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Hu T, Liu CH, Lei M, Zeng Q, Li L, Tang H, Zhang N. Metabolic regulation of the immune system in health and diseases: mechanisms and interventions. Signal Transduct Target Ther 2024; 9:268. [PMID: 39379377 PMCID: PMC11461632 DOI: 10.1038/s41392-024-01954-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/18/2024] [Accepted: 08/11/2024] [Indexed: 10/10/2024] Open
Abstract
Metabolism, including glycolysis, oxidative phosphorylation, fatty acid oxidation, and other metabolic pathways, impacts the phenotypes and functions of immune cells. The metabolic regulation of the immune system is important in the pathogenesis and progression of numerous diseases, such as cancers, autoimmune diseases and metabolic diseases. The concept of immunometabolism was introduced over a decade ago to elucidate the intricate interplay between metabolism and immunity. The definition of immunometabolism has expanded from chronic low-grade inflammation in metabolic diseases to metabolic reprogramming of immune cells in various diseases. With immunometabolism being proposed and developed, the metabolic regulation of the immune system can be gradually summarized and becomes more and more clearer. In the context of many diseases including cancer, autoimmune diseases, metabolic diseases, and many other disease, metabolic reprogramming occurs in immune cells inducing proinflammatory or anti-inflammatory effects. The phenotypic and functional changes of immune cells caused by metabolic regulation further affect and development of diseases. Based on experimental results, targeting cellular metabolism of immune cells becomes a promising therapy. In this review, we focus on immune cells to introduce their metabolic pathways and metabolic reprogramming, and summarize how these metabolic pathways affect immune effects in the context of diseases. We thoroughly explore targets and treatments based on immunometabolism in existing studies. The challenges of translating experimental results into clinical applications in the field of immunometabolism are also summarized. We believe that a better understanding of immune regulation in health and diseases will improve the management of most diseases.
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Affiliation(s)
- Tengyue Hu
- West China School of clinical medical, West China Second University Hospital, Sichuan University, Chengdu, China
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institution of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Chang-Hai Liu
- West China School of clinical medical, West China Second University Hospital, Sichuan University, Chengdu, China
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institution of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Min Lei
- West China School of clinical medical, West China Second University Hospital, Sichuan University, Chengdu, China
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qingmin Zeng
- West China School of clinical medical, West China Second University Hospital, Sichuan University, Chengdu, China
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institution of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Division of Renal and endocrinology, Qin Huang Hospital, Xi'an, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
- Laboratory of Infectious and Liver Diseases, Institution of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
- State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Nannan Zhang
- West China School of clinical medical, West China Second University Hospital, Sichuan University, Chengdu, China.
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
- State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China.
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Kourtidou C, Stangou M, Marinaki S, Tziomalos K. Novel Cardiovascular Risk Factors in Patients with Diabetic Kidney Disease. Int J Mol Sci 2021; 22:ijms222011196. [PMID: 34681856 PMCID: PMC8537513 DOI: 10.3390/ijms222011196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with diabetic kidney disease (DKD) are at very high risk for cardiovascular events. Only part of this increased risk can be attributed to the presence of diabetes mellitus (DM) and to other DM-related comorbidities, including hypertension and obesity. The identification of novel risk factors that underpin the association between DKD and cardiovascular disease (CVD) is essential for risk stratification, for individualization of treatment and for identification of novel treatment targets.In the present review, we summarize the current knowledge regarding the role of emerging cardiovascular risk markers in patients with DKD. Among these biomarkers, fibroblast growth factor-23 and copeptin were studied more extensively and consistently predicted cardiovascular events in this population. Therefore, it might be useful to incorporate them in risk stratification strategies in patients with DKD to identify those who would possibly benefit from more aggressive management of cardiovascular risk factors.
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Affiliation(s)
- Christodoula Kourtidou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
- Correspondence:
| | - Maria Stangou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Smaragdi Marinaki
- Department of Nephrology and Renal Transplantation, Medical School, National and Kapodistrian University of Athens, Laiko Hospital, 11527 Athens, Greece;
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
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Olawale OO, Adekanmbi AF, Sonuga AA, Sonuga OO, Akodu SO, Ogundeyi MM. Assessment of Renal Function Status in Steady-State Sickle Cell Anaemic Children Using Urine Human Neutrophil Gelatinase-Associated Lipocalin and Albumin:Creatinine Ratio. Med Princ Pract 2021; 30:557-562. [PMID: 34348300 PMCID: PMC8740162 DOI: 10.1159/000518458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sickle cell anaemia is characterized by defective haemoglobin synthesis and is associated with both endocrine and metabolic alterations. The effects of this clinical condition on kidney function are multifactorial and often begin early in childhood. This study aims to assess renal function in children with sickle cell anaemia using urine albumin:creatinine ratio (ACR) and urine human neutrophil gelatinase-associated lipocalin (NGAL). METHODS This case-control study was conducted on 200 children aged 5-15 years in 2 tertiary hospitals in South West Nigeria: 150 were of haemoglobin S genotype and 50 were of haemoglobin A genotype. Serum urea, creatinine, urine albumin, and NGAL were assayed by known standard methods. eGFR, urine ACR, and urine NGAL/creatinine ratio (urine NCR) were calculated. RESULTS The weight, height, BMI, systolic blood pressure, plasma urea, plasma creatinine, and spot urine creatinine of the HbS genotype children were significantly lower compared to that of the HbA genotype children. The eGFR, spot urine albumin, and urine ACR were significantly higher in the HbS group compared to the HbA group. There was no significant difference in the spot urine NGAL and urine NCR between the 2 groups, though both were higher in the HbS group compared to the HbA group. CONCLUSIONS Kidney injury probably starts early in childhood in sickle cell individuals as indicated by the higher urine ACR detected in them. We infer that urine NGAL and uNCR are not sensitive markers of kidney disease especially in young sickle cell individuals possibly because of the hyperfiltration present at this age.
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Affiliation(s)
| | | | | | | | - Samuel Olufemi Akodu
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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4
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Bayrasheva VK, Pchelin IY, Dobronravov VA, Babenko AY, Chefu SG, Shatalov IS, Vasilkova VN, Hudiakova NV, Ivanova AN, Andoskin PA, Grineva EN. Short-term renal and metabolic effects of low dose vildagliptin treatment added-on insulin therapy in non-proteinuric patients with type 2 diabetes: open-label randomized prospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:418-426. [PMID: 32267348 PMCID: PMC10522081 DOI: 10.20945/2359-3997000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022]
Abstract
Objective The aim of this randomized comparative study was to assess renal and metabolic effects of vildagliptin in insulin-treated type 2 diabetes (T2DM) patients without overt chronic kidney disease. Subjects and methods We randomized 47 insulin-treated non-proteinuric patients with satisfactory controlled T2DM and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m 2 either to continue insulin therapy (control) or to receive combined insulin-vildagliptin treatment (VIG group). We assessed eGFR using serum creatinine (eGFRcreat), cystatin C (eGFRcys), and both (eGFRcreat-cys), and urinary creatinine-adjusted excretion of albumin (UACR), type IV collagen (uCol IV/Cr), and neutrophil gelatinase-associated lipocalin (uNGAL/Cr) at baseline and after 6 months of treatment. Results Study groups were comparable in terms of age and sex (60.1 ± 6.1 years and 42.9% men in control group vs. 60.8 ± 5.2 years and 39.1% in VIG group). After 6 months of treatment, there were no significant changes in main assessed parameters in control group. VIG group demonstrated significant decrease in HbA1c, diastolic blood pressure, frequency of hypoglycemia, and high-sensitivity C-reactive protein level as compared to the changes in control group. While eGFRcreat, UACR, and uNGAL/Cr showed no significant changes after vildagliptin addition, eGFRcys, eGFRcreat-cys, and uCol IV/Cr changed significantly in comparison with control group (+7.0% [3.7;13.3]; +5.1% [1.4;8.5]; -32,8% [-55.8;-24.4], respectively, p < 0.01 each). Correlation and regression analysis revealed glucose-independent pattern of these changes. Conclusion Addition of vildagliptin to ongoing insulin therapy in patients with T2DM was associated with a reduction in uCol IV/Cr and an increase in eGFRcys and eGFRcreat-cys, independent of T2DM control parameters.
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Affiliation(s)
- Valentina K Bayrasheva
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Ivan Y Pchelin
- Department of Faculty Therapy, Saint Petersburg State University,, Saint Petersburg, Russia
| | - Vladimir A Dobronravov
- Research Institute of Nephrology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Alina Yu Babenko
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Svetlana G Chefu
- Experimental Research Laboratory, Laser Medicine Center, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Ivan S Shatalov
- Scientific and Research Institute of Bioengineering, Saint Petersburg National Research University of Information, Technologies, Mechanics and Optics, Saint Petersburg, Russia
| | - Volha N Vasilkova
- Department of Internal Medicine No.1 with the Course of Endocrinology, Gomel State Medical University, Gomel, Belarus
| | - Natalia V Hudiakova
- Department of Faculty Therapy, Saint Petersburg State University,, Saint Petersburg, Russia
| | - Alexandra N Ivanova
- Department of Faculty Therapy, Saint Petersburg State University,, Saint Petersburg, Russia
| | - Pavel A Andoskin
- Laboratory of Protein Biochemistry, State Research Institute of Highly Pure BioSubstances, Saint Petersburg, Russia
| | - Elena N Grineva
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
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Abstract
PURPOSE OF REVIEW Diabetic kidney disease (DKD) is the leading cause of kidney failure in the USA, representing ~ 44% of all cases of kidney failure. Advancements in both glucose management and inhibitors of the renin-angiotensin system have significantly improved prognosis for individuals with DKD, yet DKD continues to affect 30-40% of people with type 2 diabetes and is still a major predictor of mortality in this population. Thus, new interventions are required to address this significant health burden. RECENT FINDINGS One potential target for intervention is cellular senescence. Senescence permanently arrests cell division in response to genotoxic, oncogenic, or metabolic stresses-coupled to the secretion of inflammatory cytokines, chemokines, growth factors, proteases, and other molecules that can have potent local and systemic effects. This senescence-associated secretory phenotype (SASP) explains how a relatively small number of senescent cells can promote pathology, and a growing number of degenerative conditions have been found to be caused or aggravated by senescent cells. Many SASP factors are also associated with loss of kidney function. Targeted elimination of senescent cells prevents the development of several degenerative pathologies. Since senescent cells appear in the proximal tubules and podocytes of patients with DKD, they are an appealing target for intervention in these disorders. Here, we review the current literature linking senescence to DKD and speculate on the likely routes to intervention in a clinical setting.
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Affiliation(s)
- Christopher D Wiley
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA, 94945, USA.
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Takemura S, Shimizu T, Oka M, Sekiya S, Babazono T. Transplantation of adipose-derived mesenchymal stem cell sheets directly into the kidney suppresses the progression of renal injury in a diabetic nephropathy rat model. J Diabetes Investig 2020; 11:545-553. [PMID: 31622047 PMCID: PMC7232293 DOI: 10.1111/jdi.13164] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/15/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION Adipose-derived mesenchymal stem cell (ASC) transplantation is a promising therapy for diabetic nephropathy (DN). However, intravascular administration of ASCs is associated with low engraftment in target organs. Therefore, we considered applying the cell sheet technology to ASCs. In this study, ASC sheets were directly transplanted into the kidneys of a DN rat model, and therapeutic consequences were analyzed. MATERIALS AND METHODS Adipose-derived mesenchymal stem cells were isolated from adipose tissues of 7-week-old enhanced green fluorescent protein rats, and ASC sheets were prepared using a temperature-responsive culture dish. A DN rat model was established from 5-week-old Spontaneously Diabetic Torii fatty rats. Seven-week-old DN rats (n = 21) were assigned to one of the following groups: sham-operated (n = 6); ASC suspension (6.0 × 106 cells/mL) administered intravenously (n = 7); six ASC sheets transplanted directly into the kidney (n = 8). The therapeutic effect of the cell sheets was determined based on urinary biomarker expression and histological analyses. RESULTS The ASC sheets survived under the kidney capsule of the DN rat model for 14 days after transplantation. Furthermore, albuminuria and urinary tumor necrosis factor-α levels were significantly lower in the ASC sheets transplanted directly into the kidney group than in the sham-operated and ASC suspension administered intravenously groups (P < 0.05). Histologically, the ASC sheets transplanted directly into the kidney group presented mild atrophy of the proximal tubule and maintained the renal tubular structure. CONCLUSIONS Transplantation of ASC sheets directly into the kidney improved transplantation efficiency and suppressed renal injury progression. Therefore, the ASC sheet technology might be a promising novel treatment for DN.
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Affiliation(s)
- Shunsuke Takemura
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women’s Medical UniversityTokyoJapan
| | - Tatsuya Shimizu
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women’s Medical UniversityTokyoJapan
| | - Masatoshi Oka
- Department of MedicineKidney CenterTokyo Women’s Medical UniversityTokyoJapan
| | - Sachiko Sekiya
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women’s Medical UniversityTokyoJapan
| | - Tetsuya Babazono
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
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Abbasi F, Moosaie F, Khaloo P, Dehghani Firouzabadi F, Fatemi Abhari SM, Atainia B, Ardeshir M, Nakhjavani M, Esteghamati A. Neutrophil Gelatinase-Associated Lipocalin and Retinol-Binding Protein-4 as Biomarkers for Diabetic Kidney Disease. Kidney Blood Press Res 2020; 45:222-232. [PMID: 32008005 DOI: 10.1159/000505155] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022] Open
Abstract
AIMS This study was designed to evaluate the conflicting association between 2 tubular protein markers including neutrophil gelatinase-associated lipocalin (NGAL) and retinol-binding protein-4 (RBP-4) with albuminuria and glomerular filtration rate (GFR) and calculate the accuracy of the role of NGAL and RBP-4 in diagnosis of diabetic nephropathy (DN) in patients with type2 diabetes. METHODS This is a cross-sectional study that included 133 patients with type 2 diabetes. There were 3 diabetic study groups with normoalbuminuria, moderately increased albuminuria, severely increased albuminuria, and non-diabetic control group without any renal disease. We analyzed the difference of urinary NGAL (uNGAL) and RBP-4 between nondiabetics and diabetics, as well as within the diabetic group. We also assessed the association between albuminuria and NGAL and RBP-4. RESULTS The urinary levels of NGAL and RBP-4 were higher in patients with type 2 diabetes compared to nondiabetics as well as in albuminuric diabetics compared to nonalbuminuric patients with diabetes (p value <0.001). These 2 proteins were higher in patients with severely increased albuminuria compared to patients with moderately increased albuminuria, even after adjustment for other metabolic factors (all p < 0.01). Moreover, areas under the curve of NGAL and RBP-4 for the diagnosis of chronic kidney disease were 80.6 and 74.6%, respectively. CONCLUSION uNGAL and RBP-4 are potential markers of tubular damage that may increase before the onset of glomerular markers such as albuminuria and GFR in patients with type 2 diabetes. Therefore, these markers can be used as complementary measurements to albuminuria and GFR in the earlier diagnosis of DN.
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Affiliation(s)
- Fatemeh Abbasi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bahar Atainia
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshir
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,
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Shufang H, Kui C, Li Y, Yu Z. Diagnostic Values of Urinary Biomarkers in Early Diagnosis of Diabetic Nephropathy. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.851.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Li Y, Li Q, Wang C, Lou Z, Li Q. Trigonelline reduced diabetic nephropathy and insulin resistance in type 2 diabetic rats through peroxisome proliferator-activated receptor-γ. Exp Ther Med 2019; 18:1331-1337. [PMID: 31363374 DOI: 10.3892/etm.2019.7698] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022] Open
Abstract
Trigonelline has been reported to serve an important role in cell cycle control, oxidative and ultraviolet stress and DNA methylation. In the present study, the effects of trigonelline were examined on type-2 diabetes mellitus (T2DM)-induced renal dysfunction, and its possible mechanism was investigated. Sprague-Dawley rats were fed with high-fat diet (HFD) for 4 weeks and intraperitoneally injected with 35 mg/kg of streptozotocin for 4 weeks. As a result, trigonelline increased body weight, inhibited the kidney weight/body weight ratio and blood glucose levels, and reduced the levels of blood urea nitrogen, creatinine and albumin in type 2 diabetic rats. In addition, trigonelline also reduced inflammation, oxidative stress and kidney cell apoptosis in T2DM rats. In terms of the molecular mechanisms involved, trigonelline induced the protein expression of peroxisome proliferator-activated receptor (PPAR)-γ and suppressed glucose transporter 4 but suppressed the protein expression of tumor necrosis factor-α and leptin in T2DM rats. The present results demonstrated that trigonelline reduced diabetic nephropathy and insulin resistance in T2DM rats through PPAR-γ.
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Affiliation(s)
- Yinyan Li
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qaobei Li
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Chunyan Wang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Zhe Lou
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qingchang Li
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Effects of redox label location on the performance of an electrochemical aptamer-based tumor necrosis factor-alpha sensor. Talanta 2018; 189:585-591. [PMID: 30086964 DOI: 10.1016/j.talanta.2018.07.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022]
Abstract
We report the development of an electrochemical aptamer-based sensor for real time detection of tumor necrosis factor-alpha. The focus of this study is to evaluate the effects of the redox label location on the overall sensor performance, including sensor stability, detection limit, reusability, and selectivity. Three aptamer probes, each labeled with methylene blue (MB) at a specific location, were designed and employed in the fabrication of the sensors. Among the three sensors, the sensor fabricated using an aptamer with the MB label located at the distal end has a detection limit of 100 pM and is regenerable. The sensor fabricated using an aptamer with an internal MB modification has a detection limit of 10 nM and is not regenerable. Both sensors can be employed in complex biological samples such as 50% urine and 50% saliva. However, the sensor fabricated with an aptamer with the MB label located at the proximal end suffers from poor reproducibility and is highly unstable, thus limiting its application as a sensor. On the bases of these results, placing the MB label at the distal end of the aptamer probe appears to be the most advantageous for this sensor design for it does not interfere with monolayer formation and target binding.
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Siddiqui K, Joy SS, Ilias S, Alzeer HS, Al-Rubeaan K. Urinary biomarkers reporting weakness and validation failure in Type 2 diabetic nephropathy: systematic review. Biomark Med 2018; 12:487-499. [PMID: 29697277 DOI: 10.2217/bmm-2017-0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
For better identification of novel diagnostic urinary biomarker in Type 2 diabetic nephropathy (T2DN), methodological and reporting quality is as important as validity of biomarkers. The aim of this systematic review is to find out the best-reported diagnostic urinary biomarkers study in T2DN based on STARD criteria. We also analyzed the validity of urinary markers in the selected articles those followed STARD criteria. The diagnostic accuracy of urinary biomarkers on T2DN is not conclusive because of the poor reporting quality and differences in adjustment for conventional risk factors. For a proper validation of urinary biomarkers on T2DN, in future large well-designed longitudinal studies, with specific prediction analysis and validation of the biomarkers by adjusting with possible conventional risk factors.
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Affiliation(s)
- Khalid Siddiqui
- Department of Biochemistry, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Salini S Joy
- Department of Biochemistry, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Shumaila Ilias
- Department of Biochemistry, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Haya S Alzeer
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al-Rubeaan
- Department of Biochemistry, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia.,University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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12
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Orellana JM, Kampe K, Schulze F, Sieber J, Jehle AW. Fetuin-A aggravates lipotoxicity in podocytes via interleukin-1 signaling. Physiol Rep 2018; 5:e13287. [PMID: 28554965 PMCID: PMC5449566 DOI: 10.14814/phy2.13287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022] Open
Abstract
Sterile inflammation is considered critical in the pathogenesis of diabetic nephropathy (DN). Here we show that Fetuin-A (FetA) or lipopolysaccharide (LPS) exacerbate palmitic acid-induced podocyte death, which is associated with a strong induction of monocyte chemoattractant protein-1 (MCP-1) and keratinocyte chemoattractant (KC). Moreover, blockage of TLR4 prevents MCP-1 and KC secretion and attenuates podocyte death induced by palmitic acid alone or combined with FetA. In addition, inhibition of interleukin-1 (IL-1) signaling by anakinra, a recombinant human IL-1Ra, or a murinized anti-IL-1β antibody attenuates the inflammatory and ultimate cell death response elicited by FetA alone or combined with palmitic acid. In vivo short-term therapy of diabetic DBA/2J mice with an anti-IL1-β antibody for 4 weeks prevented an increase in serum FetA and considerably decreased urinary tumor necrosis alpha (TNF-α), a known risk factor for DN progression. In summary, our results suggest that FetA similarly to LPS leads to an inflammatory response in podocytes, which exacerbates palmitic acid-induced podocyte death and our data imply a critical role for IL-1β signaling in this process. The study offers the rational for prolonged in vivo studies aimed at testing anti-IL-1β therapy for prevention and treatment of DN.
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Affiliation(s)
- Jana M Orellana
- Department of Biomedicine, Molecular Nephrology, University Hospital, Basel, Switzerland
| | - Kapil Kampe
- Department of Biomedicine, Molecular Nephrology, University Hospital, Basel, Switzerland
| | - Friederike Schulze
- Department of Biomedicine, Diabetes Research, University Hospital, Basel, Switzerland
| | - Jonas Sieber
- Department of Biomedicine, Molecular Nephrology, University Hospital, Basel, Switzerland.,Harvard Medical School and Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andreas W Jehle
- Department of Biomedicine, Molecular Nephrology, University Hospital, Basel, Switzerland.,Department of Internal Medicine, Transplantation Immunology and Nephrology, University Hospital, Basel, Switzerland
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13
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Kaul A, Behera MR, Rai MK, Mishra P, Bhaduaria DS, Yadav S, Agarwal V, Karoli R, Prasad N, Gupta A, Sharma RK. Neutrophil Gelatinase-associated Lipocalin: As a Predictor of Early Diabetic Nephropathy in Type 2 Diabetes Mellitus. Indian J Nephrol 2018. [PMID: 29515302 PMCID: PMC5830810 DOI: 10.4103/ijn.ijn_96_17] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m2 and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.
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Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M K Rai
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - P Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D S Bhaduaria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Yadav
- Department of Medicine, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Karoli
- Department of Endocrinology, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Gala-Błądzińska A, Dumnicka P, Kuśnierz-Cabala B, Rybak K, Drożdż R, Żyłka A, Kuźniewski M. Urinary Neutrophil Gelatinase-Associated Lipocalin Is Complementary to Albuminuria in Diagnosis of Early-Stage Diabetic Kidney Disease in Type 2 Diabetes. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4691389. [PMID: 28845433 PMCID: PMC5563398 DOI: 10.1155/2017/4691389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/19/2017] [Accepted: 07/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Two clinical phenotypes of diabetic kidney disease (DKD) have been reported, that is, with or without increased albuminuria. The aim of study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for the early diagnosis of DKD in the type 2 diabetes mellitus (T2DM). METHODS The study group consisted of 123 patients with T2DM (mean age 62 ± 14 years), with urine albumin/creatinine ratio (uACR) < 300 mg/g and eGFR ≥ 60 ml/min/1.73 m2. The control group included 22 nondiabetic patients with comparable age, sex, and comorbidities. uNGAL, albumin, and creatinine were measured in the first morning urine samples. uACR and uNGAL/creatinine ratios (uNCR) were calculated. RESULTS In the control group, maximum uNCR was 39.64 µg/g. In T2DM group, 24 patients (20%) had higher results, with the maximum value of 378.6 µg/g. Among patients with uNCR > 39.64 µg/g, 13 (54%) did not have markedly increased albuminuria. Women with T2DM had higher uNCR than men (p < 0.001), without difference in uACR (p = 0.09). uNCR in T2DM patients correlated significantly with HbA1c. Sex, total cholesterol, and uACR were independent predictors of uNCR above 39.64 µg/g. CONCLUSIONS Increased uNGAL and uNCR may indicate early tubular damage, associated with dyslipidemia and worse diabetes control, especially in females with T2DM.
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Affiliation(s)
- Agnieszka Gala-Błądzińska
- Department of Dialysis and Nephrology, St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszów, Lwowska 60 Street, 35-301 Rzeszów, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, 15A Kopernika Street, 31-501 Krakow, Poland
| | - Katarzyna Rybak
- Department of Internal Medicine, Nephrology & Endocrinology, St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszów, Lwowska 60 Street, 35-301 Rzeszów, Poland
| | - Ryszard Drożdż
- Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Agnieszka Żyłka
- St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszów, Lwowska 60 Street, 35-301 Rzeszów, Poland
| | - Marek Kuźniewski
- Department of Nephrology, Jagiellonian University Medical College, 15 Kopernika Street, 31-501 Krakow, Poland
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Al-Rubeaan K, Siddiqui K, Al-Ghonaim MA, Youssef AM, Al-Sharqawi AH, AlNaqeb D. Assessment of the diagnostic value of different biomarkers in relation to various stages of diabetic nephropathy in type 2 diabetic patients. Sci Rep 2017; 7:2684. [PMID: 28577020 PMCID: PMC5457399 DOI: 10.1038/s41598-017-02421-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/11/2017] [Indexed: 01/28/2023] Open
Abstract
Albuminuria is widely used to indicate early phases of diabetic nephropathy although it is limited by the fact that structural damage might precede albumin excretion. This necessitates identifying better biomarkers that diagnose or predict diabetic nephropathy. This is a cross-sectional hospital based study recruiting type 2 diabetic patients cohort aged 35–75 years with diabetes duration of ≥10 years. Out of total eligible 467 patients, 200 patients were with normal albumin excretion, 184 patients with microalbuminuria and 83 patients with macroalbuminuria. All the patients were tested for the 22 selected biomarkers including serum, plasma and urinary markers. Sensitivity, specificity, and area under the curve (AUC) were calculated as measures of diagnostic accuracy. Out of the tested biomarkers, urinary transferrin, urinary Retinol binding protein (RBP) and serum osteopontin had the best diagnostic value for diabetic nephropathy presence based on the AUC value. The rest of the biomarkers had comparatively less or even no discriminative power. The urinary transferrin and RBP and serum osteopontin, had the best diagnostic value in type 2 diabetic patients at different stages of diabetic nephropathy. Further longitudinal prospective studies are needed to evaluate the predictive power of those markers for detecting diabetic nephropathy before any structural damage occurs.
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Affiliation(s)
- Khalid Al-Rubeaan
- University Diabetes Center, College of medicine, King Saud University, Riyadh, PO Box 18397, Saudi Arabia.
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, King Saud University, Riyadh, PO Box 245, Saudi Arabia
| | - Mohammed A Al-Ghonaim
- College of medicine, King Khalid University Hospital, King Saud University, Riyadh, PO Box 45299, Saudi Arabia
| | - Amira M Youssef
- Registry Department, University Diabetes Center, King Saud University, Riyadh, PO Box 245, Saudi Arabia
| | - Ahmed H Al-Sharqawi
- University Diabetes Center, College of medicine, King Saud University, Riyadh, PO Box 18397, Saudi Arabia
| | - Dhekra AlNaqeb
- Research Department, University Diabetes Center, King Saud University, PO Box 245, Riyadh, Saudi Arabia
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Gala-Błądzińska A, Żyłka A, Dumnicka P, Kuśnierz-Cabala B, Kaziuk MB, Kuźniewski M. Sterile leukocyturia affects urine neutrophil gelatinase-associated lipocalin concentration in type 2 diabetic patients. Arch Med Sci 2017; 13:321-327. [PMID: 28261284 PMCID: PMC5332454 DOI: 10.5114/aoms.2016.64043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/27/2015] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Increased urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations are associated with the early phase of kidney damage. Urine NGAL may increase due to production by neutrophils present in urine, particularly in patients with urinary tract infections. The aim of the study was to assess the relationship between sterile leukocyturia and uNGAL concentrations in patients with type 2 diabetes (DMt2) at early stages of diabetic kidney disease. MATERIAL AND METHODS The study included 115 DMt2 patients aged 60.0 ±15.5 years, with albuminuria < 300 mg/g creatinine and estimated glomerular filtration rate ≥ 60 ml/min/1.73 m² prospectively recruited at the nephrology ambulatory clinic in 2014-2015. The exclusion criteria were urinary tract infections (excluded by urine culture) and other diseases influencing uNGAL, including inflammatory and other kidney diseases. Urine concentrations of NGAL, albumin and creatinine were measured in the first morning samples, and the urine albumin to creatinine ratio (UACR) and uNGAL to creatinine ratio (UNCR) were calculated. Leukocyturia was detected microscopically. RESULTS Sterile leukocyturia was present in 15% (95% confidence interval: 9-23%) of patients. Patients with leukocyturia had higher uNGAL and UNCR than patients without leukocyturia. ln(UNCR) correlated with ln(UACR) in the whole group (R = 0.59; p < 0.001) and in patients without leukocyturia (R = 0.56; p < 0.001). In multiple regression, age, ln(UACR), ln(HbA1c) and leukocyturia were independent positive predictors of ln(UNCR). Among patients with leukocyturia, the associations of UNCR with UACR, age and HbA1c were non-significant. CONCLUSIONS In patients with DMt2, the presence of sterile leukocyturia coexists with increased uNGAL and UNCR. Leukocyturia interferes with the relationship between UNCR and UACR or HbA1c.
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Affiliation(s)
- Agnieszka Gala-Błądzińska
- Department of Internal Medicine, Nephrology and Endocrinology, St Queen Jadwiga Clinical District Hospital No. 2, Rzeszow, Poland
| | - Agnieszka Żyłka
- Department of Internal Medicine, Nephrology and Endocrinology, St Queen Jadwiga Clinical District Hospital No. 2, Rzeszow, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | | | - Marek Kuźniewski
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
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Bennett MR, Pleasant L, Haffner C, Ma Q, Haffey WD, Ying J, Wagner M, Greis KD, Devarajan P. A Novel Biomarker Panel to Identify Steroid Resistance in Childhood Idiopathic Nephrotic Syndrome. Biomark Insights 2017; 12:1177271917695832. [PMID: 28469399 PMCID: PMC5391984 DOI: 10.1177/1177271917695832] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022] Open
Abstract
Idiopathic nephrotic syndrome (NS) is the most common glomerular disorder of childhood. Response to initial treatment with corticosteroids is an indicator of prognosis, as resistant patients often present more progressive disease. In this cross-sectional pilot study, we set out to discover a panel of noninvasive biomarkers that could distinguish steroid-resistant nephrotic syndrome (SRNS) from steroid-sensitive nephrotic syndrome (SSNS). Information gleaned from such a panel could yield more individualized treatment plans and prevent unnecessary steroid exposure in patients unlikely to respond. Urine was collected from 50 pediatric patients diagnosed with idiopathic NS at Cincinnati Children's Hospital Medical Center. Isobaric tags for relative and absolute quantitation (iTRAQ) was used to discover 13 proteins that were differentially expressed in SSNS vs SRNS in a small 5 × 5 discovery cohort. Suitable assays were found for 9 of the 13 markers identified by iTRAQ and were used in a 25 SRNS × 25 SSNS validation cohort. Vitamin D-binding protein (VDBP), alpha-1 acid glycoprotein 1 (AGP1), alpha-1 acid glycoprotein 2 (AGP2), alpha-1-B glycoprotein (A1BG), fetuin-A, prealbumin, thyroxine-binding globulin and hemopexin, and alpha-2 macroglobulin were measured and combined with urine neutrophil gelatinase-associated lipocalin (NGAL), which had been previously shown to distinguish patients with SRNS. Urinary VDBP, prealbumin, NGAL, fetuin-A, and AGP2 were found to be significantly elevated in SRNS using univariate analysis, with area under the receiver operating characteristic curves (AUCs) ranging from 0.65 to 0.81. Multivariate analysis revealed a panel of all 10 markers that yielded an AUC of 0.92 for identification of SRNS. A subset of 5 markers (including VDBP, NGAL, fetuin-A, prealbumin, and AGP2) showed significant associations with SRNS and yielded an AUC of 0.85.
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Affiliation(s)
- Michael R Bennett
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Michael R Bennett, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH 45229, USA.
| | - LaTawnya Pleasant
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher Haffner
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Qing Ma
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Wendy D Haffey
- Department of Cancer and Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jun Ying
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Wagner
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kenneth D Greis
- Department of Cancer and Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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18
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Is Urinary NGAL Determination Useful for Monitoring Kidney Function and Assessment of Cardiovascular Disease? A 12-Month Observation of Patients with Type 2 Diabetes. DISEASE MARKERS 2016; 2016:8489543. [PMID: 28050059 PMCID: PMC5165154 DOI: 10.1155/2016/8489543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/18/2016] [Indexed: 12/25/2022]
Abstract
Background. Diabetic kidney disease (DKD) may start as glomerular or tubular damage. We assessed kidney function during one-year-long observation of patients with type 2 diabetes mellitus (T2DM) after initiation of nephroprotective treatment, with emphasis on the changes in urinary neutrophil gelatinase-associated lipocalin (uNGAL), and evaluated the association between tubular damage and cardiovascular complications of T2DM. Materials and Methods. Adult T2DM patients (55) were assessed initially and 30 patients after 1 year. Albumin and uNGAL and creatinine were measured in first morning urine. Albumin/creatinine (uACR) and uNGAL/creatinine (uNCR) ratios were calculated. Results. In logistic regression, both uACR above 30 mg/g and uNCR the median (21.3 μg/g) were associated with cardiovascular complications, independently of classical risk factors and diabetes duration. One year after initiation of treatment, a significant reduction in HbA1c was observed. BMI and lipid profiles did not change. Increase in serum creatinine and reduction in eGFR occurred, along with decrease in uNGAL and uNCR. Increasing uNCR and uACR were associated with higher control HbA1c. The increase in uNCR was more frequent in patients with hypertension. Conclusions. Better glycemic control in T2DM patients results in improved tubular function, as reflected by reduced uNCR and uNGAL. First morning urine uNGAL and uNCR may be useful to assess renal function and cardiovascular risk, along with albuminuria and eGFR.
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Kuribayashi R, Suzumura H, Sairenchi T, Watabe Y, Tsuboi Y, Imataka G, Kurosawa H, Arisaka O. Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants. Exp Ther Med 2016; 12:3706-3710. [PMID: 28105101 PMCID: PMC5228453 DOI: 10.3892/etm.2016.3837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/20/2016] [Indexed: 12/22/2022] Open
Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is produced in response to tubular epithelial injury and is a biomarker of tubulointerstitial injury. The aim of the present study was to examine whether acute kidney injury (AKI) could be predicted by measuring uNGAL in very low-birth weight (VLBW) infants. Forty VLBW infants with birthweight below 1,500 g were enrolled in the present study. uNGAL and serum creatinine (sCre) were measured daily from postnatal days 0 to 8. Infants with sCre ≥1.2 mg/dl were diagnosed with AKI. The relationship of uNGAL with sCre was measured on the day after uNGAL measurement (next-day sCre) was examined. The results showed that 16 infants had sCre ≥1.2 mg/dl in this period. Logistic regression analysis revealed that uNGAL on postnatal days 2, 3, 4, 5 and 6 was correlated with next-day sCre (P<0.05). uNGAL corrected by urinary Cre (uCre) (uNGAL/uCre) was only correlated with an increase in next-day sCre on postnatal days 5 and 6 (P<0.05). For the logistic analysis, subjects with high and low uNGAL levels based on the median value for each day, uNGAL on postnatal days 2, 3 and 6 in the high uNGAL group was correlated with an increase in next-day sCre. Thus, AKI may be predicted by measuring uNGAL in VLBW infants. This measurement was non-invasive, and is potentially useful for the evaluation of renal function in VLBW infants.
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Affiliation(s)
- Ryota Kuribayashi
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Yoshiyuki Watabe
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Yayoi Tsuboi
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - George Imataka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Hidemitsu Kurosawa
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Osamu Arisaka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
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Bacci MR, Chehter EZ, Azzalis LA, Costa de Aguiar Alves B, Fonseca FLA. Serum NGAL and Cystatin C Comparison With Urinary Albumin-to-Creatinine Ratio and Inflammatory Biomarkers as Early Predictors of Renal Dysfunction in Patients With Type 2 Diabetes. Kidney Int Rep 2016; 2:152-158. [PMID: 29142952 PMCID: PMC5678634 DOI: 10.1016/j.ekir.2016.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/12/2016] [Accepted: 10/07/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction Diabetic nephropathy is associated with specific histological changes. Early detection of poor glomerular and tubular function can be achieved with biomarkers of diabetes. The aim of this study was to evaluate the accuracy of kidney dysfunction biomarkers in type 2 diabetes (T2D). Methods Patients with T2D were grouped according to their glycated hemoglobin level. Patients' urine and blood samples were taken to measure cystatin C (CysC), neutrophil gelatinase-associated lipocalin, beta-trace protein levels, and the first morning void albumin-to-creatinine ratio. Patients in the end stage of renal disease or receiving dialysis were not included. Receiver operating characteristic curves were generated, and the areas under the curve were compared with the performance of the biomarkers used to evaluate kidney dysfunction in T2D. Results Ninety patients with T2D were chosen. CysC was positively correlated with creatinine (P < 0.001), estimated glomerular filtration rate (P < 0.001), and urinary beta-trace protein (P = 0.01). The area under the curve was 0.635 for CysC, 0.621 for serum neutrophil gelatinase-associated lipocalin, and 0.660 for the albumin-to-creatinine ratio. A crude logistic regression model showed a positive association between serum CysC (P = 0.01) and serum neutrophil gelatinase-associated lipocalin (P < 0.001). A linear regression model showed a positive association between serum CysC, creatinine, and estimated glomerular filtration rate (P < 0.001) but did not show a positive association with glycated hemoglobin (P = 0.892). Discussion Neutrophil gelatinase-associated lipocalin and serum CysC were positively associated with the presence of renal dysfunction and had better performance on receiver operating characteristic analysis than the other markers evaluated in patients with T2D without kidney dysfunction.
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Affiliation(s)
- Marcelo R Bacci
- Department of General Practice, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Ethel Z Chehter
- Department of General Practice, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Fernando L A Fonseca
- Department of General Practice, Faculdade de Medicina do ABC, Santo André, Brazil.,Clinical Analysis Laboratory of Faculdade de Medicina do ABC, Santo André, Brazil
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Sangoi MB, de Carvalho JAM, Tatsch E, Hausen BS, Bollick YS, Londero SWK, Duarte T, Scolari R, Duarte MMMF, Premaor MO, Comim FV, Moretto MB, Moresco RN. Urinary inflammatory cytokines as indicators of kidney damage in type 2 diabetic patients. Clin Chim Acta 2016; 460:178-83. [PMID: 27353644 DOI: 10.1016/j.cca.2016.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether urinary levels of interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) are altered in normoalbuminuric patients with type 2 diabetes mellitus (T2DM), and whether these cytokines are able to identify diabetic kidney disease (DKD) among these patients. METHODS This study included 125 T2DM patients classified into 3 groups according to urinary albumin/creatinine ratio (uACR): uACR <10mg/g creatinine, uACR 10-30mg/g creatinine and uACR >30mg/g creatinine. Urinary inflammatory cytokines were measured. RESULTS The urinary IL-6 concentrations increased from uACR <10 (97.2±26.4pg/ml) to uACR 10-30 (113.6±28.0pg/ml) and to uACR >30mg/g creatinine (163.5±25.6pg/ml) (P<0.05 and P<0.001, respectively) patients. The urinary IL-10 concentrations decreased in these uACR ranges [100.0 (58.0-141.0) pg/ml vs. 62.0 (54.5-71.5) pg/ml vs. 42.0 (32.0-48.0) pg/ml] (P<0.05 and P<0.001, respectively). All urinary cytokines demonstrated good ability to identify DKD (areas under curves >0.9). CONCLUSIONS Urinary inflammatory cytokines, especially IL-6 and IL-10, may assist in the identification of DKD in T2DM patients, even in the absence of micro- and macroalbuminuria.
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Affiliation(s)
- Manuela Borges Sangoi
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil; Department of Health Sciences, Integrated Regional University of High Uruguay and Missions, Santiago, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - José Antonio M de Carvalho
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil; University Hospital, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Etiane Tatsch
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Bruna S Hausen
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Yãnaí S Bollick
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sílvia W K Londero
- University Hospital, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Thiago Duarte
- Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Rogério Scolari
- Clinical Analysis Laboratory, Labimed, Santa Maria, RS, Brazil
| | - Marta M M F Duarte
- Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil; Clinical Analysis Laboratory, Labimed, Santa Maria, RS, Brazil; Department of Health Sciences, Lutheran University of Brazil, Santa Maria, RS, Brazil
| | - Melissa O Premaor
- Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil; Department of Clinical Medicine, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Fabio V Comim
- Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil; Department of Clinical Medicine, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Maria B Moretto
- Pharmaceutical Sciences Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Rafael N Moresco
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmacology Postgraduate Program, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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Urinary Markers of Tubular Injury in Early Diabetic Nephropathy. Int J Nephrol 2016; 2016:4647685. [PMID: 27293888 PMCID: PMC4884862 DOI: 10.1155/2016/4647685] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/26/2016] [Indexed: 01/08/2023] Open
Abstract
Diabetic nephropathy (DN) is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), N-acetyl-beta-glucosaminidase (NAG), alpha-1 microglobulin (A1M), beta 2-microglobulin (B2-M), and retinol binding protein (RBP) associated with early DN.
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Domingueti CP, Fóscolo RB, Reis JS, Campos FMF, Dusse LMS, Carvalho MDG, Braga Gomes K, Fernandes AP. Association of Haemostatic and Inflammatory Biomarkers with Nephropathy in Type 1 Diabetes Mellitus. J Diabetes Res 2015; 2016:2315260. [PMID: 26770985 PMCID: PMC4684869 DOI: 10.1155/2016/2315260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/04/2015] [Indexed: 12/30/2022] Open
Abstract
This study aimed at investigating the association between haemostatic biomarkers, proinflammatory, and anti-inflammatory cytokines with chronic kidney disease in type 1 diabetic patients. Patients were divided into two groups: with nephropathy (albuminuria ≥ 30 mg/g and/or GFR < 60 mL/min/1.73 m(2)), n = 65; and without nephropathy (albuminuria < 30 mg/g and GFR ≥ 60 mL/min/1.73 m(2)), n = 60. INF-γ, IL-6, IL-10, and TNF-α plasma levels were determined by flow cytometry. VWF, ADAMTS13 antigen, and D-Dimer plasma levels were determined by enzyme-linked immunosorbent assay and ADAMTS13 activity was assessed by fluorescence resonance energy transfer assay. Elevated levels of INF-γ, VWF, ADAMTS13 antigen, D-Dimer, and reduced ADAMTS13 activity/antigen ratio were observed in patients with nephropathy as compared to those without nephropathy (P = 0.001, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, resp.). Cytokines and haemostatic biomarkers remained associated with nephropathy after adjustments (use of statin, acetylsalicylic acid, angiotensin converting enzyme inhibitor, and angiotensin antagonist). INF-γ, TNF-α, and IL-10 significantly correlated with haemostatic biomarkers. Inflammatory and hypercoagulability status are associated with nephropathy in type 1 diabetes mellitus and an interrelationship between them may play an important role in pathogenesis of diabetic nephropathy.
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Affiliation(s)
- Caroline Pereira Domingueti
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de São João Del-Rei, Campus Centro Oeste Dona Lindu, 35501-296 Divinopolis, MG, Brazil
| | - Rodrigo Bastos Fóscolo
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, MG, Brazil
| | - Janice Sepúlveda Reis
- Departamento de Endocrinologia e Metabolismo, Instituto de Educação e Pesquisa da Santa Casa de Belo Horizonte, 30150-250 Belo Horizonte, MG, Brazil
| | - Fernanda Magalhães Freire Campos
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Luci Maria S. Dusse
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Maria das Graças Carvalho
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Karina Braga Gomes
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Ana Paula Fernandes
- Departamento de Analises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
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Shao X, Li N, Zhan J, Sun H, An L, Du P. Protective Effect of Compound K on Diabetic Rats. Nat Prod Commun 2015. [DOI: 10.1177/1934578x1501000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Compound K (CK), the metabolic product of protopanaxadiol saponin in vivo, has many pharmacological activities. In this study, we discuss the preparation of CK, and its protective effect on kidneys of diabetic rats. CK was prepared from ginsenoside Rb1 after transformation by β-glucosidase, separation and purification by silica gel column chromatography. In the present study, we established a rat model of diabetes mellitus using high-fat diet and streptozotocin (STZ). After seven weeks of treatment, the levels of fasting blood glucose (FBG), total cholesterol (TC), total glycerin (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), blood urea nitrogen (BUN), uric acid (UA), serum creatinine (Scr), malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) activity and glutathione peroxidase (GSH-PX) were evaluated in normal and diabetic rats. Also, renal pathomorphism changes were observed by HE stain, and TGF-β1 protein expression in the renal tissue was measured by Western blot. The yield of CK was 14.55 mg/mL, which was higher than that of other methods. After seven weeks, CK could decrease FBG, TC, TG, LDL-C, BUN, UA, Scr and MDA of diabetic rats, while CK also enhanced HDL-C and GSH, SOD and GSH-PX. Additionally, CK improved the pathological changes and decreased TGF-β1 protein expression in the renal tissue. CK improved the pathological changes in the renal tissue, enhanced the antioxidant capacity, reduced the damage of TGF-β1 to renal tissue, and protected the diabetic rats.
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Affiliation(s)
- Xiaotong Shao
- College of Pharmacy, Beihua University, Jilin, Jilin 132013, China
| | - Na Li
- College of Pharmacy, Beihua University, Jilin, Jilin 132013, China
| | - Jinzhuo Zhan
- College of Pharmacy, Beihua University, Jilin, Jilin 132013, China
| | - Hui Sun
- College of Pharmacy, Beihua University, Jilin, Jilin 132013, China
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Garg V, Kumar M, Mahapatra HS, Chitkara A, Gadpayle AK, Sekhar V. Novel urinary biomarkers in pre-diabetic nephropathy. Clin Exp Nephrol 2015; 19:895-900. [PMID: 25634253 DOI: 10.1007/s10157-015-1085-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal involvement was thought to occur more than 10 years after onset of diabetes, but recent studies provide evidence that it starts even in the pre-diabetes stage. However, there is no sensitive marker to detect these changes at such early stages. Novel urinary biomarkers have showed promising results in detection of early nephropathy in pre-diabetics. METHODS A total of 91 subjects (diabetes 61 and pre-diabetes 30) were enrolled into the study. Urinary biomarkers such as urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), urine Cystatin C and urine albumin-creatinine ratio (UACR) were estimated. Subjects were further divided in four groups on the basis of UACR: pre-diabetes with normoalbuminuria (21); pre-diabetes with microalbuminuria (9); diabetes with normoalbuminuria (37); and diabetes with microalbuminuria (24). The relationship of UACR, NGAL, and Cystatin C was estimated. RESULTS Urine levels of NGAL and Cystatin C were significantly higher in microalbuminuria group compared to normoalbuminuria. UACR was positively correlated to urine NGAL-creatinine ratio (UNCR) and urine Cystatin C-creatinine ratio (UCCR) in both diabetes and pre-diabetes. On logistic regression odds ratio of UNCR to predict microalbuminuria in diabetes and pre-diabetes was 1.070 (p = 0.000) and 1.138 (p = 0.010), respectively. Area under curve was determined by ROC analysis, and UNCR was found to be better than UCCR for estimating microalbuminuria. CONCLUSION Tubular damage may play major role in development of nephropathy in pre-diabetes. Newer markers like urine NGAL and Cystatin C are raised early in diabetes and pre-diabetes nephropathy.
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Affiliation(s)
- Vikas Garg
- Room No 307, Admin Block, PGIMER, Dr RML Hospital, New Delhi, India
| | - Manish Kumar
- Room No 307, Admin Block, PGIMER, Dr RML Hospital, New Delhi, India
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Tanaka K, Hara S, Hattori M, Sakai K, Onishi Y, Yoshida Y, Kawazu S, Kushiyama A. Role of elevated serum uric acid levels at the onset of overt nephropathy in the risk for renal function decline in patients with type 2 diabetes. J Diabetes Investig 2014; 6:98-104. [PMID: 25621139 PMCID: PMC4296709 DOI: 10.1111/jdi.12243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/11/2014] [Accepted: 04/07/2014] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION Despite the use of intensive therapies, declining renal function is often observed during the overt nephropathy stage of type 2 diabetes. We aimed at investigating the role of serum uric acid (SUA) levels at the onset of overt nephropathy in the risk of renal function decline in type 2 diabetes patients. MATERIALS AND METHODS The present cohort study included 290 type 2 diabetes patients who were followed from the onset of overt nephropathy. The relationship between SUA and declining renal function was assessed using Cox regression models after adjusting for known risk factors. RESULTS Over a median 4.8-year follow-up period, 85 patients (4.9/100 person-years) showed serum creatinine (Cr) doubling with a total cumulative incidence of 71.9% at 20 years of follow up. The highest SUA tertile resulted in significantly a higher incidence (7.7/100 person-years) and cumulative incidence at 20 years (85.7%) than the middle (3.9/100 person-years, 54.2%) and lowest (3.0/100 person-years, 55.5%) tertiles. The univariate Cox hazard model resulted in significant risks for Cr doubling related to female sex, short diabetes duration, smoking and elevated levels of low-density lipoprotein cholesterol (LDL-c), glycated hemoglobin and SUA tertiles. SUA tertiles remained statistically significant in the multivariate model (highest vs lowest hazard ratio 2.68, 95% confidence interval 1.48-5.00, P = 0.0009). CONCLUSIONS Elevated SUA levels within the normal range (men >6.3 mg/dL, women >5.1) at the onset of overt nephropathy resulted in an increased risk for declining renal function in type 2 diabetes patients.
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Affiliation(s)
- Kentaro Tanaka
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Shigeko Hara
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Masakazu Hattori
- Division of Diabetes, Clinical Research Center for Endocrinology and Metabolic Diseases, National Hospital Organization, Kyoto Medical Center Kyoto, Japan
| | - Ken Sakai
- Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University Tokyo, Japan
| | - Yukiko Onishi
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Yoko Yoshida
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Shoji Kawazu
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
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Lampropoulou IT, Stangou M, Papagianni A, Didangelos T, Iliadis F, Efstratiadis G. TNF-α and microalbuminuria in patients with type 2 diabetes mellitus. J Diabetes Res 2014; 2014:394206. [PMID: 25587544 PMCID: PMC4284977 DOI: 10.1155/2014/394206] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 01/15/2023] Open
Abstract
AIM Recent evidence suggests that chronic subclinical inflammation plays a key role in the pathogenesis and progression of diabetic nephropathy. Aim of the present study was to investigate possible correlation between the presence and degree of microalbuminuria and markers of inflammation in patients with type 2 diabetes mellitus (DM). PATIENTS-METHODS Eighty patients were enrolled and clinical and laboratory data were recorded. Albumin-creatinine ratio (ACR) was calculated in first-morning urine samples. Serum and urinary tumor necrosis factor-α (TNF-α) levels were determined by ELISA. RESULTS Forty-five patients had normoalbuminuria, 33 microalbuminuria, and 2 macroalbuminuria. Patients with microalbuminuria were older, with higher glycosylated hemoglobin levels (HbA1c) and they more frequently had diabetic retinopathy, neuropathy, and cardiovascular disease and were on treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARBs). ACR was significantly correlated with the presence of cardiovascular disease, hypertension, and HbA1c levels and the administration of clopidogrel and ACEi or ARBs. ACR was not correlated with C-reactive protein, fibrinogen, or serum TNF-α levels but had a strong correlation with urinary TNF-α levels. CONCLUSIONS In patients with type 2 DM, urinary, but not serum, TNF-α levels are associated with the presence and severity of microalbuminuria.
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Affiliation(s)
- I.-Th. Lampropoulou
- Department of Nephrology, “Hippokratio” General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 546 42 Thessaloniki, Greece
| | - M. Stangou
- Department of Nephrology, “Hippokratio” General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 546 42 Thessaloniki, Greece
| | - A. Papagianni
- Department of Nephrology, “Hippokratio” General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 546 42 Thessaloniki, Greece
- *A. Papagianni:
| | - T. Didangelos
- 1st Propedeutic Department of Internal Medicine, Diabetes Center, “AHEPA” General Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece
| | - F. Iliadis
- 1st Propedeutic Department of Internal Medicine, Diabetes Center, “AHEPA” General Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece
| | - G. Efstratiadis
- Department of Nephrology, “Hippokratio” General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 546 42 Thessaloniki, Greece
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