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Evaluating new biomarkers for diabetic nephropathy: Role of α2-macroglobulin, podocalyxin, α-L-fucosidase, retinol-binding protein-4, and cystatin C 评估糖尿病肾病的新生物标记物:α2-巨球蛋白、荚膜黏蛋白、α-L-岩藻糖苷酶、视黄醇结合蛋白-4 和胱抑素 C 的作用
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1212
Jing-Jing Li, Ru-La Sa, Yu Zhang, Zhao-Li Yan
BACKGROUND The intricate relationship between type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) presents a challenge in understanding the significance of various biomarkers in diagnosis. AIM To elucidate the roles and diagnostic values of α2-macroglobulin (α2-MG), podocalyxin (PCX), α-L-fucosidase (AFU), retinol-binding protein-4 (RBP-4), and cystatin C (CysC) in DN. METHODS From December 2018 to December 2020, 203 T2DM patients were enrolled in the study. Of these, 115 were diagnosed with DN (115 patients), while the remaining 88 patients were classified as non-DN. The urinary levels of α2-MG, PCX, and AFU and the serum concentrations RBP-4 and CysC were measured in conjunction with other relevant clinical indicators to evaluate their potential correlations and diagnostic utility. RESULTS After adjustments for age and gender, significant positive correlations were observed between the biomarkers CysC, RBP-4, α2-MG/urinary creatinine (UCr), PCX/UCr, and AFU/UCr, and clinical indicators such as urinary albumin-to-creatinine ratio (UACR), serum creatinine, urea, 24-h total urine protein, and neutrophil-to-lymphocyte ratio (NLR). Conversely, these biomarkers exhibited negative correlations with the estimated glomerular filtration rate (P < 0.05). Receiver operating characteristic (ROC) curve analysis further demonstrated the diagnostic performance of these biomarkers, with UACR showcasing the highest area under the ROC curve (AUCROC) at 0.97. CONCLUSION This study underscores the diagnostic significance of α2-MG, PCX, and AFU in the development of DN. The biomarkers RBP-4, CysC, PCX, AFU, and α2-MG provide promising diagnostic insights, while UACR is the most potent diagnostic biomarker in assessing DN.
背景 2 型糖尿病(T2DM)与糖尿病肾病(DN)之间的关系错综复杂,这给了解各种生物标志物在诊断中的意义带来了挑战。目的 阐明α2-巨球蛋白(α2-MG)、荚膜黏蛋白(PCX)、α-L-岩藻糖苷酶(AFU)、视黄醇结合蛋白-4(RBP-4)和胱抑素 C(CysC)在 DN 中的作用和诊断价值。方法 从 2018 年 12 月至 2020 年 12 月,203 名 T2DM 患者被纳入研究。其中,115 名患者被诊断为 DN(115 例患者),其余 88 例患者被归类为非 DN 患者。研究人员结合其他相关临床指标测定了尿液中的α2-MG、PCX和AFU水平以及血清中的RBP-4和CysC浓度,以评估其潜在的相关性和诊断效用。结果 对年龄和性别进行调整后,发现 CysC、RBP-4、α2-MG/尿肌酐(UCr)、PCX/UCr 和 AFU/UCr 等生物标志物与尿白蛋白与肌酐比值(UACR)、血清肌酐、尿素、24 小时尿蛋白总量和中性粒细胞与淋巴细胞比值(NLR)等临床指标之间存在显著的正相关。相反,这些生物标志物与估计肾小球滤过率呈负相关(P < 0.05)。接收者操作特征(ROC)曲线分析进一步证明了这些生物标志物的诊断性能,其中 UACR 的 ROC 曲线下面积(AUCROC)最高,为 0.97。结论 本研究强调了α2-MG、PCX 和 AFU 在 DN 发病过程中的诊断意义。生物标记物 RBP-4、CysC、PCX、AFU 和 α2-MG 提供了有前景的诊断见解,而 UACR 是评估 DN 最有效的诊断生物标记物。
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引用次数: 0
Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic 重新考虑抑郁症和常见精神障碍在 2 型糖尿病流行中的作用
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1374
A. E. Claro, Clelia Palanza, Marianna Mazza, A. Rizzi, Andrea Corsello, L. Tartaglione, G. Marano, Giovanna Elsa Ute Muti Schuenemann, M. Rigoni, Alfredo Pontecorvi, Luigi Janiri, Paola Muti, Dario Pitocco
Common psychiatric disorders (CPDs) and depression contribute significantly to the global epidemic of type 2 diabetes (T2D). We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs, promotes the establishment of emotional eating, activation of the reward system, onset of overweight and obesity and, ultimately the increased risk of developing T2D. The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexone-bupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction, but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction. We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.
常见精神障碍(CPD)和抑郁症在很大程度上导致了 2 型糖尿病(T2D)在全球的流行。我们假设了一种可能的病理生理机制,即通过抑郁症和常见精神障碍中的桥接症状,促进情绪化饮食的形成、奖赏系统的激活、超重和肥胖的发生,并最终增加患 T2D 的风险。纳曲酮-安非他酮等药物目前被批准用于治疗伴有 T2D 的肥胖/超重,并作为单独的活性药物成分用于治疗药物成瘾,这些药物的作用机制也支持了所提出的病理生理机制的合理性,同时也有初步证据表明,胰高血糖素样肽 1 受体激动剂似乎能有效治疗药物成瘾。我们希望我们的假设有助于解释 T2D 患者中 CPD 和抑郁症的发病率高于普通人群的情况,并有助于完善精神科-糖尿病综合治疗方法,以改善 T2D 的治疗和缓解。
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引用次数: 0
Monogenic diabetes in children: An underdiagnosed and poorly managed clinical dilemma 儿童单基因糖尿病:诊断不足、管理不善的临床难题
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1051
Saptarshi Bhattacharya, Joseph M Pappachan
Monogenic diabetes, constituting 1%-2% of global diabetes cases, arises from single gene defects with distinctive inheritance patterns. Despite over 50 ass-ociated genetic disorders, accurate diagnoses and management of monogenic diabetes remain inadequate, underscoring insufficient clinician awareness. The disease spectrum encompasses maturity-onset diabetes of the young (MODY), characterized by distinct genetic mutations affecting insulin secretion, and neonatal diabetes mellitus (NDM) – a heterogeneous group of severe hyperglycemic disorders in infants. Mitochondrial diabetes, autoimmune monogenic diabetes, genetic insulin resistance and lipodystrophy syndromes further diversify the monogenic diabetes landscape. A tailored approach based on phenotypic and biochemical factors to identify candidates for genetic screening is recommended for suspected cases of MODY. NDM diagnosis warrants immediate molecular genetic testing for infants under six months. Identifying these genetic defects presents a unique opportunity for precision medicine. Ongoing research aimed to develop cost-effective genetic testing methods and gene-based therapy can facilitate appropriate identification and optimize clinical outcomes. Identification and study of new genes offer a valuable opportunity to gain deeper insights into pancreatic cell biology and the pathogenic mechanisms underlying common forms of diabetes. The clinical review published in the recent issue of World Journal of Diabetes is such an attempt to fill-in our knowledge gap about this enigmatic disease.
单基因糖尿病占全球糖尿病病例的 1%-2%,由具有独特遗传模式的单基因缺陷引起。尽管存在 50 多种相关的遗传疾病,但对单基因糖尿病的准确诊断和管理仍然不足,这凸显了临床医生的认识不足。疾病谱包括以影响胰岛素分泌的独特基因突变为特征的青年成熟型糖尿病(MODY)和新生儿糖尿病(NDM)--一组异质性的婴儿严重高血糖疾病。线粒体糖尿病、自身免疫性单基因糖尿病、遗传性胰岛素抵抗和脂肪营养不良综合征进一步丰富了单基因糖尿病的种类。建议对 MODY 疑似病例采取基于表型和生化因素的定制方法,以确定基因筛查的候选病例。对于 6 个月以下的婴儿,NDM 诊断需要立即进行分子基因检测。识别这些基因缺陷为精准医疗提供了一个独特的机会。目前正在进行的旨在开发具有成本效益的基因检测方法和基因疗法的研究,可促进适当的识别和优化临床结果。新基因的鉴定和研究为深入了解胰腺细胞生物学和常见糖尿病的致病机制提供了宝贵的机会。近期出版的《世界糖尿病杂志》(World Journal of Diabetes)上发表的临床综述就是这样一次尝试,它填补了我们对这一神秘疾病的知识空白。
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引用次数: 0
New perspectives in the management of diabetic nephropathy 糖尿病肾病治疗的新视角
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1086
Anna Psyllaki, Konstantinos Tziomalos
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and is also associated with increased risk for cardiovascular events. Until recently, strict glycemic control and blockade of the renin-angiotensin system (RAS) constituted the mainstay of treatment of DN. However, randomized controlled trials showed that sodium-glucose cotransporter 2 inhibitors further reduce the progression of DN. Therefore, these agents are recommended in all patients with DN regardless of DN stage and HbA1c levels. Moreover, additional blockade of the RAS with finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, was also shown to prevent both the decline of renal function and cardiovascular events in this population. Finally, promising preliminary findings suggest that glucagon-like peptide 1 receptor agonists might also exert reno- and cardioprotective effects in patients with DN. Hopefully, this knowledge will improve the outcomes of this high-risk group of patients.
糖尿病肾病(DN)是终末期肾病的主要病因,也与心血管事件风险增加有关。直到最近,严格控制血糖和阻断肾素-血管紧张素系统(RAS)仍是治疗糖尿病肾病的主要方法。然而,随机对照试验表明,钠-葡萄糖共转运体 2 抑制剂可进一步减少 DN 的进展。因此,无论 DN 分期和 HbA1c 水平如何,所有 DN 患者都推荐使用这些药物。此外,使用非格列酮(一种选择性非甾体类矿物质皮质激素受体拮抗剂)对 RAS 进行额外阻断,也被证明可以预防该人群肾功能的衰退和心血管事件的发生。最后,令人鼓舞的初步研究结果表明,胰高血糖素样肽 1 受体激动剂也可能对 DN 患者产生肾脏和心脏保护作用。希望这些知识能改善这一高风险人群的治疗效果。
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引用次数: 0
Clinical characteristics and treatment compounds of obesity-related kidney injury. 肥胖相关肾损伤的临床特征和治疗方案。
IF 4.2 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1091
Tuo-Hua Mao, Han-Qi Huang, Chuan-Hai Zhang

Disorders in energy homeostasis can lead to various metabolic diseases, particularly obesity. The obesity epidemic has led to an increased incidence of obesity-related nephropathy (ORN), a distinct entity characterized by proteinuria, glomerulomegaly, progressive glomerulosclerosis, and renal function decline. Obesity and its associated renal damage are common in clinical practice, and their incidence is increasing and attracting great attention. There is a great need to identify safe and effective therapeutic modalities, and therapeutics using chemical compounds and natural products are receiving increasing attention. However, the summary is lacking about the specific effects and mechanisms of action of compounds in the treatment of ORN. In this review, we summarize the important clinical features and compound treatment strategies for obesity and obesity-induced kidney injury. We also summarize the pathologic and clinical features of ORN as well as its pathogenesis and potential therapeutics targeting renal inflammation, oxidative stress, insulin resistance, fibrosis, kidney lipid accumulation, and dysregulated autophagy. In addition, detailed information on natural and synthetic compounds used for the treatment of obesity-related kidney disease is summarized. The synthesis of detailed information aims to contribute to a deeper understanding of the clinical treatment modalities for obesity-related kidney diseases, fostering the anticipation of novel insights in this domain.

能量平衡失调可导致各种代谢性疾病,尤其是肥胖症。肥胖症的流行导致肥胖相关性肾病(ORN)的发病率增加,这是一种以蛋白尿、肾小球肿大、进行性肾小球硬化和肾功能衰退为特征的独特疾病。肥胖及其相关的肾脏损害在临床实践中很常见,其发病率正在上升,并引起了人们的高度重视。目前亟需找到安全有效的治疗方法,利用化学合成物和天然产品进行治疗正受到越来越多的关注。然而,有关化合物治疗 ORN 的具体效果和作用机制的总结还很缺乏。在这篇综述中,我们总结了肥胖和肥胖引起的肾损伤的重要临床特征和化合物治疗策略。我们还总结了 ORN 的病理和临床特征及其发病机制,以及针对肾脏炎症、氧化应激、胰岛素抵抗、纤维化、肾脏脂质堆积和自噬失调的潜在疗法。此外,还总结了用于治疗肥胖相关肾病的天然和合成化合物的详细信息。综述详细信息的目的是加深对肥胖相关肾脏疾病临床治疗方法的理解,促进对该领域新见解的预测。
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引用次数: 0
Boron-containing compounds as labels, drugs, and theranostic agents for diabetes and its complications 作为糖尿病及其并发症的标签、药物和治疗剂的含硼化合物
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1060
M. Soriano-Ursúa, R. I. Cordova-Chávez, E. Farfán-García, George Kabalka
Diabetes is a disease with a high global burden. Current strategies have failed to limit the advancement and impact of the disease. Successful early diagnosis and treatment will require the development of new agents. In this sense, boron-containing compounds have been reported as agents with the ability to reduce glycemia and lipidemia. They have also been used for labeling and measuring carbohydrates and other molecules linked to the initial stages of diabetes and its progression. In addition, certain boron compounds bind to molecules related to diabetes development and their biological activity in the regulation of elevated glycemia. Finally, it should be noted that some boron compounds appear to exert beneficial effects on diabetes complications such as accelerating wound healing while ameliorating pain in diabetic patients.
糖尿病是一种全球负担沉重的疾病。目前的策略未能限制该疾病的发展和影响。要想成功实现早期诊断和治疗,就必须开发新的药物。从这个意义上讲,含硼化合物已被报道为能够降低血糖和血脂的药物。它们还被用于标记和测量碳水化合物和其他与糖尿病初期阶段及其进展有关的分子。此外,某些硼化合物还能与与糖尿病发展有关的分子结合,并在调节血糖升高的过程中发挥生物活性。最后,应该指出的是,某些硼化合物似乎对糖尿病并发症有好处,如加速伤口愈合,同时减轻糖尿病患者的疼痛。
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引用次数: 0
Vasorelaxant effects of biochemical constituents of various medicinal plants and their benefits in diabetes 多种药用植物生化成分的血管舒张作用及其对糖尿病的益处
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1122
Sadettin Demirel
Endothelial function plays a pivotal role in cardiovascular health, and dysfunction in this context diminishes vasorelaxation concomitant with endothelial activity. The nitric oxide-cyclic guanosine monophosphate pathway, prostacyclin-cyclic adenosine monophosphate pathway, inhibition of phosphodiesterase, and the opening of potassium channels, coupled with the reduction of calcium levels in the cell, constitute critical mechanisms governing vasorelaxation. Cardiovascular disease stands as a significant contributor to morbidity and mortality among individuals with diabetes, with adults afflicted by diabetes exhibiting a heightened cardiovascular risk compared to their non-diabetic counterparts. A plethora of medicinal plants, characterized by potent pharmacological effects and minimal side effects, holds promise in addressing these concerns. In this review, we delineate various medicinal plants and their respective biochemical constituents, showcasing concurrent vasorelaxant and anti-diabetic activities.
内皮功能在心血管健康中起着举足轻重的作用,内皮功能失调会降低血管舒张功能和内皮活性。一氧化氮-环鸟苷-单磷酸途径、前列环素-环腺苷-单磷酸途径、磷酸二酯酶的抑制、钾通道的开放以及细胞内钙含量的降低,构成了调节血管舒张的关键机制。心血管疾病是导致糖尿病患者发病和死亡的重要因素,与非糖尿病患者相比,成年糖尿病患者的心血管风险更高。大量药用植物具有药理作用强、副作用小的特点,有望解决这些问题。在这篇综述中,我们介绍了多种药用植物及其各自的生化成分,展示了它们同时具有的舒张血管和抗糖尿病活性。
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引用次数: 0
Adipose-derived stem cells in diabetic foot care: Bridging clinical trials and practical application 糖尿病足护理中的脂肪来源干细胞:连接临床试验与实际应用
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1162
Song-Lu Tseng, Lin Kang, Zhu-Jun Li, Li-Quan Wang, Zi‐Ming Li, Tian‐Hao Li, Jie-Yu Xiang, Jiu‐Zuo Huang, Nan-Ze Yu, Xiao Long
Diabetic foot ulcers (DFUs) pose a critical medical challenge, significantly im-pairing the quality of life of patients. Adipose-derived stem cells (ADSCs) have been identified as a promising therapeutic approach for improving wound healing in DFUs. Despite extensive exploration of the mechanical aspects of ADSC therapy against DFU, its clinical applications remain elusive. In this review, we aimed to bridge this gap by evaluating the use and advancements of ADSCs in the clinical management of DFUs. The review begins with a discussion of the classification and clinical management of diabetic foot conditions. It then discusses the current landscape of clinical trials, focusing on their geographic distribution, reported efficacy, safety profiles, treatment timing, administration techniques, and dosing considerations. Finally, the review discusses the preclinical strategies to enhance ADSC efficacy. This review shows that many trials exhibit biases in study design, unclear inclusion criteria, and intervention protocols. In conclusion, this review underscores the potential of ADSCs in DFU treatment and emphasizes the critical need for further research and refinement of therapeutic approaches, with a focus on improving the quality of future clinical trials to enhance treatment outcomes and advance the field of diabetic wound care.
糖尿病足溃疡(DFU)是一项严峻的医学挑战,严重影响患者的生活质量。脂肪源性干细胞(ADSCs)被认为是改善糖尿病足溃疡伤口愈合的一种很有前景的治疗方法。尽管对ADSC治疗DFU的机械方面进行了广泛的探索,但其临床应用仍然遥遥无期。在本综述中,我们旨在通过评估 ADSCs 在 DFU 临床治疗中的应用和进展来弥补这一差距。综述首先讨论了糖尿病足的分类和临床治疗。然后讨论了目前的临床试验情况,重点关注其地理分布、疗效报告、安全性概况、治疗时机、给药技术和剂量注意事项。最后,综述讨论了提高 ADSC 疗效的临床前策略。综述显示,许多试验在研究设计、纳入标准和干预方案方面存在偏差。总之,本综述强调了 ADSCs 在 DFU 治疗中的潜力,并强调了进一步研究和完善治疗方法的迫切需要,重点是提高未来临床试验的质量,以改善治疗效果并推动糖尿病伤口护理领域的发展。
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引用次数: 0
Effect of dates on blood glucose and lipid profile among patients with type 2 diabetes 红枣对 2 型糖尿病患者血糖和血脂的影响
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1079
H. Mirghani
Poor fruit and vegetable consumption is one of the 10 major risk factors for mortality. There is a misconception regarding the consumption of dates among patients with diabetes. This manuscript assessed the effects of date consumption on fasting and postprandial blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoproteins, high-density lipoproteins, and microbial markers. Four literature databases were searched for relevant articles. Of the 595 studies retrieved, 24 assessed the effects of dates on glycemic control and lipids. Overall, the evidence suggests that dates have a lowering effect on blood glucose. Dates reduce total cholesterol and triglyceride levels and increase high-density lipoprotein levels. Dates also promote the abundance of beneficial gut microbiota. Therefore, patients with diabetes and dyslipidemia can consume dates to reduce their blood glucose, cholesterol, and triglycerides.
水果和蔬菜摄入不足是导致死亡的十大风险因素之一。糖尿病患者对食用红枣存在误解。本稿件评估了食用红枣对空腹和餐后血糖、糖化血红蛋白、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和微生物标志物的影响。我们在四个文献数据库中搜索了相关文章。在检索到的 595 项研究中,有 24 项评估了红枣对血糖控制和血脂的影响。总体而言,证据表明红枣有降低血糖的作用。红枣能降低总胆固醇和甘油三酯水平,提高高密度脂蛋白水平。红枣还能促进有益肠道微生物群的丰富。因此,糖尿病和血脂异常患者可以食用红枣来降低血糖、胆固醇和甘油三酯。
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引用次数: 0
Unraveling the biological link between diabetes mellitus and prostate cancer: Insights and implications 揭示糖尿病与前列腺癌之间的生物学联系:见解和影响
IF 4.2 3区 医学 Pub Date : 2024-06-15 DOI: 10.4239/wjd.v15.i6.1367
Jian Li, Zhi-Peng Li, Si-Si Xu, Wei Wang
This article is a comprehensive study based on research on the connection between diabetes mellitus (DM) and prostate cancer (PCa). It investigates the potential role of DM as an independent risk factor for PCa, delving into the biological links, including insulin resistance and hormonal changes. The paper critically analyzes previous studies that have shown varying results and introduces mendelian randomization as a method for establishing causality. It emphasizes the importance of early DM screening and lifestyle modifications in preventing PCa, and proposes future research directions for further under-standing the DM - PCa relationship.
本文是一项基于糖尿病(DM)与前列腺癌(PCa)之间联系研究的综合研究。文章调查了糖尿病作为 PCa 独立风险因素的潜在作用,深入探讨了其中的生物学联系,包括胰岛素抵抗和激素变化。论文批判性地分析了以往显示出不同结果的研究,并介绍了 "亡羊补牢 "随机法作为确定因果关系的一种方法。论文强调了早期 DM 筛查和生活方式调整对预防 PCa 的重要性,并提出了进一步了解 DM 与 PCa 关系的未来研究方向。
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引用次数: 0
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World Journal of Diabetes
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