Abstract

Background: Diabetic nephropathy (DNP) is a type 2 diabetes mellitus (T2DM) chronic complication, which is the largest single cause of end-stage kidney disease. There is an increasing evidence of the role of inflammation and Toll-like receptors (TLRs) as part of innate immune system in its development and progression. In addition, Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) downward signaling causes the production of proinflammatory cytokines, which can induce insulin (INS) resistance in T2DM.Objective: The goal of this study was to estimate the expression of TLRs (TLR2 and TLR4) in relation to inflammation and INS resistance in nephrotic type 2 diabetic patients with or without renal failure and to discuss the role of these TLRs in DNP progression.Patients and Methods: In this study, blood samples were obtained from type 2 diabetic patients with or without renal failure, and patients with non-diabetic renal failure were compared to healthy controls. All participants were tested for analysis of fasting plasma glucose and serum insulin, kidney function tests, C-reactive protein (CRP), and proinflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), and interleukin 6 (IL-6) as well as expression of TLR2 and TLR4 in peripheral blood (PB). Statistical analysis of data was done by using SPSS.Results: Diabetic patients with renal failure exhibited significant increase in TLR2, TLR4 mRNA expression in PB in comparison with normal subjects, diabetic patients without renal failure and non-diabetic patients with renal failure. Both diabetic patients with or without kidney failure and non-diabetic patients with renal failure had increased TLR2 and TLR4 mRNA expression in association with increased levels of proinflammatory cytokines (TNF-α, IFN-γ, and IL-6) compared to normal subjects. The diabetic patients with kidney failure exhibited the highest elevation of TLRs, Th1 cytokines and CRP in association the highest record of insulin resistance.Conclusion: Toll-like receptor 2 and Toll-like receptor 4 increased expression and Th2 cytokines may have an important role in the progression of DNP and deteriorations in insulin resistance in type 2 diabetic patients. Therefore, TLR2 and TLR4 may be a promising therapeutic target to prevent or retard DNP in type 2 diabetic patients.

Highlights

  • Diabetes mellitus (DM) is a chronic metabolic endocrinal disease, which is characterized by elevation in blood glucose level and is associated with multiple complications

  • Analysis of fasting plasma glucose level between the four groups indicated that there was a significant difference between group 1, on one hand, and group 3 (DM + HD) and group 4 (DM) on the other, but there was no significant difference between group 1 and group 2

  • The calculated Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) value showed that there was a significant difference between group 1 and group 3 (DM + HD)

Read more

Summary

Introduction

Diabetes mellitus (DM) is a chronic metabolic endocrinal disease, which is characterized by elevation in blood glucose level and is associated with multiple complications. Proinflammatory cytokines produced by T helper cells (Th1) such as interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) can induce resident renal cells such as tubular epithelial cells, mesangial cells, and podocytes to produce chemokines (Lim and Tesch, 2012) Such chemokines function as “chemoattractant” molecules, playing a key role in inflammatory cell recruitment, migration, and interaction, as well as in cellular adhesion, differentiation, and tissue damage in the setting of DNP (Ruster and Wolf, 2008; Pérez-Morales et al, 2019). Chronic exposure to diabetic substrates damages renal cells, resulting in injury or cell death and the release of intracellular damage-associated molecular patterns (DAMPs) into the extracellular space (Figure 1) This signal is recognized by pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs; Tang and Yiu, 2020). Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) downward signaling causes the production of proinflammatory cytokines, which can induce insulin (INS) resistance in T2DM

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call