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| Author(s): |
Maria Beatriz Camargo Monteiro Caillaud
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | São Paulo. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) |
| Defense date: | 2016-01-20 |
| Examining board members: |
Maria Lucia Cardillo Correa Giannella;
Lucia da Conceição Andrade;
Sérgio Atala Dib;
José Butori Lopes de Faria;
Ubiratan Fabres Machado
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| Advisor: | Maria Lucia Cardillo Correa Giannella |
| Abstract | |
Diabetic nephropathy (DN) is a major cause of end stage renal disease. Glomerular and tubulointerstitial compartments are affected not only by proteinuria but also by the pro-inflammatory, profibrotic, pro-oxidants and pro-angiogenic effects exerted by hyperglycemia and advanced glycation end products (AGEs) in the development of DN. It is well known that concentrations of oxidative stress markers are increased in patients with diabetes mellitus (DM). The thioredoxin system (TXN) is one of the majors endogenous antioxidant systems; TXN molecule is able to interact with a large number of transcription factors and proteins such as Thioredoxin interacting protein (TXNIP), which has been recognized in the pathogenesis of DM and its complications. Deficiency of thiamine, or B1 vitamin, has been reported in experimental models of DM concomitantly with an increase in its renal clearance. Thiamine transporter 1 (THTR1), encoded by the SLC19A2 gene and Thiamine transporter 2 (THTR2), encoded by the SLC19A3 gene are responsible for thiamine reabsorption in the proximal tubule after glomerular filtration. Studies have shown that increased urinary excretion of thiamine may be a risk predictor for an early decline in kidney function in diabetic patients. Another protein of interest is beta-2-microglobulin (B2M), expressed in situations of inflammation, a well-characterized phenomenon in diabetic tubulopathy. The study of activation or inactivation of intrarenal pathways potentially associated with progression of DN in humans is complicated by the need for renal biopsy. Recently urinary sediment has been used in the evaluation of kidney diseases in an attempt to identify biomarkers that can predict kidney function decline and as a tool for a better understanding of the pathogenesis of this complication. The objective of this work was to study the participation of the target genes TXNIP, TXN, SLC19A2, SLC19A3 and B2M in the pathogenesis of DN in type 1 DM (T1D) patients. We studied the urinary sediment messenger RNA (mRNA) from patients with T1D (n=55); with focal and segmental glomerulosclerosis (FSGS, a non diabetic nephropathy model, n=12) and from control subjects (n=11) to assess the expression of the target genes and their association with the severity of DN. We also studied the mRNA expression of peripheral lymphomononuclear (PLMN) cells from T1D patients (n=162) and control subjects (n=26) in order to compare with the results obtained in the urinary sediment. Plasmatic concentrations of thiamine were also measured in a subgroup of T1D patients and control subjects. In addition, a lineage of human kidney cells was exposed to high glucose concentrations and to glycated and non-glycated albumin to evaluate if AGEs are implicated in the modulation of expression of the target genes. As a result we found that (1) TXNIP and TXN are upregulated in the urinary sediment of T1D patients with kidney disease and TXNIP is associated with the magnitude of glomerular filtration rate decline; (2) TXNIP and TXN are upregulated in PLMN cells from T1D patients; (3) SLC19A2 is upregulated in the urinary sediment of T1D patients with kidney disease; (4) T1D patients present decreased plasmatic thiamine concentrations compared to control subjects; (5) B2M is upregulated in the urinary sediment of T1D patients with kidney disease and (6) TXNIP and B2M are upregulated in human kidney cells exposed concomitantly to high glucose concentrations and glycated albumin. The results of the present study strongly suggest the participation of the TXN system and of B2M in the pathogenesis of DN. Descriptors: diabetes mellitus, diabetic nephropathies, urine, glycosylation end products, advanced, thiamine, thioredoxins, beta 2-microglobulin Diabetic nephropathy (DN) is a major cause of end stage renal disease. Glomerular and tubulointerstitial compartments are affected not only by proteinuria but also by the pro-inflammatory, profibrotic, pro-oxidants and pro-angiogenic effects exerted by hyperglycemia and advanced glycation end products (AGEs) in the development of DN. It is well known that concentrations of oxidative stress markers are increased in patients with diabetes mellitus (DM). The thioredoxin system (TXN) is one of the majors endogenous antioxidant systems; TXN molecule is able to interact with a large number of transcription factors and proteins such as Thioredoxin interacting protein (TXNIP), which has been recognized in the pathogenesis of DM and its complications. Deficiency of thiamine, or B1 vitamin, has been reported in experimental models of DM concomitantly with an increase in its renal clearance. Thiamine transporter 1 (THTR1), encoded by the SLC19A2 gene and Thiamine transporter 2 (THTR2), encoded by the SLC19A3 gene are responsible for thiamine reabsorption in the proximal tubule after glomerular filtration. Studies have shown that increased urinary excretion of thiamine may be a risk predictor for an early decline in kidney function in diabetic patients. Another protein of interest is beta-2-microglobulin (B2M), expressed in situations of inflammation, a well-characterized phenomenon in diabetic tubulopathy. The study of activation or inactivation of intrarenal pathways potentially associated with progression of DN in humans is complicated by the need for renal biopsy. Recently urinary sediment has been used in the evaluation of kidney diseases in an attempt to identify biomarkers that can predict kidney function decline and as a tool for a better understanding of the pathogenesis of this complication. The objective of this work was to study the participation of the target genes TXNIP, TXN, SLC19A2, SLC19A3 and B2M in the pathogenesis of DN in type 1 DM (T1D) patients. We studied the urinary sediment messenger RNA (mRNA) from patients with T1D (n=55); with focal and segmental glomerulosclerosis (FSGS, a non diabetic nephropathy model, n=12) and from control subjects (n=11) to assess the expression of the target genes and their association with the severity of DN. We also studied the mRNA expression of peripheral lymphomononuclear (PLMN) cells from T1D patients (n=162) and control subjects (n=26) in order to compare with the results obtained in the urinary sediment. Plasmatic concentrations of thiamine were also measured in a subgroup of T1D patients and control subjects. In addition, a lineage of human kidney cells was exposed to high glucose concentrations and to glycated and non-glycated albumin to evaluate if AGEs are implicated in the modulation of expression of the target genes. As a result we found that (1) TXNIP and TXN are upregulated in the urinary sediment of T1D patients with kidney disease and TXNIP is associated with the magnitude of glomerular filtration rate decline; (2) TXNIP and TXN are upregulated in PLMN cells from T1D patients; (3) SLC19A2 is upregulated in the urinary sediment of T1D patients with kidney disease; (4) T1D patients present decreased plasmatic thiamine concentrations compared to control subjects; (5) B2M is upregulated in the urinary sediment of T1D patients with kidney disease and (6) TXNIP and B2M are upregulated in human kidney cells exposed concomitantly to high glucose concentrations and glycated albumin. The results of the present study strongly suggest the participation of the TXN system and of B2M in the pathogenesis of DN (AU) | |
| FAPESP's process: | 12/02003-4 - Expression of mRNA of the TXNIP, SCL19A2 and SCL19A3 genes in the urinary sediment of patients with type 1 diabetes with and without diabetic nephropathy |
| Grantee: | Maria Beatriz Camargo Monteiro Caillaud |
| Support Opportunities: | Scholarships in Brazil - Doctorate |