糖尿病肾病的中医药实验研究进展

糖尿病肾病是糖尿病极其常见的并发症之一,是构成终末期肾脏病的重要组成部分,西医主要依靠治疗原发病来延缓疾病进展,糖尿病肾病发病机制尚不明确,目前研究表明与足细胞损伤、微循环障碍、炎症反应、氧化应激等密切相关。动物实验可重复性高、可操作性强,中药复方、单味中药及中药成分确有疗效,就近十多年来中医药治疗糖尿病肾病的实验研究进行综述。     

大麻二酚对高糖诱导小鼠肾脏足细胞系MPC5细胞凋亡的保护作用

目的 探讨大麻二酚(cannabidiol,CBD)对高糖环境中小鼠足细胞系MPC5细胞凋亡的影响.方法 将MPC5细胞分为对照组(Vehicle)、高糖组(high glucose,HG)和CBD组.CCK-8试剂盒检测MPC5细胞的增殖活性,流式细胞术检测MPC5细胞的凋亡率,Western blot检测裂孔膜蛋白...     

Expression and localization of insulin-like growth factor binding proteins in normal and proteinuric kidney glomeruli

Aim: Insulin‐like growth factor I (IGF‐I) acts on target cells in an endocrine and/or local manner through the IGF‐I receptor (IGF‐IR), and its actions are modulated by multiple IGF binding proteins (IGFBP). To elucidate the roles of local IGFBP in kidney glomeruli, the expression and localization of their genes were examined and compared with normal and proteinuric kidney glomeruli. Methods: A cDNA microarray database (MAd‐761) was constructed using human kidney glomeruli and cortices. The gene expression levels of IGF‐I, IGF‐1R and IGFBP (1–10) were examined in glomeruli and cortices by polymerase chain reaction (PCR) and in situ hybridization (ISH), and the expression levels of IGFBP that were abundantly found in the glomerulus were compared between normal and proteinuric kidneys in rats and humans. Results: IGFBP‐2, ‐7 and ‐8 were demonstrated to be abundantly and preferentially expressed in the glomerulus. In PCR, the expression levels of the IGFBP‐2, ‐7, ‐8 and ‐10 genes in glomeruli were shown to have more than doubled compared with their levels in the cortices. In ISH, the IGFBP‐2, ‐7, ‐8 and ‐10 genes were found to be localized in glomerular cells including podocytes, and their increased expression was observed in inflammatory glomeruli. IGF‐I gene expression was localized in glomerular podocytes, whereas the IGF‐IR gene was expressed in glomerular podocytes and cortical tubular cells. In nephrotic rats, the expression of the IGFBP‐10 gene was increased in glomerular podocytes; however, the expression levels of IGFBP‐2, ‐7 and ‐8 did not change. Conclusion: IGFBP‐2, ‐7, ‐8 and ‐10 are produced by normal and injured glomerular podocytes and may regulate local IGF‐I actions in podocytes and/or cortical tubular cells in the kidney.     

尿液足细胞排泄与IgA肾病的相关关系

目的 探讨尿液足细胞排泄与IgA肾病病理损伤严重程度的相关性.方法 36例IgA肾病患者,按IgA肾病病理组织学Lee分级分为4组,采用免疫酶细胞化学方法,应用小鼠抗人PCX单克隆抗体进行标记,计数足细胞,同时检测临床检验指标,进行尿液足细胞排泄水平及临床检验指标与IgA肾病病理损伤严重程度的分析.结果 IgA肾病4组与1组相比,尿蛋白定量、血清胆固醇、血尿素氮及血清肌酐水平明显升高,血浆白蛋白水平明显降低;3组与1组相比,尿蛋白定量及血尿素氮水平明显升高;2组与1组相比,仅血尿素氮水平明显升高(P<0.05).IgA肾病4组尿液足细胞排泄水平明显高于1组和2组(P<0.05);尿液足细胞排泄水平与IgA肾痛Lee分级水平具有明显的相关性(r=0.432,P=0.01).结论 尿液足细胞的排泄水平随IgA肾病肾脏病理改变的加重而增多,两者具有明显的相关性.     

鼠输尿管完全梗阻后肾脏病理及足细胞表型改变的研究

 目的观察鼠输尿管完全梗阻后肾脏病理和足细胞表型改变的时序变化,寻找输尿管梗阻后肾脏发生不可逆损伤的时相。方法建立单侧输尿管完全梗阻动物模型,梗阻后不同时间点取出肾脏,经HE染色和免疫荧光双标方法,观察肾脏病理及足细胞表型的改变。结果大体观察,梗阻24h后出现肾盂扩张,梗阻3d后出现肾皮质变薄。组织学观察,梗阻12h后出现一部分近曲小管扩张,小管上皮细胞呈水样变性肿胀,在梗阻3d后出现大量小管上皮细胞变形肿胀。免疫荧光双标法,梗阻24h后有少量足细胞、巨噬细胞同时被2种抗体标记,2d后足细胞呈减少趋势,而巨噬细胞逐渐增多。结论输尿管梗阻后在肾脏病理改变早于肾脏发生形态学改变的发生,输尿管梗阻后24h发生足细胞表型的改变,与肾脏肾盂出现明显扩张的时间相近,随着梗阻时间的延长,肾脏病理改变逐渐加重,足细胞转化逐渐增多。     

A new role for the neuronal ubiquitin C-terminal hydrolase-L1 (UCH-L1) in podocyte process formation and podocyte injury in human glomerulopathies

Glomerular epithelial cell (podocyte) injury is characterized by foot process retraction, slit diaphragm reorganization, and degradation of podocyte-specific proteins. However, the mechanisms underlying podocyte injury are largely unknown. The ubiquitin C-terminal hydrolase-L1 (UCH-L1) is a key modulator of ubiquitin modification in neurons. Like neurons, UCH-L1 expression was associated with an undifferentiated status in cultured human podocytes, whereas differentiation and arborization decreased UCH-L1 and monoUb expression. Inhibition of UCH-L1 induced time and concentration-dependent process formation with alpha-actinin-4 distribution to the cell membrane and processes. An immunohistochemical approach was used to evaluate whether UCH-L1 expression was associated with podocyte injury in 15 different human glomerular diseases. Whereas normal kidneys expressed no UCH-L1 and little ubiquitin, a subset of human glomerulopathies associated with podocyte foot process effacement (membranous nephropathy, SLE class V, FSGS) de novo expressed UCH-L1 in podocyte cell bodies, nuclei, and processes. Interestingly, UCH-L1 expression correlated with podocyte ubiquitin content and internalization of the podocyte-specific proteins nephrin and alpha-actinin-4. In contrast, minimal change glomerulonephritis, a reversible disease, demonstrated minimal UCH-L1 and ubiquitin expression with intact alpha-actinin-4 but internalized nephrin. Glomerular kidney diseases typically not associated with foot process effacement (SLE class IV, ANCA+ necrotizing GN, amyloidosis, IgA nephritis) expressed intermediate to no UCH-L1 and ubiquitin. These studies show a role for UCH-L1 and ubiquitin modification in podocyte differentiation and injury.     

Nephrin—signature molecule of the glomerular podocyte?

In recent years there has been an explosion of interest in the glomerular podocyte, which plays a central role in control of glomerular filtration. A host of new molecules have been identified as playing essential roles in the maintenance of podocyte integrity in both humans and mouse models. Of all of these, arguably the most pivotal is nephrin, a transmembrane receptor molecule located at the specialized podocyte cell–cell junction, termed the slit diaphragm. Mutations in this gene cause the most severe form of congenital nephrotic syndrome, and many interacting proteins have now been described to form a large multiprotein complex with complex dynamics. There is little evidence of functional nephrin expression outside the glomerulus, and there are accumulating data that nephrin is essential for the unique properties of podocyte biology. Utilizing a powerful human cell culture model, comparing wild‐type with nephrin‐null podocytes, we can show that several crucial functional properties of podocytes depend on nephrin, including insulin responsiveness and cytoskeletal reorganization. Thus, it is reasoned that nephrin is a signature molecule required to define distinct podocyte characteristics. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

加味当归补血汤对阿霉素肾病大鼠肾脏足细胞保护机制的研究

目的 利用阿霉素肾病模型研究加味当归补血汤对肾小球足细胞作用的影响。方法 实验动物分为正常组、模型组、贝那普利组和加味当归补血汤组。分别在造模第7、28、42、56天留取尿液标本,观察尿白蛋白定量的动态变化;取肾组织进行光镜、电镜和足细胞表达蛋白nephrin、podocin的免疫荧光检测,并进一步应用分子生物学（RT-PCR及Wetern blot）的方法对肾组织中足细胞裂孔膜表达蛋白的表达情况进行分析。结果（1）尿白蛋白：各治疗组治疗7天尿白蛋白减少不明显,但在28、42、56天表现为非常明显的下降,贝那普利组和加味当归补血汤组与模型组比较,差异均有统计学意义(P<0.05),而且加味当归补血汤最为明显;（2）肾脏组织和足细胞的影响：光镜和电镜观察结果显示加味当归补血汤治疗组与贝那普利治疗组和模型组比较,系膜细胞增生情况、肾小管-间质病变情况、足细胞融合和足细胞表达蛋白nephrin、podocin的表达情况均较轻,尿白蛋白定量相对模型组明显减少的情况下仍然存在与肾脏纤维化相关的肾脏病理进展,说明肾脏病变程度相比模型组较轻但不是逆转;（3）治疗第56天肾脏组织足细胞RT-PCR及Wetern blot检测 nephrin、podocin表达;各治疗组与模型组比较,差异有统计学意义(P<0.05)。结论加味当归补血汤对于阿霉素肾病模型具有治疗作用,作用主要是通过减少尿白蛋白,抑制系膜细胞增生和减轻肾小管-间质损伤,保护足细胞裂孔膜结构的完整性。     

熊果酸对糖尿病肾病大鼠足细胞损伤的保护作用

目的:通过复制糖尿病肾病大鼠模型,探讨熊果酸(ursolic acid,UA)对糖尿病肾病大鼠足细胞损伤的保护作用及其机制。方法:SPF级大鼠采用链脲霉素(streptozocin,STZ)及高糖高脂饲料联合复制糖尿病肾病大鼠模型,实验分为正常组,模型组,阳性药组(厄贝沙坦,15 mg·kg-1),UA高剂量组(UA-H,60 mg·kg-1)和UA低剂量组(UA-L,30 mg·kg-1);观察大鼠血糖、尿蛋白量、肾指数的变化,苏木精-伊红(hematoxylin-eosin,HE)染色法和过碘酸-希夫(periodic acid-schiff,PAS)染色法观察肾脏病理变化,酶联免疫吸附测定(ELISA)检测血清和肾脏中的肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),白细胞介素-6(interleukin-6,IL-6),白细胞介素-1β(interleukin-1β,IL-1β)含量,试剂盒检测肾脏组织超氧化物歧化酶(superoxide dismutase,SOD)活性和丙二醛(malonaldehyde,MDA)含量,蛋白免疫印迹法(Western blot)检测大鼠肾组织足细胞裂孔膜CD2相关蛋白(CD2-associated protein,CD2AP)和podocin蛋白的表达。结果:与正常组比较,模型组大鼠的血糖,24 h尿蛋白量,血清和肾脏IL-1β,IL-6及TNF-α含量,肾脏组织中MDA含量,肾指数均显著增加,体质量,肾脏组织SOD活性,肾脏中podocin,CD2AP蛋白表达量均显著降低(P0.01);与模型组比较,UA明显降低血糖值和尿蛋白量,肾指数,肾脏MDA含量,血清和肾脏IL-1β,IL-6及TNF-α水平,能够升高模型组大鼠体质量,肾脏SOD活性,肾脏中podocin,CD2AP蛋白的表达(P0.05,P0.01),逆转糖尿病所致大鼠肾小球病变。结论:UA可通过保护肾脏足细胞作用及调节裂孔膜蛋白CD2AP和podocin表达而抑制高血糖对肾脏的病理损害、降低尿蛋白和保护肾功能。     

Notch通路在糖尿病肾病大鼠的表达及化瘀通络中药的干预作用

目的探讨Notch通路在糖尿病肾病(DN)大鼠肾脏的表达以及化瘀通络中药对其的干预作用。方法 60只SD雄性大鼠,随机取10只为对照组,其余大鼠给予高糖高脂饲料喂养联合ip小剂量链脲佐菌素(STZ)制备DN模型。成模大鼠随机分为模型组、厄贝沙坦组、化瘀通络中药组,厄贝沙坦组、化瘀通络中药组均ig给药,于16周末检测大鼠24 h尿蛋白定量,Real-time PCR法检测Notch1、Jagged1和Hey1 m RNA的表达,免疫组化及Western blotting法检测Notch1、Jagged1和Hey1蛋白的表达。结果与对照组比较,模型组大鼠24 h尿蛋白定量及Notch1、Jagged1、Hey1 m RNA和蛋白的表达量明显升高(P0.01)。与模型组比较,化瘀通络中药组及厄贝沙坦组大鼠24 h尿蛋白定量及Notch1、Jagged1、Hey1m RNA和蛋白的表达量降低(P0.01)。结论化瘀通络中药可以减少DN大鼠24 h尿蛋白定量,且能够抑制DN大鼠肾脏Notch通路中Notch1、Jagged1和Hey1的高表达,该作用可能是其减少蛋白尿排泄的主要途径之一。