亚硒酸钠对糖尿病肾病大鼠肾脏Nephrin表达的影响与意义

探讨亚硒酸钠对糖尿病肾病大鼠肾脏Nephrin表达的影响及二者间的关系,从而研究亚硒酸钠和Nephrin在糖尿病肾病中的作用机制.通过链脲佐菌素法及给予高脂饮食诱导模拟大鼠糖尿病肾病模型,实验设空白对照组、糖尿病肾病对照组、亚硒酸钠干预组,亚硒酸钠干预组每日给予亚硒酸钠溶液灌胃,其它组给予等量生理盐水灌胃.灌胃10周后处死大鼠,取血、尿标本测相关生化指标.取肾脏组织戊二醛固定制作切片电镜下观察超微结构改变,取肾脏组织多聚甲醛固定制石蜡切片光镜下观察病理改变和免疫组化定位蛋白表达.取肾脏组织RT-PCR检测Nephrin的mRNA表达、Western Blotting检测nephrin的蛋白表达,分析各组数据的统计差异.结果发现亚硒酸钠干预组大鼠基本状况和生化指标较糖尿病肾病对照组明显改善,光镜和电镜下观察病理改变和超微结构病变较糖尿病肾病对照组明显减轻.免疫组化nephrin蛋白表达着色糖尿病肾病对照组较空白对照组减少,亚硒酸钠干预组较糖尿病肾病对照组着色明显增多.Nephrin mRNA和蛋白表达糖尿病肾病对照组较空白对照组明显降低,而亚硒酸钠干预组较糖尿病肾病对照组升高,但低于空白对照组,差异均有统计学意义（P〈0．05）．亚硒酸钠明显促进肾脏Nephrin表达,改善了糖尿病肾病,表明亚硒酸钠和Nephrin在防治和延缓糖尿病肾病的发生发展中可能起重要作用．     

骨桥蛋白与糖尿病肾病关系的研究进展

骨桥蛋白(OPN)是一种具有细胞粘附和迁移功能的分泌型磷酸化糖蛋白。在肾脏中有广泛分布,研究发现其参与糖尿病肾病(DN)蛋白尿形成、DN的炎症反应及肾脏纤维化过程,抑制OPN可改善糖尿病肾脏病变。     

骨桥蛋白与糖尿病肾病关系的研究进展

骨桥蛋白（OPN）是一种具有细胞粘附和迁移功能的分泌型磷酸化糖蛋白。在肾脏中有广泛分布,研究发现其参与糖尿病肾病（DN）蛋白尿形成、DN的炎症反应及肾脏纤维化过程,抑制OPN可改善糖尿病肾脏病变。     

糖尿病肾病蛋白尿发生机制的研究进展

糖尿病肾病蛋白尿的发生发展是多因素综合作用的结果.虽然蛋白尿的确切病因仍未清楚,但基本是由肾脏血流动力学改变、肾小球滤过屏障异常、多种生长因子、细胞因子、免疫炎症因子异常表达以及肾小管异常等多个因素综合所致.在分子水平上,氧化应激是糖尿病并发症发生的早期事件.此外,内皮细胞结构异常和功能紊乱以及肾小管重吸收功能异常可能也参与了蛋白尿的发生发展.本文着重探讨糖尿病肾病蛋白尿发生的细胞及分子机制研究进展,为更好的防治糖尿病肾病提供有力的依据.     

骨化三醇干预糖尿病肾病大鼠蛋白尿发生机制的研究

目的:观察骨化三醇对糖尿病肾病(diabetic nephropathy,DN)大鼠肾组织中肾素水平,肾小球基底膜乙酰肝素酶(Heparanases,HPA)和足细胞podocin蛋白及m RNA表达的影响,并探讨其可能机制。方法:采用链尿佐菌素(streptozotocin,STZ)腹腔注射的方法构建DN大鼠动物模型,将造模成功的大鼠随机分为骨化三醇组(T组)、DN组(D组),并设置健康对照组(N组)。T组给予0.03μg·kg-1·d-1的骨化三醇灌胃;D组与N组给予等量花生油灌胃。12周后检测24小时尿蛋白定量及血生化指标,通过ELISA法检测肾组织中肾素和血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)浓度变化,免疫组化法和RT-PCR检测HPA、podocin蛋白及m RNA的表达。结果:与N组相比,T组和D组24小时尿蛋白定量、血清肌酐、肾素及AngⅡ水平较高,D组显著高于T组,差异均有统计学意义(P0.05)。与N组相比,T组和D组HPA m RNA及蛋白表达较高,D组显著高于T组;T组和D组podocin m RNA及蛋白表达较低,D组显著低于T组,差异均有统计学意义(P0.05)。肾素和HPA蛋白表达存在正相关趋势(r=0.79,P0.05);和podocin蛋白表达存在负相关趋势(r=-0.65,P0.05)。结论:骨化三醇可显著减少DN大鼠早期蛋白尿,此作用可能通过抑制肾素,下调DN肾小球基底膜HPA、上调足细胞podocin蛋白的表达实现。     

糖尿病肾病合并非糖尿病肾病的临床病理分析

目的：分析糖尿病肾病合并非糖尿病肾病的临床病理特点。方法：选取我院肾内科收治的临床诊断为糖尿病肾病的患者56 例,肾脏穿刺进行肾脏活体组织检查,通过病理诊断将患者分为两组,分别为糖尿病肾病组和糖尿病肾病合并非糖尿病肾病组, 比较两组患者的糖尿病病程、糖化血红蛋白、血压、血肌酐、血尿素氮、血尿酸、血清白蛋白、尿蛋白定量、血尿、视网膜病变。结果： 经肾脏组织活检,56例患者中NDRD 患者24 例(42.9%),DN患者32 例(57.1%);对24 例NDRD患者进行病理类型分类,其中IgA 肾病33.0%,膜性肾病25.0%、系膜增生性肾小球肾炎20.2%、高血压肾损害8.3%、微小病变4.2%、局灶节段硬化性肾炎4.2%、新 月体性肾小球肾炎4.2%。与DN组比较,NDRD 组糖尿病病程、糖化血红蛋白、血尿、视网膜病变均有差异(P＜0.05);而血肌酐、血 尿素氮、血尿酸、血清白蛋白、尿蛋白定量均无明显差异(P＞0.05)。结论：临床诊断的糖尿病肾病患者中有很大一部分实际上为糖 尿病肾病合并非糖尿病肾病,且以IgA 型肾病比较多见,糖尿病病程、糖化血红蛋白、血尿、视网膜病变对鉴别二者具有一定的指 导意义。     

Nephrin 信号转导机制研究进展

Nephrin作为肾小球足细胞膜上的跨膜蛋白,是足细胞裂隙膜重要的结构分子。近来发现,nephrin分子细胞内段的酪氨酸残基在被酪氨酸激酶fyn（属Src激酶家族成员）磷酸化后,能激活下游信号分子,形成足细胞内特有的信号转导通路,如nephrin—podocin—MAPK—AP-1、nephrin—CD2AP-P13K-Akt／PKB、nephrin-Nck—Rac／CDC42等。这些信号通路参与了足细胞胚胎发生、细胞生存与细胞骨架重组等许多重要生理病理过程的调节。同样,nephrin蛋白及mRNA的表达也受许多因素的调节。研究nephrin及其信号转导机制对了解并防治肾小球硬化有重要意义。     

糖尿病肾病动物模型的研究进展

糖尿病肾病是糖尿病的主要并发症之一,也是终末期肾衰的元凶,其发病机制至今尚未阐明。因此,建立理想的实验动物模型是研究糖尿病肾病发病机制、疾病防治、新药开发的关键环节。本文回顾并分析了有关该疾病模型的国内外文献,从造模方法、发病机制、病理改变、适用条件、模型的优缺点等方面进行比较分析,为选择合适的动物模型应用于糖尿病肾病的研究提供参考。     

蛋白质组学在糖尿病肾病研究中的应用

糖尿病肾病作为糖尿病的主要并发症之一,是导致终末期肾功能衰竭(end-stage renal disease,ERSD)的最主要原因之一。目前,人们对糖尿病肾病的发病机制尚不完全清楚。近年来蛋白质组学技术逐渐被应用于这一疾病发病机制的研究中,为人们探索糖尿病肾病的发病机制提供了有力的实验依据。本文对蛋白质组学在糖尿病肾病研究中的新近进展进行了综述和讨论,并通过具体实例介绍了如何对蛋白质组学数据进行系统分析,揭示潜在的新调控网络及其生理与病理生理意义,为糖尿病肾病的研究与治疗提供新的思路。     

糖尿病肾病动物模型的研究进展

糖尿病肾病是终末期肾衰的主要原因,也是糖尿病致命的重要原因。但是糖尿病肾病的致病机制迄今尚不完全明了,理想的动物模型无疑可对糖尿病肾病的研究提供重要线索。糖尿病肾病动物模型包括诱发性、自发性和转基因等多种类型的动物模型,各种类型的动物模型在疾病的发生发展、病理生理变化等多个方面与人类糖尿病肾病具有相似的特征。应用这些模型有助于开展对糖尿病肾病的防治、发病机理、相关药物的开发等多方面的研究。     

子痫前期患者尿液中足细胞裂孔膜蛋白和标记蛋白的检测及意义

目的：检测子痫前期患者尿液中足细胞裂孔膜蛋白和足细胞标记蛋白的浓度并探讨其临床意义。方法：本实验以62例妊娠期妇女为研究对象,分为三组,其中正常妊娠期妇女25例为正常对照组,慢性高血压的妊娠期妇女17例为高血压组,子痫前期患者20例为子痫前期组。ELISA检测各组妊娠期妇女的尿液中足细胞裂孔膜蛋白和足细胞标记蛋白的表达;Bradford法检测各组妊娠期妇女的尿蛋白。结果：足细胞裂孔膜蛋白和足细胞标记蛋白在正常对照组尿液中含量极少,在高血压组中分泌增加,而子痫前期组患者中明显升高（P〈0．01）,且在子痫前期组尿液中足细胞裂孔膜蛋白和标记蛋白的分泌含量均成正相关（r2=0．79,P〈0．05）。子痫前期组患者中足细胞裂孔膜蛋白和足细胞标记蛋白与尿蛋白浓度成正相关（r2=0．58,P〈0．05;r2=0．79,P〈0．05）。结论：足细胞蛋白脱落主要发生于子痫前期患者,且足细胞蛋白脱落量与尿蛋白成正相关,能直接反映妊娠期患者的肾损伤程度,可作为预测罹患妊娠期高血压的指标。     

Dynamin-mediated Nephrin Phosphorylation Regulates Glucose-stimulated Insulin Release in Pancreatic Beta Cells

We have previously demonstrated a role for Nephrin in glucose stimulated insulin release (GSIR). We now hypothesize that Nephrin phosphorylation is required for GSIR and that Dynamin influences Nephrin phosphorylation and function. MIN6-C3 Nephrin-deficient pancreatic beta cells and human islets were transfected with WT-Nephrin or with a mutant Nephrin in which the tyrosine residues responsible for SH2 domain binding were substituted with phenylalanine (3YF-Nephrin). GSIR and live images of Nephrin and vesicle trafficking were studied. Immunoprecipitation experiments and overexpression of WT-Dynamin or dominant negative Dynamin mutant (K44A-Dynamin) in WT-Nephrin, 3YF-Nephrin, or Nephrin siRNA-transfected cells were utilized to study Nephrin-Dynamin interaction. In contrast to WT-Nephrin or to single tyrosine mutants, 3YF-Nephrin did not positively affect GSIR and led to impaired cell-cell contacts and vesicle trafficking. K44A-Dynamin prevented the effect of Nephrin on GSIR in the absence of protein-protein interaction between Nephrin and Dynamin. Nephrin gene silencing abolished the positive effects of WT-Dynamin on GSIR. The effects of protamine sulfate and vanadate on Nephrin phosphorylation and GSIR were studied in MIN6 cells and human islets. WT-Nephrin phosphorylation after glucose occurred at Tyr-1176/1193 and resulted in improved GSIR. On the contrary, protamine sulfate-induced phosphorylation at Tyr-1176/1193/1217 was associated with Nephrin degradation and impaired GSIR. Vanadate, which prevented Nephrin dephosphorylation after glucose stimulation, improved GSIR in human islets and MIN6 cells. In conclusion, Dynamin-dependent Nephrin phosphorylation occurs in response to glucose and is necessary for Nephrin-mediated augmentation of GSIR. Pharmacological modulation of Nephrin phosphorylation may thus facilitate pancreatic beta cell function.     

Nephrin expression is increased in anti-Thy1.1-induced glomerulonephritis in rats

Nephrin is an important constituent of the glomerular filtration barrier and alteration of its expression is associated with severe proteinuria. In this study we show that injection of an anti-Thy1.1 antibody in rats not only induces a mesangioproliferative glomerulonephritis associated with increased proteinuria, but also leads to a sustained increase of nephrin mRNA and protein expression in renal glomeruli over a time period of 29 days. In contrast, podocin and CD2AP, two proteins shown to interact with nephrin in the slit diaphragm, are acutely downregulated at days 3-7 and, thereafter, recovered again to normal levels after 29 days. Interestingly, immunofluorescence staining of kidney sections at day 10 of the disease shows a highly heterogeneous pattern, in that some podocytes show complete absence of nephrin, whereas others show highly accumulated staining for nephrin compared to control sections, which in total results in an increased level of nephrin per glomerulus. In summary, our data show that in the course of mesangioproliferative glomerulonephritis in rats, an upregulation of nephrin expression occurs with a concomitant transient downregulation of podocin and CD2AP which may account for a highly dysregulated filtration barrier and increased proteinuria.     

Diabetic Nephropathy and Extracellular Matrix

Diabetic nephropathy (DN) is a serious complication in diabetes. Major typicalmorphological changes are the result of changes in the extracellular matrix (ECM). Thus,basement membranes are thickened and the glomerular mesangial matrix and thetubulointerstitial space are expanded, due to increased amounts of ECM. One important ECMcomponent, the proteoglycans (PGs), shows a more complex pattern of changes in DN. PGs inbasement membranes are decreased but increased in the mesangium and the tubulointerstitialspace. The amounts and structures of heparan sulfate chains are changed, and such changesaffect levels of growth factors regulating cell proliferation and ECM synthesis, with cellattachment affecting endothelial cells and podocytes. Enzymes modulating heparan sulfatestructures, such as heparanase and sulfatases, are implicated in DN. Other enzyme classesalso modulate ECM proteins and PGs, such as matrix metalloproteinases (MMPs) and serineproteases, such as plasminogen activator, as well as their corresponding inhibitors. Thelevels of these enzymes and inhibitors are changed in plasma and in the kidneys in DN.Several growth factors, signaling pathways, and hyperglycemia per se affect ECM synthesisand turnover in DN. Whether ECM components can be used as markers for early kidney changesis an important research topic, whereas at present, the clinical use remains to beestablished.     

Direct Regulation of Nephrin Tyrosine Phosphorylation by Nck Adaptor Proteins

The transmembrane protein nephrin is a key component of the kidney slit diaphragm that contributes to the morphology of podocyte foot processes through signaling to the underlying actin cytoskeleton. We have recently reported that tyrosine phosphorylation of the cytoplasmic tail of nephrin facilitates recruitment of Nck SH2/SH3 adaptor proteins and subsequent actin remodeling and that phosphorylation of the Nck binding sites on nephrin is decreased during podocyte injury. We now demonstrate that Nck directly modulates nephrin phosphorylation through formation of a signaling complex with the Src family kinase Fyn. The ability of Nck to enhance nephrin phosphorylation is compromised in the presence of a Src family kinase inhibitor and when the SH3 domains of Nck are mutated. Furthermore, induced loss of Nck expression in podocytes in vivo is associated with a rapid reduction in nephrin tyrosine phosphorylation. Our results suggest that Nck may facilitate dynamic signaling events at the slit diaphragm by promoting Fyn-dependent phosphorylation of nephrin, which may be important in the regulation of foot process morphology and response to podocyte injury.     

Planar Cell Polarity Pathway Regulates Nephrin Endocytosis in Developing Podocytes

The noncanonical Wnt/planar cell polarity (PCP) pathway controls a variety of cell behaviors such as polarized protrusive cell activity, directional cell movement, and oriented cell division and is crucial for the normal development of many tissues. Mutations in the PCP genes cause malformation in multiple organs. Recently, the PCP pathway was shown to control endocytosis of PCP and non-PCP proteins necessary for cell shape remodeling and formation of specific junctional protein complexes. During formation of the renal glomerulus, the glomerular capillary becomes enveloped by highly specialized epithelial cells, podocytes, that display unique architecture and are connected via specialized cell-cell junctions (slit diaphragms) that restrict passage of protein into the urine; podocyte differentiation requires active remodeling of cytoskeleton and junctional protein complexes. We report here that in cultured human podocytes, activation of the PCP pathway significantly stimulates endocytosis of the core slit diaphragm protein, nephrin, via a clathrin/β-arrestin-dependent endocytic route. In contrast, depletion of the PCP protein Vangl2 leads to an increase of nephrin at the cell surface; loss of Vangl2 functions in Looptail mice results in disturbed glomerular maturation. We propose that the PCP pathway contributes to podocyte development by regulating nephrin turnover during junctional remodeling as the cells differentiate.     

Paeoniflorin Prevents Diabetic Nephropathy in Rats

The aim of this study was to test the hypothesis that paeoniflorin prevents the progression of diabetic nephropathy by modulating the inflammatory process. Sprague–Dawley rats were divided into 5 groups: nondiabetic control rats; untreated diabetic model (DM) rats; and DM rats treated with 5, 10, or 20 mg/kg paeoniflorin in drinking water once daily. Rats received a single intravenous injection of streptozotocin to induce diabetes; 9 wk after injection, rats began the 8-wk daily paeoniflorin treatment regimen. Compared with that of nonDM controls, the urinary albumin:creatinine ratio was increased significantly in untreated DM rats; this ratio was decreased in DM rats treated with 5, 10, or 20 mg/kg paeoniflorin compared with that of untreated DM rats. In addition, paeoniflorin treatment effectively suppressed glomerular hypertrophy; blood glucose; the expression of transforming growth factor β, type IV collagen, and intercellular adhesion molecule 1; and renal infiltration of macrophages compared with levels in untreated DM rats. Furthermore, renal nuclear factor κB activity was increased in untreated but not paeoniflorin-treated DM rats. In conclusion, our data suggest that the preventive effects of paeoniflorin may be mediated by its antiinflammatory actions.Abbreviations: DM, diabetic model; ECM, extracellular matrix; ICAM1, intercellular adhesion molecule 1; MCP1, monocyte chemoattractant protein 1; NFκB, nuclear factor κB; TGFβ, transforming growth factor βDiabetic nephropathy is the most common cause of endstage renal disease and high mortality in humans. Adequate control of blood glucose may slow the rate of its progression, but it is still difficult to achieve strict glycemic control for diabetic patients in the longer term, due at least in part to the limitations of available therapeutic approaches.³ Recent studies have suggested the emerging role of inflammatory processes in the pathogenesis of diabetic nephropathy in addition to other well-known mechanisms.In human renal disease, transforming growth factor β (TGFβ) may mediate the buildup of tissue extracellular matrix (ECM) proteins.¹⁷ This cytokine reportedly stimulated ECM protein accumulation in diabetic tissues by upregulating the production of ECM proteins or by downregulating the production of ECM-degrading enzymes.²⁶ Renal levels of TGFβ1 increase in both experimental and human diabetes. In addition, TGFβ1 induces the synthesis of ECM components including collagen types I, III, and IV and fibronectin.^2,5Intercellular adhesion molecule 1 (ICAM1) is a key adhesion molecules. In addition, the ICAM1-dependent infiltration of macrophages into the kidney is very important in the pathogenesis of diabetic nephropathy.¹⁸ In addition, the expression of ICAM1 is rapidly induced and maintained for a long time in renal tissues after induction of diabetes in experimental type 1 diabetic rats.^14,20 Macrophage infiltration was blocked by antiICAM1 antibody, confirming that ICAM1 mediates macrophage infiltration into the diabetic kidney.⁶ Furthermore, ICAM1-deficient mice were protected from renal injury after the induction of diabetes, suggesting that the inflammatory process is a critical factor for the development of diabetic nephropathy.²¹Despite the availability of treatments that lower blood glucose and blood pressure, many diabetic patients are still prone to developing kidney failure, which no currently available therapies can reverse.²⁴ Therefore a search is needed for new therapeutic approaches—based on novel mechanisms of action—to the treatment of diabetic nephropathy. Paeoniflorin is a monoterpene glucoside and a component of the total glucoside extract obtained from the root of Paeonia lactiflora.²⁸ This extract was approved for marketing in China in 1998.²³ As a disease-modifying drug, the total glucoside extract of peony has both antiinflammatory and immune-regulatory effects and is used in the treatment of rheumatoid arthritis, hepatitis, systemic lupus erythematosus, and mesenteric hyperplastic nephritis.^8,9,27 The goal of this study is to address whether paeoniflorin might prevent the progression of diabetic nephropathy through the inhibition of the inflammatory processes including TGFβ, type IV collagens, and ICAM1 expression, monocyte chemoattractant protein 1 (MCP1), nuclear factor κB (NFκB) activation, and macrophage infiltration.     

Increased SHP-1 Protein Expression by High Glucose Levels Reduces Nephrin Phosphorylation in Podocytes

Nephrin, a critical podocyte membrane component that is reduced in diabetic nephropathy, has been shown to activate phosphotyrosine signaling pathways in human podocytes. Nephrin signaling is important to reduce cell death induced by apoptotic stimuli. We have shown previously that high glucose level exposure and diabetes increased the expression of SHP-1, causing podocyte apoptosis. SHP-1 possesses two Src homology 2 domains that serve as docking elements to dephosphorylate tyrosine residues of target proteins. However, it remains unknown whether SHP-1 interacts with nephrin and whether its elevated expression affects the nephrin phosphorylation state in diabetes. Here we show that human podocytes exposed to high glucose levels exhibited elevated expression of SHP-1, which was associated with nephrin. Coexpression of nephrin-CD16 and SHP-1 reduced nephrin tyrosine phosphorylation in transfected human embryonic kidney 293 cells. A single tyrosine-to-phenylalanine mutation revealed that rat nephrin Tyr¹¹²⁷ and Tyr¹¹⁵² are required to allow SHP-1 interaction with nephrin. Overexpression of dominant negative SHP-1 in human podocytes prevented high glucose-induced reduction of nephrin phosphorylation. In vivo, immunoblot analysis demonstrated that nephrin expression and phosphorylation were decreased in glomeruli of type 1 diabetic Akita mice (Ins2^+/C96Y) compared with control littermate mice (Ins2^+/+), and this was associated with elevated SHP-1 and cleaved caspase-3 expression. Furthermore, immunofluorescence analysis indicated increased colocalization of SHP-1 with nephrin in diabetic mice compared with control littermates. In conclusion, our results demonstrate that high glucose exposure increases SHP-1 interaction with nephrin, causing decreased nephrin phosphorylation, which may, in turn, contribute to diabetic nephropathy.