Plasma endoglin in Type2 diabetic patients with nephropathy.

BACKGROUND: Diabetic nephropathy may be a common complication of diabetes mellitus. Endoglin is glycoprotein located on cell surfaces of endothelial cells and is part of the transforming growth factor beta (TGF- ß) receptor. Endoglin expression is enhanced in endothelial cells during injury and inflammation. The aim of this study was to estimate the plasma level of soluble endoglin (sEng) in type 2 diabetic patients (with and without nephropathy). Also to explore its availability as marker for disease progression. METHODS: In this study, sixty eight patients with type 2 diabetes mellitus (T2DM) were included; the patients were sub-grouped to normoalbuminuria without nephropathy and moderately increased albuminuria (microalbuminuria) with nephropathy groups with 13 individuals as control group. Plasma soluble endoglin level was determined using ELISA technique. Fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), lipid profile, and creatinine were determined using colorimetric assay, whereas glomerular filtration rate (GFR) was calculated. RESULTS: The plasma level of sEng of both normoalbuminuria group 1 and microalbuminuria group 2 were significantly higher when compared to control group. While, the plasma level of sEng in microalbuminuria group 2 was nonsignificant lower when compared to normoalbuminuria group 1. Also, there was a significant positive association between plasma level of sEng and HbA1c, HDL-C and urinary albumin concentration in normoalbuminuria group. CONCLUSION: Plasma level of soluble Endoglin is markedly increase prior to alteration in endothelial function, and increases to lesser extent with the developing of diabetic nephropathy which indicated disease progression and development of vascular abnormalities.

The Role of Vildagliptin in Treating Hypertension Through Modulating Serum VEGF in Diabetic Hypertensive Patients.

BACKGROUND: Several trials have reported that dipeptidyl peptidase-4 (DPP-4) inhibitors are used to improve endothelial function in addition to treating type 2 diabetes (T2DM). The current study investigated the effects of vildagliptin, DPP-4 inhibitor, compared to metformin on endothelial function and blood pressure through vascular endothelial growth factor (VEGF) modulation in patients with T2DM and hypertension. METHODS: This study was designed as a randomized controlled parallel study. A total of 120 volunteers were recruited and allocated into 4 groups: healthy volunteers, patients recently diagnosed with hypertension and diabetes, patients treated with captopril for hypertension in addition to metformin, and patients treated with captopril in addition to vildagliptin. The percentage change in body weight was calculated in addition to serum VEGF levels, blood pressure, glycated hemoglobin (HbA1c), total lipid profile, and insulin resistance. RESULTS: At the end of the therapeutic period, the results showed that vildagliptin significantly decreased blood pressure and increased serum VEGF levels, while metformin was more effective at lowering body weight. In comparison with metformin, vildagliptin showed a promising action through its antihypertensive effect via elevating VEGF levels and improving physiological angiogenesis and vasculature. WHAT IS NEW AND CONCLUSION: Vildagliptin showed a promising action through its blood pressure-regulating effect via modulating VEGF levels and improving physiological angiogenesis and vasculature, in addition to improving the lipid profile of patients, while metformin was better in reducing body weight.

Clinical significance of inflammatory and fibrogenic cytokines in diabetic nephropathy.

OBJECTIVES: To study the role of inflammatory chemokine; monocyte chemoattractant protein-1 (MCP-1), and fibrogenic markers [transforming growth factor beta-1 (TGF-ß(1)), connective tissue growth factor (CTGF) and fibronectin (FN)] in diabetic nephropathy (DN). DESIGN AND METHODS: This study included 17 control and 65 type 2 diabetic subjects (18 normoalbuminuric, 22 microalbuminuric and 25 macroalbuminuric). Demographic characteristics, diabetic index and kidney function tests were monitored. Serum TGF-ß(1), plasma CTGF, MCP-1 and FN levels were assayed. RESULTS: Microalbuminuric and macroalbuminuric subjects showed a significant elevation in TGF-ß(1), CTGF, MCP-1 and FN levels as compared with control and normoalbuminuric subjects. There was positive correlation between these markers and fasting plasma glucose, albumin excretion rate and with each other. CONCLUSION: This study revealed the importance of these markers in DN pathogenesis which is powered by their association and thus the possibility of their use as biochemical markers in DN was suggested.