Research Division, Joslin Diabetes Center, Boston, MA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
Nat Med. 2019 May;25(5):805-813. doi: 10.1038/s41591-019-0415-5. Epub 2019 Apr 22.
Chronic inflammation is postulated to be involved in the development of end-stage renal disease in diabetes, but which specific circulating inflammatory proteins contribute to this risk remain unknown. To study this, we examined 194 circulating inflammatory proteins in subjects from three independent cohorts with type 1 and type 2 diabetes. In each cohort, we identified an extremely robust kidney risk inflammatory signature (KRIS), consisting of 17 proteins enriched in tumor necrosis factor-receptor superfamily members, that was associated with a 10-year risk of end-stage renal disease. All these proteins had a systemic, non-kidney source. Our prospective study findings provide strong evidence that KRIS proteins contribute to the inflammatory process underlying end-stage renal disease development in both types of diabetes. These proteins point to new therapeutic targets and new prognostic tests to identify subjects at risk of end-stage renal disease, as well as biomarkers to measure responses to treatment of diabetic kidney disease.
慢性炎症被认为与糖尿病终末期肾病的发生有关,但哪些特定的循环炎症蛋白与此风险相关仍不清楚。为了研究这一问题,我们检测了来自三个独立的 1 型和 2 型糖尿病队列的 194 种循环炎症蛋白。在每个队列中,我们确定了一个极其强大的肾脏风险炎症特征(KRIS),由富含肿瘤坏死因子受体超家族成员的 17 种蛋白组成,与终末期肾脏疾病的 10 年风险相关。所有这些蛋白都具有全身性、非肾脏来源。我们的前瞻性研究结果提供了强有力的证据,表明 KRIS 蛋白有助于 1 型和 2 型糖尿病终末期肾脏疾病发展背后的炎症过程。这些蛋白为识别终末期肾脏疾病风险的患者提供了新的治疗靶点和新的预后检测方法,以及用于衡量糖尿病肾病治疗反应的生物标志物。
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