID: PMC5453586 DOI: 10.1371/journal.pone.0178699] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/17/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Oxidative stress is a key player in the genesis and worsening of diabetic kidney disease (DKD). We aimed at collecting all available information on possible benefits of chronic antioxidant supplementations on DKD progression. STUDY DESIGN Systematic review and meta-analysis. POPULATION Adults with DKD (either secondary to type 1 or 2 diabetes mellitus). SEARCH STRATEGY AND SOURCES Cochrane CENTRAL, Ovid-MEDLINE and PubMed were searched for randomized controlled trials (RCTs) or quasi-RCTs without language or follow-up restriction. INTERVENTION Any antioxidant supplementation (including but not limited to vitamin A, vitamin C, vitamin E, selenium, zinc, methionine or ubiquinone) alone or in combination. OUTCOMES Primary outcome was progression to end-stage kidney disease (ESKD). Secondary outcomes were change in albuminuria, proteinuria, serum creatinine and renal function. RESULTS From 13519 potentially relevant citations retrieved, 15 articles referring to 14 full studies (4345 participants) met the inclusion criteria. Antioxidant treatment significantly decreased albuminuria as compared to control (8 studies, 327 participants; SMD: -0.47; 95% CI -0.78, -0.16) but had apparently no tangible effects on renal function (GFR) (3 studies, 85 participants; MD -0.12 ml/min/1.73m2; 95% CI -0.06, 0.01). Evidence of benefits on the other outcomes of interest was inconclusive or lacking. LIMITATIONS Small sample size and limited number of studies. Scarce information available on hard endpoints (ESKD). High heterogeneity among studies with respect to DKD severity, type and duration of antioxidant therapy. CONCLUSIONS In DKD patients, antioxidants may improve early renal damage. Future studies targeting hard endpoints and with longer follow-up and larger sample size are needed to confirm the usefulness of these agents for retarding DKD progression.
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Affiliation(s)
| | - Valeria Cernaro
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Guido Gembillo
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Michele Buemi
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Xie X, Xia W, Fei X, Xu Q, Yang X, Qiu D, Wang M. Relaxin Inhibits High Glucose-Induced Matrix Accumulation in Human Mesangial Cells by Interfering with TGF-β1 Production and Mesangial Cells Phenotypic Transition. Biol Pharm Bull 2016; 38:1464-9. [PMID: 26424011 DOI: 10.1248/bpb.b15-00127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). DN is characterized by glomerular extracellular matrix accumulation, mesangial expansion, basement membrane thickening, and renal interstitial fibrosis. To date, mounting evidence has shown that H2 relaxin possesses powerful antifibrosis properties; however, the mechanisms of H2 relaxin on diabetic nephropathy remain unknown. Here, we aimed to explore whether H2 relaxin can reduce production of extracellular matrix (ECM) secreted by human mesangial cells (HMC). HMC were exposed to 5.5 mM glucose (NG) or 30 mM glucose (HG) with or without H2 relaxin. Fibronectin (FN) and collagen type IV levels in the culture supernatants were examined by solid-phase enzyme-linked immunoadsorbent assay (ELISA). Western blot was used to detect the expression of α-smooth muscle actin (α-SMA) protein. Quantitative polymerase chain reaction (qPCR) method was employed to analyze transforming growth factor (TGF)-β1 mRNA expression. Compared with the normal glucose group, the levels of fibronectin and collagen type were markedly increased after being cultured in high glucose medium. Compared with the high glucose group, remarkable decreases of fibronectin, collagen type IV, α-smooth muscle actin, and TGF-β1 mRNA expression were observed in the H2 relaxin-treated group. The mechanism by which H2 relaxin reduced high glucose-induced overproduction of ECM may be associated with inhibition of TGF-β1 mRNA expression and mesangial cells' phenotypic transition. H2 relaxin is a potentially effective modality for the treatment of DN.
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Affiliation(s)
- Xiangcheng Xie
- Department of Nephrology, Hangzhou First People's Hospital, Affiliated Hangzhou Hospital of Nanjing Medical University
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