Cause of Early Stage Kidney Disease Uncovered?

December 20, 2007

Worldwide, 100 million people are affected by the early stage kidney disease. Massachusetts General Hospital, the largest training hospital for Harvard Medical School, conducted a study where they identified a molecular pathway that seems to be the cause of urinary protein loss. If this is blocked, then the kidney failure can be slowed down.

The senior author of this study who is also the director of the Program in Glomerular Disease at MGH, Jochen Reiser, MD, PhD, said they have information on this in both animal and human models. It will appear in Nature Medicine but is now available online.

Changli Wei, MD, PhD said that targeting the mechanism with molecule compounds or antibodies can stop or lower the urinary protein loss. This may then become a new way to treat kidney diseases like diabetic nephropathy.

The filtering activity of the kidney is done in the blood vessels where there are extensions called podocytes that sift extra water out while keeping the larger proteins in. Some kidney diseases show these podocytes as having shrunk thus unable to do the filtering properly and allowing the proteins to seep out of the urine.

The researchers studied this situation and for the first time found what was capable of the motion that contributes to the breakdown of the podocytes. They focused on this and found uPar as linked to the movement. These are the same molecules associated with the healing of wounds, inflammation, metastasis and invasion of tumor.

There is a need for more studies to find out how uPar interacts with the others that are involved in the filtering of the protein and its leakage to the urine. They are now carrying out a clinical trial to block the uPar. Hopefully this will be the first step to intervene in these diseases.

Moderate Exercise Reduces Metabolic Syndrome Rate

Around a quarter of Americans have metabolic syndrome. This is a condition linked to an increased risk of developing diabetes, heart disease and stroke. There are risk factors linked to metabolic syndrome: High blood sugar, low amount of good cholesterol, high blood pressure, big waist circumference, and high triglycerides.

The Medical Center at Duke University conducted a study and found out that even a moderate quantity of brisk walking a week is adequate to reduce the waistline and therefore the risk of metabolic syndrome as well. Clients have to have three of the above five risks to be diagnosed with metabolic syndrome.

The main author of this study, Johanna Johnson, said that people who walk 30 minutes daily, six days a week can lower the risk of metabolic syndrome. This is the equivalent of 11 miles per week. Even without changing one's diet, the benefit is still there.

William Kraus, Duke cardiologist, said that the result of the study just proved that " Some exercise is better than none; more exercise is generally better than less, and no exercise can be disastrous." This study is in the American Journal of Cardiology's December 15 issue.

This multi-year study that received federal funding is called "Studies of a Targeted Risk Reduction Intervention through Defined Exercise" (STRRIDE). It examined how the different intensity and quantity of exercise affected 171 middle-aged, overweight people.

Before starting the exercise program, 41% had metabolic syndrome and by the end of eight months, just 27% had the condition. This is good news for those who want to be healthier because just by walking around where they live and work after a meal will do it for them instead of having to run miles.

The researchers were surprised though to find out that those who did intense exercise for a short period of time did not gain as much improvement as those who did less vigorous exercise for a longer duration of time. This led Kraus to think that there may be better benefit from moderate exercise daily than performing vigorous exercise only a few days a week.

Therapy for Cancer and Arthritis May Be Good as Diabetes Treatment

Researchers for Yale School of Medicine report that an antibody used for treatment of some cancers and arthritis seem to holdup type 1 diabetes when they tried it on mice. They say that even after stopping the administration of the antibody, it continues to be of benefit.

They say that rituximab, the antibody they used, reduces the B cells. There is evidence that B cells have a part in autoimmune disease by interrelating with the immune system's T cells. The T cells are the ones that destroy the cells that produce insulin.

Li Wen, the division of endocrinology's senior research scientist, said that after successfully depleting the B cells, regulatory cells come out which can hold back the autoimmune and inflammatory reaction even after the return of the B cells. Li Wen and team were stunned by the fact that there were both T and B cells in the regulatory cells.

What Li Wen and her Yale collaborator, Mark Shlomchik, M.D. did to find out whether the depletion of the B cells would be a treatment for type 1 diabetes, was develop a mouse model. They engineered these mice to be predisposed to diabetes and put the molecule retuximab on surface of the B cells of these mice.

The investigators found that the drug therapy considerably delayed diabetes by 10 to 15 weeks than their mice counterparts which were treated with a placebo. This translates to about 10 to 15 years in humans. Five of the 14 mice who had already diabetes stopped requiring insulin for two to five months while their counterparts stayed being diabetic.

What does this mean? Shlomchik said that it looks like the B cells play two parts in diabetes and perhaps in other autoimmune disease as well. At the start the B cells may encourage the disease to appear but after depletion with rituximab, they stop the disease. This shows there may be no need for multiple medications to further deplete the B cells.

Diabetics Have Most Risk From After Meal Sugar Peak

The Medical School at the University of Warwick reports that diabetics have more to worry about than expanding waistline during the Christmas season and any other time of the year when food is overabundant. A study has shown that post meal peak does more harm than even a persistent rise in blood glucose.

The treatment for diabetics has been centered on lowering the blood glucose and on this focus, they have been successful in keeping the blood sugar level within normal target but this new research is saying that this is not enough to maintain optimized control.

The title of this research report is "Guideline for Managing Postmeal Glucose". This was reported by a worldwide panel of diabetes experts for the International Diabetes Federation, the chairman of which was Professor Antonio Ceriello of the University of Warwick's Medical School.

What the researchers did was look at studies on the two hour after meal peak in blood glucose. They found considerable proof that lowering the plasma glucose after meal is as or maybe more significant than obtaining optimum level. People with normal glucose tolerance have levels that hardly ever goes over 7.9 mmol/l and returning to normal level after eating.

This was not what happened in the studies the researchers examined. One study of 443 type 2 diabetics had plasma glucose of more than 14 mmol/l. Another study that looked at the plasma glucose every day of 3284 diabetics showed more than 8.9 mmol which is translated to the metric system value of 160 mg/dl at least one time in 84% of the participants.

The damage can lead to the narrowing of the blood vessels leading to high blood pressure. Other researches they examined showed damage as well like the higher risk of atherosclerosis. A Japanese study showed that the postmeal peak can better forecast diabetic retinopathy which is the damage to the eye's retina. Other studies linked it to damage to the cells lining up in the blood vessels, to pancreatic cancer, kidney disease and others.

These are challenges that can be squarely faced. There are pharmaceutical and dietary ways to solve the problem and the best way is through SMBG, an acronym for self monitoring of blood glucose. This provides real time information that makes timely intervention possible.

There is also a new technology called Continuous Glucose Monitoring which uses a sensor to measure glucose. The reading is done every 1 to 10 minutes, the results of which can be downloaded or displayed in the monitor. This helps people to monitor their post meal peak.

Research Reports Camel Milk May Help Diabetics

Report from Jaipur says that although India has the most number of diabetics in the world, there are camel breeders in Rajasthan who are immune to diabetes. They say this is due to camel milk which is the main item in their every day meal.

Diabetes Care conducted the research at the SP Medical College Bikaner and found that a liter of camel's milk has around 52 units of insulin. This is different from other forms of insulin that is dispensed orally in the sense that the stomach's acidic juices do not neutralize the camel milk.

By now, we know there are type 1 and type 2 kinds of diabetes. Type 2 could still be treated with changing to a healthy lifestyle while the option for type 1 is to take insulin shots Now they have proven that drinking camel milk every day would add 60 to 70% of insulin to Type 1 diabetics.

This translates to the Type 1 diabetics who require a yearly supply of 20 units of insulin to reduce this need to six to seven units if they take camel milk regularly. This result came after a first survey that indicated low diabetes prevalence among the camel milk drinkers when compared to those who do not like camel milk.

The initial survey was followed by successfully testing albino rats and then 50 type 1 and type 2 diabetics for over two years. The blood glucose levels of these people fell dramatically. This has been published before with the American Diabetes Association even recommending it.

ICMR (Indian Council of Medical Research) has newly acknowledged this discovery but most are still not aware of this. Other countries like Japan and USA have shown interest in this finding which Dr. Agrawal said that scientists are crediting the camel milk feature as due to phytonutrient from plants that are the staple of the camel's diet every day.

Black Community Urged to Make Lifestyle Change

Representative Cummings wrote in Louisiana Weekly urging the black community to make lifestyle changes to stop the threat of diabetes from them. It is now the fourth main cause of death among the blacks who have almost twice the rate with this disease than the whites.

He said that a lot of the factors leading to diabetes are preventable. The traditional diet the blacks have contribute to this disease and this should change now in order to save lives later. What we eat, he says, is frequently linked to how we die.

Changing the lifestyle by eating less and moving more will spell the difference. He said there's a national movement for every American child to get healthy foods and they're working on it in the congress. However, passing laws is not enough. The community has to work together to educate every one of the risk linked to the every day diet.

Risk of Developing Diabetes Goes Up with Smoking

The risk for developing type 2 diabetes is considerably increased by smoking. This is what a US study has found. This research at the University of Lausanne studied 25 researches that involved 1.2 million smokers and found smokers have a 44% increase to develop type 2 diabetes. And the more one smokes, the risk goes higher.

This study conducted by the Journal of American Medical Association found that those who smoke 20 cigarettes per day had their risk to develop diabetes rise to 61% while the light smokers' risk is 29% higher than those who do not smoke. The researchers said the study did not prove that smoking contributed to diabetes but that the statistics were significant.

Smoking has previously been linked to insulin resistance but it is not easy to prove that it contributes to the development of diabetes because smokers usually have other habits that are not good for health like eating unhealthy meals and not getting adequate physical activity.

Charity Diabetes UK's Douglas Smallwood found the study interesting. He said that this may very well be the missing piece of the puzzle in identifying those who are at risk and knowledge like this that piles up contributes to slowing down the development of diabetes.

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