胰岛素控制血糖对糖尿病大鼠肾组织Smad7表达及纤维化病变的影响

 目的：观察胰岛素控制糖尿病大鼠血糖后是否能上调肾组织Smad7的表达，减轻或延缓糖尿病肾病(DN)肾纤维化病变的发生发展。方法：链脲菌素复制大鼠糖尿病模型，随机分为糖尿病组(DM组) 和胰岛素治疗组(INS组) (n=8)；INS组于成模13周起用胰岛素将血糖控制在4~7 mmol/L；同时设正常对照组(NC组)(n=8)。17周处死大鼠，检测相应生化指标，观察胰腺和肾组织病理学改变，免疫组化和Western blotting检测各组大鼠肾组织组织转化生长因子β1 (transforming growth factor β1, TGF-β1)、Smad泛素化调节因子2(Smad ubiquitin regulatory factor 2, Smurf2)、Smad7、 E-钙黏蛋白(E-cadherin)、α-平滑肌肌动蛋白(α-smooth muscle actin, α-SMA)、层连蛋白(fibronectin, FN)和胶原蛋白Ⅰ(collagenⅠ)的蛋白表达。结果：与NC组比较，DM组大鼠体重显著减轻，24 h尿蛋白、血糖和甘油三酯显著升高(P<0.05)，病理检查显示胰岛被破坏，肾组织TGF-β1、Smurf2、α-SMA、FN和collagenⅠ蛋白的表达均显著增加(P<0.05)，并伴有肾小管Smad7和E-cadherin的表达减少(P<0.05)；而经胰岛素控制血糖后，INS组大鼠较DM组体重逐渐增加，24 h尿蛋白和血糖均显著降低 (P<0.05)，肾纤维化病变明显改善，TGF-β1、Smurf2、α-SMA、FN和collagenⅠ蛋白的表达均显著减少(P< 0.05)，Smad7和E-cadherin的表达显著上调(P<0.05)。结论：控制血糖能恢复糖尿病大鼠肾组织Smad7蛋白表达水平，减少细胞外基质的沉积，延缓DN的纤维化进展，其机制可能与肾组织中TGF-β1和Smurf2表达降低、Smad7蛋白的泛素化降解减少有关。

Effect of blood glucose control on expression of Smad7 and renal fibrosis in diabetic rats

AIM： To verify the hypothesis that treatment with insulin to control the blood glucose (BG) may relieve or slow down the development of diabetic nephropathy (DN) in diabetic rats by increasing the expression of Smad7. METHODS：The diabetic rat model was established by tail-vein injection of streptozotocin. Sixteen rats were divided into 2 groups. Eight of these animals in diabetes mellitus (DM) group had no treatment. The remaining eight of them in insulin treatment (INS) group were injected with insulin. After 13 weeks, the rats in INS group were given individual treatment with insulin to let the blood glucose level keep within 4 to 7 mmol/L. Meanwhile, 8 rats were used for normal control (NC group). After 16 weeks, the rats were sacrificed to detect the relevant biochemical parameters, and to observe the histophathological changes of the kidney and pancreas. In addition, immunohistochemical staining and Western blotting were employed to detect the protein expression of transforming growth factor β1 (TGF-β1), Smad ubiquitin regulatory factor 2 (Smurf2), Smad7, E-cadherin, α-sooth muscle actin (α-SMA), fibronectin (FN) and collagen I. RESULTS：Compared with NC group, the body weight was significantly reduced in DM group, whereas the body weight in INS group increased gradually. Compared with NC group, the levels of 24 h urine protein (24 h UP), BG and triglyceride (TG) were remarkably increased in DM group. Pathological detection on pancreas indicated that the islet was destroyed. The levels of TGF-β1, Smurf2, α-SMA, FN and collagenⅠ in the kidneys were increased in DM group, and the expression of Smad7 and E-cadherin, which were mainly located in renal tubular epithelial cells, was significantly reduced. Compared with DM group, the levels of 24 h UP and BG were significantly reduced in INS group, and the alleviated renal fibrosis was observed under light microscope. In addition, the protein levels of TGF-β1, Smurf2, α-SMA, FN and collagenⅠ in INS group were decreased compared with DM group, and the expression of Smad7 and E-cadherin was increased significantly. CONCLUSION：Target glucose control with insulin treatment restores the protein expression of Smad7 in the kidney of diabetic rats, reduces the accumulation of extracellular matrix and slows down DN progress. The decrease in TGF-β1 and Smurf2 expression, and the attenuation of Smad7 ubiquitination in renal tissues are the crucial parts in this process.