Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Biotechnology Research Center, Tabriz University of Medical Sciences, Golgasht Avenue, POBOX: 14711, 5166614711 Tabriz, Iran.
Eur J Pharmacol. 2018 Aug 15;833:158-164. doi: 10.1016/j.ejphar.2018.06.001. Epub 2018 Jun 5.
Diabetic nephropathy is one of the most frequent micro-vascular complications both in type 1 and type 2 diabetic patients and is the leading cause of end-stage renal disease worldwide. Although disparate mechanisms give rise to the development of diabetic nephropathy, prevailing evidence accentuates that hyperglycemia-associated generation of advanced glycation end products (AGEs) plays a central role in the disease pathophysiology. Engagement of the receptor for AGE (RAGE) with its ligands provokes oxidative stress and chronic inflammation in renal tissues, ending up with losses in kidney function. Moreover, RAGE activation evokes the activation of different intracellular signaling pathways like PI3K/Akt, MAPK/ERK, and NF-κB; and therefore, its blockade seems to be an attractive therapeutic target in these group of patients. By recognizing the contribution of AGE-RAGE axis to the pathogenesis of diabetic nephropathy, agents that block AGEs formation have been at the heart of investigations for several years, yielding encouraging improvements in experimental models of diabetic nephropathy. Even so, recent studies have evaluated the effects of specific RAGE inhibition with FPS-ZM1 and RAGE-aptamers as novel therapeutic strategies. Despite all these promising outcomes in experimental models of diabetic nephropathy, no thorough clinical trial have ever examined the end results of AGE-RAGE axis blockade in patients of diabetic nephropathy. As most of the AGE lowering or RAGE inhibiting compounds have emerged to be non-toxic, devising novel clinical trials appears to be inevitable. Here, the current potential treatment options for diabetic nephropathy by AGE-RAGE inhibitory modalities have been reviewed.
糖尿病肾病是 1 型和 2 型糖尿病患者最常见的微血管并发症之一,也是全球终末期肾病的主要原因。尽管导致糖尿病肾病的机制不同,但现有证据强调,与高血糖相关的晚期糖基化终产物(AGEs)的产生在疾病发病机制中起着核心作用。AGE 受体(RAGE)与其配体的结合会在肾脏组织中引发氧化应激和慢性炎症,最终导致肾功能丧失。此外,RAGE 的激活会引发不同的细胞内信号通路的激活,如 PI3K/Akt、MAPK/ERK 和 NF-κB;因此,其阻断似乎是这些患者群体中一个有吸引力的治疗靶点。通过认识到 AGE-RAGE 轴对糖尿病肾病发病机制的贡献,多年来,阻止 AGE 形成的药物一直是研究的核心,在糖尿病肾病的实验模型中取得了令人鼓舞的改善。即便如此,最近的研究已经评估了特异性 RAGE 抑制与 FPS-ZM1 和 RAGE-适体作为新的治疗策略的效果。尽管在糖尿病肾病的实验模型中取得了所有这些有前景的结果,但从未有过关于 AGE-RAGE 轴阻断在糖尿病肾病患者中的最终结果的全面临床试验。由于大多数降低 AGE 或抑制 RAGE 的化合物已被证明是无毒的,因此设计新的临床试验似乎是不可避免的。在这里,我们回顾了 AGE-RAGE 抑制模式治疗糖尿病肾病的当前潜在治疗选择。
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