Critical role of mitochondrial dysfunction and impaired mitophagy in diabetic nephropathy

Mitochondrial dynamics play a critical role in deciding the fate of a cell under normal and diseased condition. Recent surge of studies indicate their regulatory role in meeting energy demands in renal cells making them critical entities in the progression of diabetic nephropathy. Diabetes is remarkably associated with abnormal fuel metabolism, a basis for free radical generation, which if left unchecked may devastate the mitochondria structurally and functionally. Impaired mitochondrial function and their aberrant accumulation have been known to be involved in the manifestation of diabetic nephropathy, indicating perturbed balance of mitochondrial dynamics, and mitochondrial turnover. Mitochondrial dynamics emphasize the critical role of mitochondrial fission proteins such as mitochondrial fission 1, dynamin-related protein 1 and mitochondrial fission factor and fusion proteins including mitofusin-1, mitofusin-2 and optic atrophy 1. Clearance of dysfunctional mitochondria is aided by translocation of autophagy machinery to the impaired mitochondria and subsequent activation of mitophagy regulating proteins PTEN-induced putative kinase 1 and Parkin, for which mitochondrial fission is a prior event. In this review, we discuss recent progression in our understanding of the molecular mechanisms targeting reactive oxygen species mediated alterations in mitochondrial energetics, mitophagy related disorders, impaired glucose transport, tubular atrophy, and renal cell death. The molecular cross talks linking autophagy and renoprotection through an intervention of 5′-AMP-activated protein kinase, mammalian target of rapamycin, and SIRT1 factors are also highlighted here, as in-depth exploration of these pathways may help in deriving therapeutic strategies for managing diabetes provoked end-stage renal disease.     

Upstream Regulators and Downstream Effectors of NADPH Oxidases as Novel Therapeutic Targets for Diabetic Kidney Disease

Oxidative stress has been linked to the pathogenesis of diabetic nephropathy, the complication of diabetes in the kidney. NADPH oxidases of the Nox family, and in particular the homologue Nox4, are a major source of reactive oxygen species in the diabetic kidney and are critical mediators of redox signaling in glomerular and tubulointerstitial cells exposed to the diabetic milieu. Here, we present an overview of the current knowledge related to the understanding of the role of Nox enzymes in the processes that control mesangial cell, podocyte and tubulointerstitial cell injury induced by hyperglycemia and other predominant factors enhanced in the diabetic milieu, including the renin-angiotensin system and transforming growth factor-β. The nature of the upstream modulators of Nox enzymes as well as the downstream targets of the Nox NADPH oxidases implicated in the propagation of the redox processes that alter renal biology in diabetes will be highlighted.     

前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响

目的:分析前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响。方法:98例糖尿病肾病患者按抽签法分为对照组与实验组,各49例,对照组予以前列地尔治疗,实验组基于对照组加用益肾化湿颗粒治疗,比较两组疗效,糖化血红蛋白(Hb A1c)、血糖(FPG)、餐后2 h血糖低(2h PG),甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),血尿素氮(BUN)、肌酐(Cr)、β2微球蛋白(β2-MG)、胱抑素(Cys-C),尿足细胞标志蛋白(PCX)nephrin,安全性。结果:实验组总有效率高于对照组(P0.05)。治疗后,两组Hb Alc、FPG、2h PG比较无差异(P0.05)。实验组TG、TC、LDL-C、BUN、Cr、β2-MG、Cys-c、PCX、尿nephrin/尿Cr低于对照组(P0.05)。实验组HDL-C高于对照组(P0.05)。结论:前列地尔联合益肾化湿颗粒治疗对糖尿病肾病的疗效确切,可利于血糖、血脂、肾功能的改善,降低尿足细胞相关蛋白的浓度。     

Adenosine mediates transforming growth factor-beta 1 release in kidney glomeruli of diabetic rats

Up regulation of the transforming growth factor-beta 1 (TGF-β1) axis has been recognized as a pathogenic event for progression of glomerulosclerosis in diabetic nephropathy. We demonstrate that glomeruli isolated from diabetic rats accumulate up to sixfold more extracellular adenosine than normal rats. Both decreased nucleoside uptake activity by the equilibrative nucleoside transporter 1 and increased AMP hydrolysis contribute to raise extracellular adenosine. Ex vivo assays indicate that activation of the low affinity adenosine A_2B receptor subtype (A_2BAR) mediates TGF-β1 release from glomeruli of diabetic rats, a pathogenic event that could support progression of glomerulopathy when the bioavailability of adenosine is increased.     

他克莫司联合黄葵胶囊治疗难治性膜性肾病的临床疗效

目的:探讨他克莫司联合黄葵胶囊治疗难治性膜性肾病疗效及安全性。方法:选取2014年3月-2015年10月我院收治的60例难治性膜性肾病患者,按随机数字表法分为观察组和对照组各30例,对照组给予泼尼松治疗,观察组在此基础上增加他克莫司联合黄葵胶囊口服,两组均治疗6个月,观察两组临床疗效,检测并对比两组治疗前后尿蛋白(uPRO)、血清白蛋白(sALB)、血清肌酐(sCr)、血谷丙转氨酶(sALT)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)以及不良反应情况。结果:观察组的有效率高于对照组(P0.05);治疗后两组uPRO、TNF-α、TGF-β1均明显降低,sALB、sCr明显升高(P0.05),且观察组uPRO、TNF-α、TGF-β1低于对照组(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论:他克莫司联合黄葵胶囊治疗难治性膜性肾病具有较好的疗效,降低肾功能损伤,不良反应低,值得临床推广。     

Novel triazine-based pyrimidines suppress glomerular mesangial cells proliferation and matrix protein accumulation through a ROS-dependent mechanism in the diabetic milieu

Diabetic nephropathy (DN) is one of the most serious complications of diabetes worldwide. It is depicted as the leading cause of end-stage renal disease. Oxidative stress plays a key role in hyperglycemia-induced DN. The preparation and characterization of novel mono-, di-, and trisubstituted-s-triazines endowed with uracil and/or thymine are described in this paper. The synthesis of the title compounds was realized through selective nucleophilic substitution reactions of cyanuric chloride with the corresponding hydrazide nucleobases. In this study, we assessed the effects of these derivatives on the progression of diabetic nephropathy. Our results show that trisubstituted-s-triazines endowed with acylhydrazides attenuate high-glucose induced glomerular mesangial cells proliferation and matrix protein accumulation in vitro. Notably, these derivatives also display anti-oxidative properties. This suggests that the novel trisubstituted-s-triazine derivatives provide renal protection through a reactive oxygen species (ROS)-dependent mechanism. Our data provide evidence that these derivatives may serve as potential therapeutic candidates in the treatment of DN.     

CXCR4基因转染人脐带间充质干细胞移植治疗糖尿病肾病的实验研究

摘要 目的：探讨过表达CXCR4的人脐带间充质干细胞（human umbilical cord mesenchymal stem cell, hUC-MSCs）移植后对糖尿病肾病的治疗作用。方法：构建CXCR4的慢病毒表达载体，并建立过表达 CXCR4 的人脐带间充质干细胞（CXCR4-MSCs）。采用8周龄健康雌性SD大鼠75只，其中15只为正常对照组，60只为实验组。实验组糖尿病成模后一个月，将糖尿病实验大鼠60只随机分为4组：①移植CXCR4-MSCs组(CXCR4基因转染MSCs组)，即CXCR4组；②移植null-MSCs组(空质粒未转染CXCR4基因的MSCs组)，即null-MSCs；③移植MSCs组( MSCs组)；④PBS组(未移植任何的MSCs，单纯PBS注射，PBS组)。将CXCR4-MSCs、null-MSCs及MSCs消化离心，取含1×106个细胞悬液经尾静脉分别注入CXCR4-MSCs组、null-MSCs组及MSCs组大鼠体内，PBS组注射l mL PBS。干细胞治疗8周后，处死五组大鼠。各组大鼠处死前放代谢笼留取24 h尿，计算尿量，保存送检。处死前尾静脉采血检测血糖、称体重并记录。观察血糖、肾脏肥大指数、肾重、体重、24小时尿蛋白排泄量，并观察肾脏组织病理学改变。结果：60只SD雌性大鼠糖尿病模型成功率达100％，至实验8周糖尿病大鼠总共死亡14只，存活率达76.67％。实验开始后的8周，所有CXCR4组、Null-MSCs组、MSCs组、PBS组大鼠与正常组比较，体重均明显减轻(P<0.01)，血糖明显升高(P<0.01)。MSCs治疗后8周，除正常组外，其余各组大鼠血糖、肾重、肾重/体重比、24小时尿蛋白均显著增高，体重显著降低(P<0.05)；与PBS组相比，CXCR4组、null-MSCs组，MSCs组大鼠的肾重、肾重/体重比、24小时尿蛋白均明显降低(P<0.05)，体重无明显增加，血糖无明显降低(P>0.05)。CXCR4组大鼠的肾重、肾重/体重比、24小时尿蛋白较除正常组外的各组均明显降低(P<0.05)。糖尿病成模后，给予大鼠尾静脉注射干细胞悬液或等量培养液，注射后8周，除正常组外，其余各组PAS染色可见大鼠肾小球肥大，肾小球基底膜增厚、系膜增生、系膜基质增多，部分肾小球出现明显硬化，符合糖尿病肾病中期病理表现。CXCR4组大鼠肾小球系膜基质增生较其余各组大鼠减少(P<0.05)。结论：转染CXCR4的MSCs可改善糖尿病肾病。