This could be a game-changer for people with diabetes who are four times more likely to need either dialysis or a kidney transplant.
Scientists have found a new way to slow the progression of Diabetic nephropathy (kidney disease), which affects 40% of people with diabetes.
The research headed by the University of Bristol and published today in JCI Insight might benefit million with diabetes in the US and around the world who are four times more likely to need dialysis or a kidney transplant.
Recent clinical trials show that spironolactone, a drug used to treat high blood pressure, is an effective treatment as it stops the protein from getting into the urine.
Despite its beneficial benefits, the medication may also have negative side effects, including elevated blood potassium levels (hyperkalemia) in patients, which makes physicians hesitant to prescribe it.
In partnership with international colleagues, Bristol Medical School researchers sought to determine how spironolactone protects the kidneys.
They discovered that the medication had a protective effect by preserving the gel-like glycocalyx coating on the surface of kidney blood vessels.
Using new therapies to directly slow down the breakdown of the glycocalyx layer in diabetes could now help them get the same effect without the bad side effects.
The team used kidney biopsies from patients to come up with a new way to measure changes in glycocalyx depth. This was done to confirm that diabetes damages the endothelial glycocalyx layer and that spironolactone stops this damage.
Their findings demonstrated that spironolactone inhibits the activity of a class of enzymes known as matrix metalloproteases, which helps to maintain the gel-like glycocalyx layer on the surface of the kidney blood vessels and slows the course of illness.
“This study is really exciting for us because it confirms that blocking mineralocorticoid receptors using spironolactone preserves kidney function by acting on the glycocalyx,” remarks joint senior author Dr. Matthew Butler.
Their next steps will be to examine the potential therapeutic benefits of repurposing medications that target matrix metalloproteases enzymes [MMPs] in patients with kidney disease while avoiding the problematic side effects related to mineralocorticoid receptor blockers.
“If we see that same level of protection using these more specific drugs, then patients will see significant benefits whilst avoiding the risks associated with high blood potassium levels.”
“Improving outcomes for patients is a key priority at Kidney Research UK. This work is an important step that will allow,” adds Dr Aisling McMahon, executive director of research and policy, Kidney Research UK, “new treatments for diabetic kidney disease to be identified faster. We congratulate Simon and Matt on this innovative approach and look forward to seeing further developments from their team.”
This study was conducted in conjunction with researchers from the University of Texas Southwestern Medical Center in the United States and the University of Groningen and Bari Aldo Moro in Italy.
Image Credit: Getty