Mediators of diabetic renal disease: The case for TGF-β as the major mediator

• Published in: Journal of the American Society of Nephrology Vol. 15; no. 1_suppl; pp. 55 - 57
• Main Author: ZIYADEH, Fuad N
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2004
• Subjects: Biological and medical sciences; Diabetic Nephropathies - etiology; Humans; Kidney - metabolism; Kidneys; Medical sciences; Nephrology. Urinary tract diseases; Transforming Growth Factor beta - physiology; Up-Regulation; Urinary system involvement in other diseases. Miscellaneous; Endocrinopathy; Kidney disease; Nephrology; Urinary system disease; Transforming growth factor β; Pathogenesis; Diabetes mellitus; Cytokine; Rodentia; Review; Vertebrata; Mammalia; Mouse; Polypeptide; Animal; Complication; Diabetic nephropathy; Growth factor
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1097/01.ASN.0000093460.24823.5B

The critical role of hyperglycemia in the genesis of diabetic nephropathy has been established by cell culture studies, experimental animal models, and clinical trials. Certain cytokines and growth factors have been identified as likely mediators of the effects of high ambient glucose on the kidney, but prominent among these is TGF-beta, a prototypical hypertrophic and fibrogenic cytokine. Overexpression of TGF-beta has been demonstrated in the glomerular and tubulointerstitial compartments of experimental diabetic animals. The TGF-beta receptor signaling system is also triggered, as evidenced by upregulation of the TGF-beta type II receptor and activation of the downstream Smad signaling pathway. Treatment of diabetic mice with neutralizing anti-TGF-beta antibodies prevents the development of renal hypertrophy, mesangial matrix expansion, and the decline in renal function. Antibody therapy also reverses the established lesions of diabetic glomerulopathy. These studies argue strongly in support of the hypothesis that overactivity of the TGF-beta system in the kidney is a crucial mediator of diabetic renal hypertrophy and mesangial matrix expansion.