Abstract
Diabetic kidney disease (DKD), a leading cause of end-stage renal disease (ESRD), has become a serious public health problem worldwide and lacks effective therapies due to its complex pathogenesis. Recent studies suggested defective autophagy involved in the pathogenesis and progression of DKD. Chinese herbal medicine, as an emerging option for the treatment of DKD, could improve diabetic kidney injury by activating autophagy. In this review, we briefly summarize underlying mechanisms of autophagy dysregulation in DKD, including AMP-activated protein kinase (AMPK), the mechanistic target of rapamycin (mTOR), and the sirtuin (Sirt) pathways, and we particularly concentrate on the current status of Chinese herbal medicine treating DKD by regulating autophagy. The advances in our understanding regarding the treatment of DKD via regulating autophagy with Chinese herbal medicine will enhance the clinical application of Chinese medicine as well as discovery of novel therapeutic agents for diabetic patients.
Highlights
Diabetic kidney disease (DKD) covers a broad spectrum of kidney abnormalities, ranging from glomerular mesangial matrix deposition, thickening of the basement membrane, podocyte foot process effacement, and renal tubular hypertrophy to interstitial fibrosis and glomerular sclerosis [1]
DKD is an important component of diabetes microvascular injury and cardiovascular risk factors, a satisfactory explanation of pathogenesis is still unavailable at the moment [6, 7]
We revealed that Tangshen formula (TSF) could suppress ECM deposition and collagen III protein expression in db/db mice and rat renal proximal tubular cell (NRK52E) cell exposed to high glucose [58], in line with increased autophagic markers LC3 II and accumulated p62, implying that the effects may be partially associated with promyelocytic leukemia zinc finger protein-mediated autophagy activation
Summary
Diabetic kidney disease (DKD) covers a broad spectrum of kidney abnormalities, ranging from glomerular mesangial matrix deposition, thickening of the basement membrane, podocyte foot process effacement, and renal tubular hypertrophy to interstitial fibrosis and glomerular sclerosis [1]. This debilitating disorder is a widely recognized major microvascular complication of diabetes, affecting almost 3540% of patients with both type 1 and type 2 diabetes [2, 3]. This review discusses the recent advances of Chinese herbal medicine in treating DKD via activating autophagy, with emphasis on the core mechanisms associated with autophagy induction
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