Effect of antihypertensive therapy on renal artery structure in type 2 diabetic rats with hypertension.

We have previously demonstrated that antihypertensive treatment with doxazosin (DZN), an alpha-adrenergic blocker, and lisinopril (LIS), an ACE inhibitor, reverse glomerular sclerosis in corpulent spontaneously hypertensive rats with type 2 diabetes. In this study, we examined the effects of the above-mentioned antihypertensive drugs alone and in combination on the structure of interlobular and arcuate arteries in these rats. Both male and female rats aged 6 months were treated with antihypertensive drugs for 16 weeks. Various structural parameters were evaluated by light microscopy, with the use of digital image analysis, in kidney sections stained with periodic acid-SCHIFF: Systolic blood pressure was significantly lower in treated than in untreated rats. Untreated diabetic rats had a significantly higher media/lumen ratio (smaller luminal diameter) of both arteries compared with the ratio in treated rats (for interlobular artery, 0.72+/-0.06 [no treatment], 0.49+/-0.03 [DZN treatment], 0.54+/-0.06 [LIS treatment], and 0.52+/-0.04 [combination therapy], P<0.05 to <0.001 for no treatment versus treatment; for arcuate artery, 0.66+/-0.11 [no treatment], 0.40+/-0.02 [DZN treatment], 0.39+/-0.04 [LIS treatment], and 0.40+/-0.03 [combination therapy], P<0.05 for no treatment versus treatment). Antihypertensive treatment caused significant increases in total arterial cross-sectional area, internal and external diameters, luminal and medial cross-sectional area, and medial thickness in both interlobular and arcuate arteries. The improvement in arterial structure after antihypertensive treatment was due to remodeling and growth of the vessels. Both DZN and LIS were equally efficacious, and combination therapy had no additive or synergistic effect.

L-lysine reduces nonenzymatic glycation of glomerular basement membrane collagen and albuminuria in diabetic rats.

In this study, we examined the hypothesis whether exogenous administration of L-lysine in drinking water would reduce nonenzymatic glycation of glomerular basement membrane (GBM) collagen and thus albuminuria in streptozotocin-diabetic rats. The rationale is that the administered lysine would combine with the circulating glucose and make it unavailable to react with epsilon-amino groups of lysine of various proteins in these diabetic rats. Lysine (0.1%) was given to diabetic rats 7 days (early treatment) or 90 days (late treatment) after induction of hyperglycemia. The treatment was continued for 60 days. Diabetic rats had significantly higher glucose, glycosylated HbA(1), kidney weight, nonenzymatic glycation of GBM collagen, albuminuria, and systolic blood pressure than normal rats. Early treatment with lysine prevented the rise in glycosylated HbA(1) (normal 6.98 +/- 0.71% vs. diabetic - early treatment - 7.78 +/- 1.50%; p = NS), reduced glycosylation of GBM collagen by 86%, and significantly improved albuminuria. There was no significant effect on plasma glucose and systolic blood pressure. However, late treatment reduced the glycosylation of GBM collagen by 46% with a significant improvement in albuminuria. Plasma creatinine levels were not different between normal and untreated diabetic or lysine-treated diabetic rats; however, the creatinine clearance was significantly higher in all groups of diabetic rats (normal 0.45 +/- 0.09 vs. diabetic 2.02 +/- 0.39 ml/min; p < 0.001). The data suggest that early rather than late treatment is more beneficial in reducing nonenzymatic glycation of collagen, although both treatments significantly reduced albuminuria. There was no nephrotoxicity as assessed by plasma creatinine levels or creatinine clearances. These beneficial effects occurred independent of changes either in blood pressure or plasma insulin concentration.

Selenium-deficient diet induces renal oxidative stress and injury via TGF-beta1 in normal and diabetic rats.

BACKGROUND: Oxidative stress has been implicated in the pathogenesis of diabetic nephropathy. Although glucose itself can initiate oxidative stress, deficiency of essential trace elements such as selenium (Se) may exacerbate this oxidative stress in diabetic rats. The mechanism by which Se deficiency causes oxidative stress and renal injury is not completely understood. This study tested the hypothesis that Se deficiency induces renal oxidative stress and renal injury via transforming growth factor-beta1 (TGF-beta1). METHODS: Fifty-four male Wistar rats were used. Diabetes was induced in 27 rats by streptozotocin, and the other 27 rats received buffer only. Ten weeks after induction of diabetes, both normal and diabetic rats were killed, their kidneys removed, and glomeruli were isolated. Glomeruli from normal and diabetic rats were incubated in the presence of TGF-beta1 alone or its neutralizing antibody. Antioxidant enzyme (Cu-Zn) superoxide dismutase (Cu-Zn SOD), catalase, and glutathione peroxidase (GSH-Px) activities; total glutathione; and lipid peroxidation were determined. For Se studies, 15 normal and 15 diabetic rats were divided into groups of five each and fed either a regular, Se-deficient, or Se-supplemented diet one week after induction of diabetes. Ten weeks after feeding these diets, rats were killed and glomeruli were isolated. Oxidative stress was examined by determining the mRNA expressions for antioxidant enzymes and also for TGF-beta1. Plasma glucose and albuminuria were determined. Histology of the kidney and interlobular artery was evaluated by light microscopy. RESULTS: In vitro studies showed that TGF-beta1 significantly reduced glomerular catalase and GSH-Px activities as well as total glutathione levels with an increase in lipid peroxidation in both normal and diabetic rats. Antibody to TGF-beta abrogated these changes. There was no effect of TGF-beta1 on Cu-Zn SOD. Like TGF-beta1, a Se-deficient diet caused a significant decrease in glomerular mRNA expression for Cu-Zn SOD, catalase, and GSH-Px, but a significant increase in TGF-beta1 mRNA expression. Also, a Se-deficient diet caused an increase in albuminuria, glomerular sclerosis, and plasma glucose levels in both normal and diabetic rats. The deficient diet caused a decrease in the lumen size of the interlobular artery. Se supplementation to diabetic rats up-regulated mRNA expression for antioxidant enzymes, and significantly reduced but did not normalize that of TGF-beta1. Glomerular sclerosis was normalized and the interlobular artery lumen size was greatly enlarged in diabetic rats by Se supplementation. Also, the tubulointerstitium was preserved by Se supplementation in diabetic rats. CONCLUSIONS: The data show that TGF-beta1 is a pro-oxidant and Se deficiency increases oxidative stress via this growth factor. In addition, Se deficiency may simulate hyperglycemic conditions. Se supplementation to diabetic rats prevents not only oxidative stress but renal structural injury, as well.

Effect of antihypertensive therapy on renal injury in type 2 diabetic rats with hypertension.

In a previous study, we demonstrated that doxazosin (DZN), an alpha(1)-adrenergic blocker, prevented proteinuria in streptozotocin diabetic rats. In this study, we investigated whether DZN would lower established proteinuria by improving glomerular sclerosis in spontaneously hypertensive corpulent rats with type 2 diabetes mellitus. DZN treatment was compared with treatment with angiotensin-converting enzyme inhibitor, lisinopril (LIS) alone, and DZN in combination with LIS. Combination therapy was used to examine any additive effect of either drug alone in the reduction of proteinuria and glomerular sclerosis. Both male and female rats age 6 months with established proteinuria were used. The rats were allocated randomly to 1 of 4 groups: untreated, DZN treated, LIS treated, or a combination of DZN and LIS treatment. Drug treatment was continued for 16 weeks. The results show that (1) either drug alone or in combination significantly lowered systolic blood pressure; (2) DZN, LIS, or combination therapy reduced albuminuria at 16 weeks of treatment from baseline by 38.61+/-5.77%, 30.70+/-4. 21%, and 42.17+/-4.77% (mean+/-SE), respectively. No difference in albuminuria was observed among the 3 groups of rats; (3) the fractional mesangial area, which was 20.55+/-3.77% in untreated rats, was significantly reduced to 11.18+/-1.32% in DZN-treated rats, with a further reduction to 8.72+/-0.64% in LIS-treated rats and to 3.48+/-0.35% in rats treated with DZN+LIS; and (4) DZN but not LIS significantly improved plasma glucose levels in spontaneously hypertensive corpulent rats (untreated 21.06+/-0.97 mmol/L versus DZN treated 15.81+/-0.93 mmol/L or DZN+LIS treated 17.38+/-1.10 mmol/L; P<0.025 to 0.005). Thus, the data suggest that 16-week treatment with either DZN or LIS improves established proteinuria and glomerular sclerosis, but combination therapy is superior to either DZN or LIS alone in preventing glomerular sclerosis in type 2 diabetic rats with hypertension.

Renal cortical expression of mRNAs for antioxidant enzymes in normal and diabetic rats.

Increased oxidative stress has been implicated in the development of vascular complications of diabetes. In this study, we examined the hypothesis whether chronic hyperglycemia induces oxidative stress by lowering renal expression and activity of antioxidant enzymes and a decrease in glutathione, an antioxidant, in streptozotocin diabetic rats. The results show that the expression of mRNAs for Cu/Zn superoxide dismutase and glutathione peroxidase was significantly increased and that of catalase was decreased in diabetic rats. However, the superoxide dismutase activity was significantly lower in diabetic than normal glomeruli, whereas the activities of the other two enzymes correlated with their mRNA expression. Total glutathione content was significantly decreased in diabetic compared to normal glomeruli. The data suggest that hyperglycemia induces oxidative stress by overexpressing rather than lowering certain antioxidant enzyme mRNAs in the kidney of diabetic rats. Enhanced nonenzymatic glycation of enzyme protein seems to be the cause for the observed decrease in glomerular superoxide dismutase activity.

Heparan sulfate proteoglycan synthesis and its expression are decreased in the retina of diabetic rats.

PURPOSE: Heparan sulfate proteoglycan (HSPG) is an integral component of all basement membranes and is implicated in the charge-selective properties of these basement membranes. Studies have shown a decrease in the number of HSPG anionic sites in the retinal capillary and glomerular basement membrane of diabetic animals. This study examined whether a decrease in both HSPG synthesis and its expression as perlecan are reduced in the retina of streptozotocin-diabetic rats. METHODS: Diabetes was induced in male Wistar rats by intraperitoneal injection of streptozotocin and the rats were sacrificed 20 weeks later. Retinas were isolated and HSPG synthesis was assessed by incorporation of 35S-sulfate into heparan sulfate. The expression of mRNA for perlecan was quantified by RNase protection assay. RESULTS: Both the synthesis of HSPG and mRNA expression for perlecan were decreased in the retina of diabetic compared to normal rats. CONCLUSIONS: The decrease in HSPG synthesis may account for the reported decrease in retinal basement membrane anionic sites and increased capillary permeability that occurs in diabetes.

Doxazosin prevents proteinuria and glomerular loss of heparan sulfate in diabetic rats.

We examined whether blood pressure reduction or good glycemic control equally lower albuminuria by preventing glomerular loss of heparan sulfate and progression of glomerulosclerosis in streptozotocin-induced diabetic rats. We used doxazosin, and alpha 1-adrenergic blocker, to lower systemic blood pressure, and good glycemic control was achieved by insulin treatment. Rats were killed after 20 weeks of treatment. Doxazosin significantly lowered systolic pressure in diabetic rats; however, it had no effect in normal rats. Good glycemic control also lowered systolic pressure. In diabetic rats with good glycemic control, doxazosin had an additive effect on blood pressure. Glomerular heparan sulfate synthesis was significantly lower and urinary albumin excretion higher in diabetic than in normal rats. Both doxazosin treatment and good glycemic control normalized these abnormalities in diabetic rats. Insulin normalized plasma glucose and glycosylated HbA1 concentrations in diabetic rats, as did doxazosin. Significant increases in mesangial area and glomeruloscelerosis were observed in diabetic rats. Only good glycemic control normalized these pathological changes in all diabetic rats. Two-way factorial ANOVA showed an interaction between the effects of doxazosin and insulin on systolic pressure and plasma glucose. The data show that after 20 weeks of doxazosin treatment, albuminuria was reduced by 80%; however, this treatment had no significant effect on mesangial expansion or progression to glomerulosclerosis. Conversely, good glycemic control prevented all three of the preceding sequelae.

Sodium depletion prevents albuminuria in hypertensive rats.

The effect of short term (8 weeks) sodium (Na+) depletion and its repletion on glomerular synthesis of heparan sulfate and urinary excretions of albumin, total protein, heparan sulfate, Na+ and potassium (K+) was studied in spontaneous hypertensive rats (SHR) and their control normotensive Wistar-Kyoto rats (WKY). Na+ depletion in SHRs significantly increased the synthesis of glomerular heparan sulfate and decreased urinary excretions of albumin, Na+ and heparan sulfate when compared with the Na+ repleted group. In WKY rats, Na+ depletion did not cause any of the above changes. These data suggest that Na+ depletion prevents the urinary loss of protein through preservation of glomerular heparan sulfate only in SHRs.

Long-term effects of antihypertensive treatment and good glycemic control on plasma lipids in diabetic rats.

The long-term effects of angiotensin-converting enzyme inhibitors (captopril and enalapril), calcium-entry blockers (diltiazem and nicardipine), and good glycemic control on plasma lipids and lipoproteins were studied in streptozotocin diabetic rats. Diabetic rats had increased plasma cholesterol, tryiglycerides, very-low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) cholesterol, and decreased levels of high-density lipoprotein (HDL) cholesterol than in normal rats. Compared to other antihypertensives, nicardipine seems to have a less beneficial effect on lipids and lipoproteins. However, it is only the good glycemic control that normalized these plasma lipids and lipoproteins in diabetic rats. This suggests that good glycemic control prevents dyslipidemia in diabetic rats. The observed beneficial effects of antihypertensives were unrelated to either food or water intake.

Effect of insulin-glipizide combination on skeletal muscle capillary basement membrane width in diabetic patients.

This study investigated the long-term effect of insulin or the combination of insulin and an oral hypoglycemic compound (glipizide) on the skeletal muscle capillary basement membrane width in insulin-requiring diabetic patients. Seventy diabetic patients were randomized to treatment with either insulin-placebo or insulin-glipizide (5 mg/d) for 3 years. Of these, only 61 patients completed the study; 27 patients received insulin-placebo and 34 patients received insulin-glipizide. Three skeletal muscle (quadriceps femoris) biopsies were performed in all patients over a 3-year period. Glycosylated hemoglobin A1 was determined every 100 +/- 20 days, including plasma glucose levels. Muscle capillary basement membrane width was quantitated by a previously described method. After approximately 16 months, glycosylated hemoglobin A1 decreased significantly in each group from its baseline (P < 0.001 insulin-glipizide group and P < 0.025 insulin-placebo), although no statistically significant difference was seen between the two groups. After 3 years this decrease was statistically significant (P < 0.001) only in the insulin-glipizide group. At baseline, no statistically significant difference was found in the muscle capillary basement membrane width between the two groups. In spite of the significant decrease in glycosylated hemoglobin A1 in both groups after 14 to 16 months, only muscle capillary basement membrane width in the insulin-glipizide group decreased significantly compared with baseline. Patients receiving insulin-placebo showed a gradual increase in the muscle capillary basement membrane width, which after 3 years was significantly higher than baseline (P < 0.02). Although the mechanisms by which the addition of glipizide to insulin treatment reduced the thickening of the muscle capillary basement membrane are not clearly understood, the current findings suggest that diabetic microangiopathy is not necessarily progressive and that prophylaxis may be attained.

Transforming growth factor-beta 1 enhances glomerular collagen synthesis in diabetic rats.

In vitro glomerular collagen synthesis and its response to various concentrations of transforming growth factor-beta 1 were studied in normal and diabetic rats. TGF-beta 1 increased collagen synthesis in normal glomeruli in a dose-dependent manner up to 5 ng/ml. Concentrations > 5 ng/ml showed a gradual decline in collagen synthesis. Basal collagen synthesis was increased in diabetic glomeruli, but addition of TGF-beta 1 had no effect. Antibody to TGF-beta 1 prevented this increase in collagen synthesis. Both circulating TGF-beta 1 concentration and its glomerular expression of mRNA were higher in diabetic than in normal rats. Although addition of TGF-beta 1 did not increase synthesis in vitro, the absence of an effect is consistent with downregulation of its receptors attributable to the high circulating levels. This study clearly indicates a regulatory role of TGF-beta 1 in renal glomerular collagen synthesis in the normal rat, and suggests a possible causal role for enhanced collagen synthesis in the diabetic rat.

Aldose reductase inhibition by ponalrestat (statil) does not prevent proteinuria in long-term diabetic rats.

The aldose reductase pathway has been implicated in the development of chronic complications of diabetes. In this study, we investigated the effect of an aldose reductase inhibitor, statil, on glomerular synthesis of heparan sulfate and albuminuria in male Wistar rats made diabetic with streptozotocin. Heparan sulfate is the predominant glycosaminoglycan (GAG) proteoglycan in the glomerular basement membrane (GBM). It confers a negative charge on the GBM, and its loss has been related to the presence of albumin in the urine. Diabetic rats synthesized less glomerular heparan sulfate and excreted more albumin than normal rats. Glomerular sorbitol concentration was significantly higher in diabetic than in normal rats. Chronic treatment of diabetic rats with statil did not improve either heparan sulfate synthesis or albuminuria despite normalization of glomerular sorbitol content. The present study does not support the role of excess sorbitol in the development of glomerular abnormalities in this rat model of streptozotocin diabetes.

Effect of diltiazem on glomerular heparan sulfate and albuminuria in diabetic rats.

Calcium entry blockers, particularly diltiazem, have been shown to lower not only systemic blood pressure but also improve proteinuria in non-insulin-dependent diabetic patients. The presence of proteinuria is attributed to the loss of glomerular heparan sulfate, which confers a negative charge on the basement membrane. In the present study, we evaluated the efficacy of diltiazem in lowering blood pressure and proteinuria in diabetic rats and also examined the possibility that diltiazem prevents proteinuria through glomerular preservation of heparan sulfate. Diabetes was induced in male Wistar rats by streptozotocin (60 mg/kg). One group of diabetic rats was treated with diltiazem (25 mg/L) in drinking water for 20 weeks. Another group of diabetic rats and a group of nondiabetic rats were given tap water only. Systolic blood pressure was measured at 4, 8, 12, and 20 weeks. Urinary excretion of albumin was done at 4, 8, 12, 16, and 20 weeks. At the end of 20 weeks, all rats were killed, kidneys were removed, and glomeruli were isolated. Total glycosaminoglycan and heparan sulfate synthesis were determined by incubating glomeruli in the presence of [35S]sulfate. Diltiazem lowered blood pressure significantly in diabetic rats at 8, 12, and 20 weeks. Diabetic glomeruli synthesized less total glycosaminoglycan and heparan sulfate than glomeruli from normal rats. Characterization of heparan sulfate by ion-exchange chromatography showed that the fraction eluted with 1 M NaCl was significantly lower and the fraction eluted with 1.25 M NaCl significantly higher in diabetic than in normal rats. Diltiazem therapy returned not only glomerular synthesis but also various fractions of heparan sulfate to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of galactose regimen on glomerular heparan sulfate synthesis and albumin excretion in diabetic rats.

Decreased glomerular heparan sulfate synthesis could account for the increased albuminuria observed in experimental diabetes. A similar albuminuria has been observed in galactose-fed animals. To test whether heparan sulfate synthesis is also decreased in galactosemic animals we measured the heparan sulfate synthesis in isolated renal glomeruli from streptozotocin diabetic and normal rats fed regular diets or 30% galactose diets for 11-12 weeks. Albumin excretion and glomerular heparan sulfate synthesis were determined at the time of sacrifice. As predicted by this hypothesis glomerular heparan sulfate synthesis was significantly lower in the diabetic group than in normals given regular diets (309 +/- 23 vs 487 +/- 56 dpm/mg glomerular wt.; P < 0.01), and albumin excretion greater in these diabetics than in the normals (20 +/- 4.3 vs 2.0 +/- 0.7 mg/24 hr; P < 0.002). Albumin excretion and glomerular heparan sulfate synthesis were also consistent with the hypothesis, but unpredictably reversed, in the galactose-fed diabetic group. Glomerular heparan sulfate synthesis was significantly increased in this group (713 +/- 67 dpm/mg glomerular wt.) and albumin excretion decreased (10.7 +/- 3.6 mg/24 hr) compared to the diabetic on regular diet. Some possible explanations are discussed, but the galactose effect described here remains phenomenological.

Effect of metformin treatment on glucose tolerance and glomerulosclerosis in KK mice.

Non-obese KK mice, aged 90-100 days, demonstrating an abnormal tolerance to glucose, hyperinsulinaemia with insulin resistance and glomerulosclerosis were treated with either water (control N = 10) or metformin (N = 15), a biguanide, orally at a concentration of 50 mg/kg twice daily for 16 weeks. Oral glucose tolerance was performed at 7 weeks. Only 10 of 15 metformin-treated mice (responders) improved their oral glucose tolerance. The remaining 5 mice (non-responders) did not improve their tolerance to the oral glucose load. A repeated oral glucose tolerance test at 16 weeks showed similar results. Blood lactate and insulin levels were similar in all 3 groups of mice. At sacrifice, responders had significantly less glomerulosclerosis compared to control mice. No difference in the incidence of glomerulosclerosis was found between control mice and non-responders. The data suggest that chronic metformin treatment improves glucose tolerance in 70% of KK mice without increasing blood lactate or insulin levels. This improvement in glycaemic control is associated with a lesser incidence of glomerulosclerosis in KK mice.

Tissue concentrations of water-soluble vitamins in normal and diabetic rats.

Changes in circulating and tissue concentrations of several vitamins have been reported in diabetic animals and human subjects. In this study, the effect of short-term (2 weeks) streptozotocin diabetes on folate, B6, B12, thiamin, nicotinate, pantothenate, riboflavin and biotin in liver, kidney, pancreas, heart, brain and skeletal muscle of rats was investigated. The tissue distribution of vitamins varied widely in normal rats. Diabetes significantly lowered folate in kidney, heart, brain, and muscle; B6 in brain; B12 in heart; thiamin in liver and heart; nicotinate in liver, kidney, heart and brain; pantothenate in all tissues; riboflavin in liver, kidney, heart, and muscle. These results indicate that experimental diabetes causes a depression of several water-soluble vitamins in various tissues of rats.